Rotator Cuff Tear Arthropathy Research Articles

Management of Shoulder Hemiarthroplasty in a Patient With Rheumatoid Arthritis

Case report. Rehabilitation after shoulder hemiarthroplasty for rotator cuff tear arthropathy (RCTA) represents a significant challenge to physical therapists. Limited goals have been defined for this patient population and include no pain or slight pain at rest, moderate pain with vigorous activity, shoulder external rotation active range of motion (AROM) greater than 20 degrees, and shoulder abduction AROM greater than 90 degrees. The patient was a 60-year-old female elementary school teacher with functional class III adult-onset rheumatoid arthritis, who came to physical therapy 2 weeks after undergoing a hemiarthroplasty for RCTA of the right shoulder. Physical therapy included 33 treatment sessions involving 4 to 11 exercises each session. All sessions were performed under the direct supervision of a physical therapist utilizing specially designed equipment. Physical therapy emphasized early active assisted elevation range of motion (ROM), graded progressive exercise, and functional training. All exercises were performed in a pain-free ROM or a ROM that did not increase shoulder pain. Following physical therapy, subjective pain scale at rest was 0/10 and during vigorous activity 1/10 to 2/10. Shoulder AROM was normal and shoulder rotation and elevation strength was good. There was a significant improvement in shoulder proprioception and the patient demonstrated a negative belly press test for subscapularis muscle integrity. Additionally, the patient's score on the self-report section of the American Shoulder and Elbow Surgeons Assessment Form increased from 0% at the initial examination to 70% at discharge. Despite limited expectations, this patient achieved normal shoulder ROM and near normal shoulder strength after 14 weeks of physical therapy. Overall, an early, aggressive, progressively graded exercise program appears to be a safe and effective form of treatment after shoulder hemiarthroplasty for RCTA.

Treatment of Rotator Cuff Tear Arthropathy with Prosthetic Replacement of Humeral Head

Purpose : To assess the effectiveness of a prosthetic replacement of the humeral head in rotator cuff tear arthropathy patients. Materials and Methods : 11 patients underwent a prosthetic replacement of the humeral head for rotator cuff tear arthropathy between 1997 and 2003. The average age was 69 years and 9 out of the 11 patients were women. The average follow-up was 44 months. The level of pain, daily activities, range of motion and patient's satisfaction were assessed both preoperatively and postoperatively. Results : The mean pain score decreased from 9.0 preoperatively to 2.2 postoperatively. The mean active forward elevation increased from 40o to 82o and the mean external rotation increased from 8.2o to 30o. The mean ASES score improved from 22 to 72. Nine patients were satisfied with the surgical outcome, particularly in terms of pain relief and the improvement in their daily activities. Conclusion : A prosthetic replacement of the humeral head is an effective treatment option for pain relief as well as for improving the functional activity in rotator cuff tear arthropathy.

In Vivo Determination of the Dynamics of Normal, Rotator Cuff-Deficient, Total, and Reverse Replacement Shoulders

Mahfouz, Mohamed PHD; Nicholson, Gregory MD; Komistek, Richard PHD; Hovis, David MD; Kubo, Matthew BS Author Information

Management of Irreparable Rotator Cuff Tears and Glenohumeral Arthritis

Glenohumeral arthritis with irreparable rotator cuff tears remain a difficult entity to treat. Varied causes include rotator cuff tear arthropathy, osteoarthritis, or rheumatoid arthritis with irreparable cuff tear. Common symptoms are progressive pain and dysfunction. Physical examination may reveal pain, crepitance, rotator cuff weakness, and loss of motion and function. Radiographs may reveal varying degrees of osteophyte formation, sclerotic bone, superior humeral head migration, and bony erosion. Additional imaging modalities may reveal cuff tear size, retraction, atrophy, and fatty infiltration. Failure of nonoperative management may lead to operative intervention. Rotator cuff repair or reconstruction may help prevent progression of tears and future arthritic changes. In patients with moderate to severe glenohumeral arthritis and irreparable rotator cuff tears, hemiarthroplasty is currently the procedure of choice. For patients with severe cuff dysfunction or loss of coracoacromial arch, or for patients who require revision, the reverse shoulder prosthesis may offer a treatment option. Future management continues to be defined with additional study.

Cuff Tear Arthropathy

Visotsky, Jeffrey L. MD; Basamania, Carl MD; Seebauer, Ludwig MD; Rockwood, Charles A. MD; Jensen, Kirk L. MD Author Information

Severe Humeral Erosion in a Bedridden Patient

This article reports a 1-yr prospective study related to a bedridden patient with rotator cuff tear arthropathy featuring severe erosion of the proximal part of the humerus. To prevent spontaneous humeral fracture, a comprehensive intervention was planned. This included drug therapy for osteoporosis and pain, nurse team training on patient handling techniques, and patient and caregiver education. After 1 yr, clinical and radiologic findings are stable.

Humeral Hemiarthroplasty With Biologic Resurfacing of the Glenoid and Acromion for Rotator Cuff Tear Arthropathy

Symptomatic rotator cuff tear arthropathy remains one of the most challenging entities in shoulder reconstruction. The appropriate surgical treatment of this patient population is highly controversial. However, it is clear that the primary goal in treating these patients remains durable and reproducible pain relief. We present here our rationale, indications, technique, and results for anatomic humeral hemiarthroplasty combined with biologic resurfacing of both the glenoid and acromion in patients with cuff tear arthropathy.

Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy

Massive rotator cuff tears associated with glenohumeral arthritis are currently an unsolvable clinical entity. We review our series of 14 patients with rotator cuff tear arthropathy (RCTA) who underwent a bipolar prosthesis of the shoulder. The average follow up was 27.8 months (range, 24–48 months), and the average age was 71 years (range, 57–84 years). Of these 14 patients, 9 were men and 5 women. None of these patients had undergone previous shoulder surgery, and all patients underwent conservative treatment that failed to improve their symptoms or range of motion. Preoperatively, the average active forward flexion was 30°, active external rotation was 10°, and the American Shoulder and Elbow Society (ASES) score was 25 points. Postoperatively, the average active forward flexion improved to 88°, active external rotation increased to 37°, and the ASES score improved to 80 points. Of the 14 patients, 12 stated that they had no pain with activities of daily living. Two patients continued to have moderate pain in everyday activity. Copyright 2003, Elsevier Science (USA). All rights reserved.

Hemiarthroplasty for rotator cufftear arthropathy

Treatment of rotator cuff tear arthropathy presents a formidable challenge for the shoulder surgeon. The alteredmechanical and nutritional environment of the shoulder thought to be responsible for the development and progression of the arthropathy also may contribute to the failures of surgical intervention. In the past, several surgical procedures, including total shoulder arthroplasty, have been used to treat rotator cuff tear arthropathy. However, hemiarthroplasty seems to have the most consistent and predictable long-term results. Even so, certain technical points must be considered while performing a hemiarthroplasty to minimize pain and maximize motion and function. These surgical considerations include mobilizing the rotator cuff and attempting to repair the tear whenever possible, appropriate sizing of the humeral head prosthesis, and placing the humeral head in increased retroversion.

Current concepts in treatment of rotator cuff tears

The expectation of a functional shoulder joint, even in advanced age, the growing experience and success in shoulder surgery have brought the operative treatment another step further. The goal of any advanced knowledge should be a proper treatment of the patients and the pathology. Complex rotator cuff tears can be repaired by means of muscle transfer and partial reconstruction. In cases of irreparable rotator cuff tear arthropathy prosthetic replacement of the gleno-humeral joint can be performed. In this article a review on the different techniques and indications for rotator cuff repair is given.

Rotator cuff tear arthropathy.

JENSEN, KIRK L. M.D.†, OAKLAND, CALIFORNIA; WILLIAMS, GERALD R. JR., M.D.‡, PHILADELPHIA, PENNSYLVANIA; RUSSELL, I. J. M.D.§; ROCKWOOD, CHARLES A. JR., M.D.§, SAN ANTONIO, TEXAS Author Information

The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management.

The symptomatic rotator cuff-deficient, arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories: (1) rotator cuff-tear arthropathy, (2) rheumatoid arthritic shoulder with cuff deficiency, or (3) degenerative arthritic (osteoarthritic) shoulder with cuff deficiency. If it is not possible to repair the cuff defect, surgical management may include prosthetic arthroplasty, with the recognition that only limited goals are attainable, particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis, resection arthroplasty, and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to "overstuff" the gleno-humeral joint with a prosthetic component. In cases of significant internal rotation contracture, subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer's "limited goals" rehabilitation are followed, approximately 80% to 90% of patients treated with humeral hemiarthroplasty can have satisfactory results.

Hemiarthroplasty in rotator cuff tear arthropathy

Rotator cuff tear arthropathy results in a painful glenohumeral joint with poor function. Loss of the stabilizing effect of the rotator cuff allows superior subluxation of the humeral head. The poor mechanical advantage of the deltoid muscle creates a weak, poorly functioning shoulder. Hemiarthroplasty with a large humeral head component can relieve pain and retain some of the mechanical advantage of the deltoid by lateralizing the center of rotation of the humeral head and regaining deltoid length. A larger-than-anatomic humeral head decreases the risk of further superior subluxation of the humeral head by decreasing wear. Stability is regained by retensioning the deltoid muscle envelope. This article reviews the technique of large head hemiarthroplasty in this difficult reconstructive problem.