What is rotator cuff arthropathy?
Cuff arthropathy (or cuff arthritis) describes a special type of shoulder arthritis secondary to a long-standing rotator cuff tear. To find out more, continue reading our article.
Relevant anatomy
The shoulder joint is formed by the articulation between the upper end of the arm bone (called the humeral head) and a certain part of the shoulder blade (called the glenoid). Therefore, it is referred to as the glenohumeral joint. It is a ball and socket type joint; the ball is formed by the humeral head (the upper end of the arm bone), and the socket is formed by the glenoid, which is part of the shoulder blade that articulates with the humerus. Both the ball and socket are covered by “cartilage”. This is the protective layer that lines the joints in our body to ensure smooth and frictionless joint movement. There is another smaller joint above the shoulder called the acromioclavicular (AC) joint. This is located between the collar bone (clavicle) and part of the shoulder blade (called the acromion).
The rotator cuff muscles are a special group of muscles that surround the shoulder blade consisting of 4 muscles (the supraspinatus, infraspinatus, subscapularis and teres minor tendons). Their tendons form a complete cuff of tissue surrounding the humerus (the ball component of the shoulder joint).
The rotator cuff muscles and tendons are vital in shoulder movement and stability. They are essential for shoulder rotation and lifting the arm and ensure the ball remains well-centred within the socket throughout the range of movement. The supraspinatus tendon is the one most commonly affected by the disease. Dr Al-Ani has published an article about the various conditions that can affect the rotator cuff tendons.
How does cuff arthropathy happen?
Cuff tear arthropathy happens when there is a significant rotator cuff tear, interfering with the stabilising effect of the cuff. Normally, the intact rotator cuff muscles pull the humeral head towards the socket (red arrows). This is very important to stabilise the shoulder so that deltoid muscle contraction (black arrow) would result in rotation of the shoulder (green arrow) when you raise the arm above the level of the head.
When there is a cuff tear, the muscle function becomes unbalanced, and the deltoid will pull the head of the humerus upwards (black arrow) rather than rotate it. Over time, the abnormal movement will result in an upward position of the humeral head (green arrow) and wear and tear changes in the shoulder joint. The shoulder movement will become painful. This is referred to as cuff tear arthropathy. To find out more about rotator cuff tears, please see our article.
What are the symptoms of cuff arthropathy?
1: The main symptom is shoulder pain. The pain can be worse when trying to lift up your arm and can interfere with sleep.
2: Weakness in the shoulder movement. There will be a tendency to shrug the shoulders when trying to lift up the arm.
3: The range of motion will reduce over time.
How to diagnose cuff arthropathy?
A shoulder X-ray is usually the first test performed. It is very useful in establishing the diagnosis and assessing the stage of cuff arthropathy changes. Shoulder ultrasound and MRI are very useful to assess the degree of rotator cuff tear and also the size of the muscle.
What is the treatment of cuff arthropathy?
Conservative management includes physiotherapy and anti-inflammatory tablets. If conservative management is not helpful, then ultrasound guided injection can be useful. These include ultrasound-guided steroid injection to the shoulder (glenohumeral) joint or suprascapular nerve block. Surgical treatment in the form of shoulder joint replacement can be considered in selected cases. Another novel surgical treatment option that can be considered in certain cases is “superior capsular reconstruction”. In this procedure, a special graft is inserted to replace the torn rotator cuff tendon. Dr Al-Ani has published an article regarding the radiological features of superior capsular reconstruction. A shoulder orthopaedic surgeon is the most suitable person to talk to about the surgical treatment options.
Shoulder conditions and treatments
