Rotator Cuff Tear Arthropathy

Doctor testing mobility of a patient`s shoulder
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A rotator cuff tear arthropathy is a condition that occurs when there is severe shoulder arthritis in the setting of a large rotator cuff tear. In order to be considered a rotator cuff tear arthropathy, there are three clinical findings that are present:

  1. Insufficient function of the rotator cuff (typically a large tear)
  2. Arthritis of the ball-and-socket (glenohumeral) joint
  1. Shifting of the normal position of the ball within the socket (superior migration)

Rotator Cuff Function

The rotator cuff is the group of four muscles and tendons that surround the ball-and-socket shoulder joint. These muscles serve several important functions such as motion and strength of the shoulder. Another critical function of the rotator cuff is to provide a compressive force that holds the ball within the socket of the shoulder.

When the rotator cuff is not functioning properly, the mechanics of the shoulder joint can be altered.  Much like having your car wheels out of alignment can cause abnormal wear of the tires, having the rotator cuff damaged can cause the ball-and-socket of the shoulder to have altered alignment. Once the alignment is shifted (the humeral head, or ball of the ball-and-socket joint, shifts upward), the shoulder joint tends to wear out unevenly. This wearing out of the cartilage leads to the loss of the normal smooth cartilage lining of the joint.

The condition of a rotator cuff tear arthropathy develops over years. Typically, people have a rotator cuff tear without even knowing it. Over time, the effect of the rotator cuff tear alters the mechanics of the shoulder joint, leading to the development of arthritis. A rotator cuff tear arthropathy is not a condition that develops suddenly.

Signs of a Rotator Cuff Tear Arthropathy

The signs of this condition are similar to normal shoulder arthritis, but there is often more weakness of the shoulder. Symptoms include:

  • Shoulder pain
  • Loss of mobility
  • Weakness of the shoulder joint
  • Swelling around the shoulder
  • Atrophy of the musculature around the shoulder

Treatment of Cuff Tear Arthropathy

A rotator cuff tear arthropathy can create a challenging treatment problem. While shoulder replacements are effective treatment for shoulder arthritis, the standard implants rely on the rotator cuff to function properly. Just as the normal shoulder relies on proper functioning of the rotator cuff, a standard shoulder replacement also relies on this function of the rotator cuff. When the rotator cuff is not working, and a standard shoulder replacement is performed, the joint is abnormally aligned, and the socket portion of the replacement tends to loosen and wear out quickly. 

When a rotator cuff tear arthropathy exists, a special type of implant is often used for treatment. One type of implant created for rotator cuff tear arthropathy is called a reverse shoulder replacement. This type of implant is designed to place a ball within the socket of the shoulder, and forms a new socket on the top of the arm bone (the humerus).

This design alters the mechanics of the shoulder joint, such that it is not necessary to have a functioning rotator cuff.

A Word From Verywell

Not every rotator cuff tear is the same, and there are certain situations that need to be addressed differently. One of these situations is a rotator cuff tear arthropathy. Because of the coexistence of arthritis in the shoulder joint with the rotator cuff tear, treatment must take into account both of these conditions. Failure to recognize a rotator cuff tear arthropathy can lead to ineffective treatments of your shoulder pain.

Sources

Ecklund KJ, Lee TQ, Tibone J, Gupta R. "Rotator Cuff Tear Arthropathy" J Am Acad Orthop Surg. 2007 Jun;15(6):340-9.