Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis and Treatment

Okan Tok Nuri Aydin

doi:10.4172/2161-0533.1000159

Abstract

The term rotator cuff tear arthropathy is a broad spectrum pathology but it involves common characteristic features as rotator cuff tear, leading to glenohumeral joint arthritis and superior migration of the humeral head. Although there are several factors described causing rotator cuff tear arthropathy, the exact mechanism is still unknown because the rotator cuff tear arthropathy develops in only a group of patients with chronic rotator cuff tear. The aim of this article is to review pathophysiology of rotator cuff tear arthropathy, to explain the diagnostic features and to discuss the management of the disease.

Highlights

The term rotator cuff tear arthropathy is used to describe a broad spectrum of pathology varying from a rotator cuff tear to a destructive arthritis which had been first described by Neer in 1983 [1]
Due to the excessive stress between the bone and the glenoid implant leading to implant loosening and complication rates have been reported to be as high as 87.5% [25], this design is no longer used in the treatment of rotator cuff tear arthropathy
In a study by Nwakama et al including seven patients with rotator cuff tear arthropathy treated with conventional total shoulder arthroplasty, only 14% success rates has been shown according to the “limited goals” criteria [30]

Summary

Introduction

The term rotator cuff tear arthropathy is used to describe a broad spectrum of pathology varying from a rotator cuff tear to a destructive arthritis which had been first described by Neer in 1983 [1]. Nutritional and inflammatory factors are described, the exact mechanism is still unclear This clinical condition develops only in a group of patients who suffer from chronic rotator cuff tear. Crystal-mediated arthropathy theory was described by Halverson et al in 1981 According to this theory; rotator cuff tear arthropathy originates from hydroxy-apatite crystals-induced phagocytosis causing degenerative process in glenohumeral joint [5]. Identification of hydroxyapatite and calcium phosphate crystals in disease-affected soft tissues supports the hypothesis that the rotator cuff tear arthropathy was an inflammatory based disorder. Rotator cuff tear plays a role at the beginning of the disease, and a developed rotator cuff tear is a result of the inflammatory process. The decrease in shoulder activity due to the developing pain as the disease progresses causes reduction in articular fluid and acceleration in cartilage degeneration [1,2,3,4]

Physical Examination

Findings

Reverse Total Arthroplasty