Cuff Tear Arthropathy

Background

Rotator cuff tear arthropathy is a complex shoulder condition that arises from a massive, chronic rotator cuff tear combined with degenerative changes in the glenohumeral joint. Over time, the absence of functional rotator cuff muscles leads to abnormal joint mechanics, superior migration of the humeral head, and progressive cartilage loss.

This condition primarily affects older adults and is often the result of long-standing, untreated rotator cuff tears that cause joint instability and degeneration of the shoulder. Patients develop progressive mechanical dysfunction of the shoulder secondary to a lack of rotator cuff function and then develop arthritic changes as a consequence.

Symptoms

Patients with rotator cuff tear arthropathy typically present with:

• • Chronic shoulder pain
• • Reduced range of motion
• • Significant weakness, particularly in lifting the arm overhead
• • Pseudoparalysis - inability to actively raise the arm despite no true neurological deficit
• • Night pain
• • Difficulty with daily activities (grooming, reaching overhead)
• • Shoulder instability or crepitus with movement

Diagnosis

Diagnosis of rotator cuff tear arthropathy involves a combination of clinical evaluation and imaging studies. Physical examination may reveal limited active range of motion, muscle atrophy, and signs of impingement.

X-rays typically show superior migration of the humeral head, narrowed joint space, and acetabularization of the acromion. An MRI is not necessary when you have these changes on plain radiographs, however, it may be helpful early in the disease process. A CT scan is obtained when surgery is being considered to help guide surgical planning.

Treatment Options

Management of rotator cuff tear arthropathy depends on symptom severity, functional impairment, and patient health status.