The rotator cuff is a series of four muscles that run along the shoulder blade (scapula) and around the shoulder socket (glenoid) to surround and attach to the ball (humeral head) of the shoulder joint by their tendons. The rotator cuff muscles work to keep the humeral head centered in the socket as we move our arm.
Significant or massive rotator cuff tears left untreated can result in the humeral head migrating upward and moving closer to the acromion (roof of the shoulder joint). This abnormal position causes the cartilage covering the bony surfaces to deteriorate (arthritis), often resulting in pain and physical limitations.
What Is Rotator Cuff Arthropathy?
Injury or degeneration (wear and tear) can result in a tear of the rotator cuff tendon. Rotator cuff tears can cause weakness and dysfunction. When significant or massive rotator cuff tears are left untreated, the humeral head can migrate upward toward the acromion, causing the cartilage covering the bony surfaces to deteriorate.
There are many theories about why this condition occurs for some patients and not others. Regardless, the combination of arthritis and a massive rotator cuff tear can lead to weakness, pain, inflammation, decreased mobility, and continued symptoms.
Causes and Risk Factors
Causes and risk factors for rotator cuff arthropathy can include:
- Aging or degeneration of the tendon with regular or excessive use
- A rotator cuff tear that has been left untreated
- A fall or injury that causes symptoms to worsen and the condition to deteriorate
- History of shoulder pain or injury
- Previous injury to the rotator cuff, including impingement
- Poor physical conditioning, including strength and flexibility
- Inadequate warm-up before activities
- Spurring of the acromion
- Repeated steroid injections
- Underlying inflammatory disease, such as rheumatoid arthritis
- Failure of a previous rotator cuff repair
Symptoms
Frequent signs and symptoms of rotator cuff arthropathy include:
- Pain along the upper arm between the shoulder and elbow
- Pain that is worse or sharper when reaching out, reaching overhead, or lifting objects
- Aching pain at rest and often pain at night while trying to sleep
- Loss of strength
- Limited shoulder motion, especially when reaching behind for a back pocket or bra
- Crepitation (a crackling sound) when moving the shoulder
Treatment
Treatment depends on the patient’s overall medical health and physical demands or activity level. Conservative treatment is the first approach to rotator cuff arthropathy and involves restricting aggravating activities combined with injections and physical therapy to enhance the strength and function of the shoulder.
If conservative treatment fails, surgery may be warranted. Arthroscopic surgery to debride (clean up) the rotator cuff and shoulder joint, release the damaged biceps tendon, repair the rotator cuff, remove the inflamed bursa, or decompress the bony space between the humeral head (ball of the shoulder) and the acromion (bony roof of the shoulder) may help relieve symptoms.
Another surgical possibility is a reverse total shoulder arthroplasty. In this procedure, prosthetic devices are used to replace the damaged surfaces of the shoulder joint. The implants are “reversed” so that the ball portion of the joint is attached to the glenoid and the socket portion is attached to the humerus. Reversing the ball and socket helps compensate for a deficient rotator cuff. This approach is more effective in patients with a deficient rotator cuff and lower activity demands.
Recovery and Outcomes
While rotator cuff tears and joint deterioration will not improve on their own, some patients are able to maintain function and pain control non-operatively through physical therapy. Additional pain control may be achieved through anti-inflammatory medications or steroid injections. For other patients, these measures may provide only temporary relief from symptoms, and they may choose to pursue surgical treatment.
Recovery from a reverse total shoulder arthroplasty involves approximately six weeks in a sling followed by several months of physical therapy to restore shoulder function.
When to See Dr. Chudik
If shoulder pain, weakness, or limited motion persists or worsens, contact Dr. Chudik’s office for an evaluation.
Call 630-324-0402, email contactus@chudikmd.com, or request an appointment online.