Rotator Cuff Arthropathy

Rotator cuff arthropathy typically occurs due to a chronic, large rotator cuff tear left untreated over a long period. Over time, the torn rotator cuff can’t keep the humeral head centered in the socket, leading to unusual wear on the joint surfaces and developing arthritis. Age, previous shoulder injuries, genetic predisposition, and overuse through heavy lifting or repetitive overhead motions can also contribute to the development of this condition.

Rotator cuff arthropathy can be classified into different stages based on severity:

• Stage 1: Mild changes with slight humeral head elevation.
• Stage 2: Moderate changes with the humeral head still centered but showing higher elevation.
• Stage 3: Severe changes with the humeral head no longer centered in the socket and high elevation.
• Stage 4: Very severe changes with extensive arthritis and significant shoulder joint damage.

Patients with rotator cuff arthropathy commonly experience:

• Severe shoulder pain, particularly with lifting or overhead activities.
• Limited range of motion in the shoulder.
• A grating or popping sensation with movement.
• Weakness in the shoulder and arm.
• Difficulty sleeping on the affected shoulder.

As the condition progresses, patients may find daily activities like dressing, bathing, or reaching overhead increasingly difficult.

Rotator cuff arthropathy is a progressive condition that, unfortunately, cannot heal on its own or be reversed with conservative treatments. While non-surgical treatments may help manage symptoms, surgical intervention is often needed for definitive treatment.

As an expert shoulder surgeon, Dr. Mayo will collect a detailed medical history, physical examination, and imaging tests. During the physical exam, your Dr. Mayo may assess your shoulder’s range of motion, strength, and pain level. Imaging tests like X-rays and MRI scans help visualize the extent of the rotator cuff tear and the presence of arthritis.

Non-surgical treatments like physical therapy, pain medications, and corticosteroid injections may help manage symptoms. However, for patients with significant pain and functional limitations, surgery may be recommended. Surgical options can include a reverse total shoulder arthroplasty, which changes the shoulder mechanics to allow other muscles to perform the rotator cuff’s function.

Surgery for rotator cuff arthropathy is generally considered for patients who have significant pain and functional limitations not relieved by conservative treatments. The timing of the surgery depends on the patient’s overall health, the severity of their symptoms, and their individual goals.

In a reverse total shoulder arthroplasty, the ball-and-socket mechanics of the shoulder are reversed: a metal ball is attached to the shoulder blade, and a plastic socket is attached to the humeral head. This design allows the deltoid muscle, instead of the damaged rotator cuff, to power the shoulder movement.

After surgery, patients will need to wear a sling for about 6 weeks to protect the repair. Physical therapy starts soon after surgery, initially focusing on gentle range of motion exercises, gradually advancing to strengthening exercises. Most patients can expect to regain functional use of their shoulder around 3 to 6 months post-surgery, but complete recovery can take up to a year.