Rotator Cuff Arthropathy

Question 1

Rotator cuff arthropathy (shoulder arthritis in setting of rotator cuff dysfunction) is defined as a combination of?

Answer 1

1) Massive chronic rotator cuff tear
2) GH cartilage destruction
3) Subchondral osteoporosis
4) Humeral head collapse
Hemorrhagic shoulder (hemophiliacs and elderly on anticoagulants) is a known risk factor

Question 2

What are some physical exam findings in rotator cuff tear arthropathy?

Answer 2

1) Prominence of anterior shoulder (anterosuperior escape of humeral head)
2) Crepitus with ROM
3) Abduction pseudoparalysis
4) Jobe’s, Hornblowers, ER lag

Question 3

What is the non-operative management of rotator cuff arthropathy?

Answer 3

NSAIDs, subacromial steroid injections, physical therapy (strengthen scapular and rotator cuff muscles)

Question 4

What are the indications for hemiarthroplasty vs reverse total shoulder arthroplasty in a pt with rotator cuff arthropathy?

Answer 4

Hemi-

1) Young and active
2) Anterior deltoid preserved
3) Coracoacromial arch intact (if no will lead to superior migration of humeral head)

Reverse TSA

1) Older
2) Pseudoparalysis
3) Intact deltoid function (axillary n.)

Hemi can improve pain but does not help function; reverse helps improve pain and function

Question 5

What surgical procedures are contraindicated in rotator cuff arthropathy?

Answer 5

1) TSA

2) Glenoid resurfacing- excessive shear forces