ROTATOR CUFF ARTHROPATHY                  KANDILNOTES                 

INTRODUCTION

  • Shoulder arthritis is a degenerative process where the cartilage between the ball and socket thins and wears down over time

  • There are two main types of shoulder arthritis: Glenohumeral Arthritis and Rotator Cuff Arthropathy

  • Rotator cuff arthropathy occurs when a patient has a chronic large rotator cuff tear that leads to abnormal shoulder mechanics and gradual cartilage loss

  • Chronic rotator cuff tears in which the head of the humerus (the upper bone in the arm) loses its proper position in the middle of the glenoid (socket)

  • Patients with rotator cuff arthropathy have shoulder pain with lifting, overhead activities, stretching beyond levels of comfort 

 

CAUSES

  • Osteophytes that block joint motion

  • Constriction of the joint capsule due to chronic inflammation, pain, and disuse

  • Weakness of the supporting muscles following a rotator cuff tear

 

SIGNS AND SYMPTOMS

  • Shoulder pain with lifting, overhead activities, stretching beyond levels of comfort 

  • Shoulder pain is usually present at baseline but becomes worse with activity and motion

  • Shoulder swelling can sometimes occur, especially with arthritis flare-ups 

  • Atrophy (wasting away) of shoulder muscles due to disuse

  • Swelling in the shoulder due to inflammation

  • Crepitus (clicking or crunching sound) during shoulder motion

  • Tenderness with palpation (touch) affecting the entire shoulder region or specific areas


TREATMENT​​

  • Rest

  • NSAIDS (non-steroidal anti-inflammatory medicines) – such as ibuprofen or naproxen

  • Exercises to increase range of motion and strength

  • Mild to moderate glenohumeral arthritis pain is often effectively controlled by using any one or a combination of the follow treatments:

  • Corticosteroid injections (cortisone shots) may be recommended for select cases that do not respond to NSAIDS. A concentrated dose of anti-inflammatory medicine is injected directly into the joint and can be used to manage pain. However, injections do not generally provide long-term relief for advanced cases of arthritis of the shoulder joint. It does not cure the disease.

  • Glucosamine and chondroitin are non-prescription supplements that may help neutralize the destructive enzymes associated with osteoarthritis. Some patients may feel relief as a result of using these agents, but they are unable to ‘regrow’ new cartilage. More research is needed to evaluate the full extent of their effectiveness.

  • Viscosupplementation therapy improves the cushioning of the joint surfaces and has gained

  • popularity in the last few years. Hyaluronic acid is injected directly into the joint in order to improve joint lubrication and reduce friction during movement. Hyaluronic compounds are generally safe although there have been reports of inflammatory reactions in patients treated with some preparations. Most of the studies on viscosupplementation have been done on the knee, so it is less clear what effects this type of treatment will have on the arthritic shoulder.

  • When severe shoulder rotator cuff arthropathy pain is unmanageable with non-operative measures, surgical treatment may be recommended.

  • Reverse shoulder replacement is a safe and effective treatment option in patients with rotator cuff arthropathy that have failed conservative management. Other indications for reverse shoulder replacement include complex fractures

  • The goal of the reverse shoulder replacement procedure of the shoulder is to remove the arthritic humeral head (ball) and glenoid (socket) and replacing with alloy metal and highly crosslinked polyethylene (plastic) components with the goal of decreasing pain and improving function

How is rotator cuff arthropathy diagnosed? 

 

The doctor will first obtain a history of the patient’s symptoms and health over the past several years. Those who suffer from shoulder rotator cuff arthropathy typically report an increase in pain over several years. The doctor will ask if the patient has any conditions that may be the underlying cause of rotator cuff arthropathy such as:

  • Previous trauma or surgery to the shoulder

  • A previous rotator cuff tear

  • Next, the doctor will do a physical examination of the shoulder to evaluate the symptoms and reveal other conditions that may exist.

  • X-ray imaging of the shoulder can confirm a diagnosis of rotator cuff arthropathy. With x-ray, the doctor can see structural changes that indicate arthritis, such as:

  • Irregularity of the joint surface

  • Osteophytes, typically located on the lower part of the joint

  • Bone erosion on the humeral head, glenoid, or both. Glenoid bone loss is often visible on the backside of the joint.

  • Other Imaging techniques used to make the diagnosis include:

  • CT-Scan (Computer Tomography) – This test is the best way for your surgeon to measure the extent of glenoid bone loss and any anatomic abnormalities that may affect treatment. It is also very helpful for taking accurate measurements for surgical planning purposes.

  • MRI (Magnetic Resonance Image) Although not as commonly used to diagnose rotator cuff arthropathy as other imaging studies, an MRI can provide detailed information about the soft tissue structures of the joint.

shoulder arthopathy figure 1.PNG