Rotator Cuff Arthropathy
The shoulder is the most mobile part of the body but this also makes it more vulnerable to instability. As the age increases, shoulder problems are likely to arise.
Rotator cuff arthropathy is identified by irreparable loss of the rotator cuff tendons and the surface of the shoulder joint. These tissues cannot be restored to their normal condition once damaged and will lead to discomfort, instability, loss of ROM with immense pain.
What is Rotator Cuff Arthropathy?
In a normal functioning shoulder, the rotator cuff muscles including the supraspinatus helps balancing the humeral head(ball) in the socket against the upward pull. These muscles are attached to the bone by the tendons and together they form the rotator cuff that surrounds the humeral head. When these muscles contract, this action causes the ball to move in the deepest part of the shoulder socket. This is important for the normal function of the shoulder.
However, in rotator cuff arthropathy the tendons that are located between the humeral head and the coracoacromial arch above rub against each other causing them to wear out which may lead to tear.
What causes Rotator Cuff Arthropathy?
It is difficult to predict which action will lead to rotator cuff tear.
Rotator cuff arthropathy can be a result of a tear in the rotator cuff tendons. If tears go untreated, they may enlarge and affect a larger area of the rotator cuff leading to more pain and complications.
Abnormal joint mechanics because of upward movement of the humeral head and loss of nutrition leads to tears. However, in the earlier stages, it is difficult to predict which tear will lead to rotator cuff tear arthropathy.
As we age, our tendons and muscles start degenerating. They lose strength and their ability to heal themselves. Repetitive use of the rotator cuff for performing sudden overhead motions for a long period of time is also a likely cause.
Some people affected with rotator cuff tear are able to perform a wide range of motions despite their rotator cuff not being intact.
Symptoms of Rotator Cuff Arthropathy
- Severe pain and poor functioning of the shoulder
- Lying on the affected shoulder will aggravate the pain.
- As the tear causes instability, there is difficulty in performing simple movements of elevation.
- Patients may develop pseudo paralysis as they are unable to lift the arm and perform motion
- Rotation of the joint will cause pain as the humeral head rubs against the acromion.
- Rupture in the tendons leading to soreness
While these are classic symptoms, the symptoms might differ with each individual.
Diagnosis of Rotator Cuff Arthropathy
As rotator cuff arthropathy is a severe problem, the patient’s history needs to be checked and physical examination needs to be done in order to understand the severity of the problem. X-rays, CT scans or MRI scans will be advised according to the findings of the physical examination.
X-rays are essential as they confirm the diagnosis. These x-rays will show how the humeral head has worn out against the upper part of the socket and the acromion. If significant wear and tear has happened against the acromion, a CT scan may be advised if there are any fractures present
MRI scans are useful as they show the tear in the tendons, size, and location.
Treatment for Rotator Cuff Arthropathy
Initially, the doctor will prescribe anti-inflammatory drugs to reduce the pain and swelling. Physical therapy is recommended for patients depending on the severity and in people who want to prolong the surgical process. It helps in restoring the shoulder to its strength and stability and ROM and also improves range of motion.
Injections as prescribed by the doctor, are also recommended but multiple injections are advised against as it may lead to infection.
Surgical intervention in the case of rotator cuff arthropathy is often required. This includes:
- Total shoulder arthroplasty is performed for patients older than 60 years old. It is done on patients who have severe degenerative tendons and muscles.
- Humeral hemiarthroplasty is a short and easier surgery. It repairs the rotator cuff and the results have shown no pain to mild pain in 50-70% of patients treated with this surgery.
- Reverse total shoulder arthroplasty is ideal for older patients with reduced function. It is the reversal of the normal shoulder ball and socket. As surgeons have gained more experience, the surgery has been expanded to include revision arthroplasty, inflammatory arthropathy with a rotator cuff tear, acute fractures, and chronic pseudo-paralysis
Rotator cuff tear arthropathy is a challenging condition that cannot be prevented but its effects can be minimized by diagnosing it early on. Most patients seek help after the tear becomes massive. Non-surgical and surgical interventions can be done based on the severity of the situation.
Each case needs to be assessed individually and treated accordingly for restoring the shoulder to its full functionality and in improving the quality of life.