Rotator Cuff Arthropathy
Orthopaedic Faculty with this Specialization
Robert T. Burks, M.D.
Patrick E. Greis, M.D.
Robert Z. Tashjian, M.D.
University Orthopaedic Resources:
Frequently Asked Questions (FAQ)
Q) What is rotator cuff arthropathy?
A) This is when a patient has a large rotator cuff tear and poor rotator cuff function that allows the shoulder to not be held correctly in the socket and the shoulder does not have adequate elevation or motion. Over time the shoulder gets arthritic and rubs abnormally, not only on the socket but frequently up on the acromion or the tip of the shoulder. Some patients have had multiple rotator cuff surgeries; others may not have had any surgery at all up to this point. Ultimately patients have a permanent nonrepairable status of the rotator cuff and have very poor range of motion and inability to lift the arm along with constant pain.
Q) How is the diagnosis made?
A) The diagnosis of rotator cuff disease is made by taking a history from the patient and doing a physical examination. After this, radiographs (x-rays) are obtained. Occasionally an MRI is used to augment the information of the status of the rotator cuff problem and sometimes ultrasound is used.
Q) What conservative treatment is there?
A) Nonsteroidal anti-inflammatory medications such as Ibuprofen can be of some help for discomfort, but obviously not for strength and motion. It is difficult to improve this situation through exercise since the muscles are not attached to the shoulder normally and really can't be exercised to help improve motion. Occasionally cortisone injections give some temporary relief and can be considered in certain individuals.
Q) What about surgical treatment?
A) A new procedure has become available in the United States for these types of patients called a reverse shoulder replacement. The reason it is called a reverse is that there is a metal ball that is actually screwed into the socket side of the shoulder and a plastic cup that is placed on the top of the shoulder or humeral bone which actually reverses the normal arrangement. The metal and plastic helps with eliminating pain and the shoulder can now function better using just the deltoid muscle to help move the shoulder. Significant motion gains are possible after this procedure for many patients where in the past these motion gains were not seen with other procedures.
Q) What are the indications for surgery?
A) This is a procedure that has relevance for people who do not have significant rotator cuff function, but have a normal deltoid. Due to the nature of the procedure, patients need to be older and usually this is at least 65 years of age. The procedure offers the most to the patient who has very minimal ability to elevate or lift the arm up into the air and also has pain. Rotator cuff repair should be determined to not be possible. Also, shoulder arthritis could be severe.
Q) How is the procedure done?
A) The procedure involves removing the top of the humeral bone and replacing this with a plastic cup that sits on a metal stem which is placed down into the humerus or arm bone. A smooth metal hemisphere is screwed onto the glenoid (or "socket"). The cup on the humerus is snapped into position under this metal ball and held in place by tension applied from the intact muscles. This allows the shoulder to have the deltoid muscle retensioned which allows it to work more efficiently in the absence of the rotator cuff muscles. This procedure takes approximately 2 1¿2 hours and the standard time in the hospital is 1 to 2 days.
Q) What about anesthesia?
A) One of the truly unique features of shoulder arthroplasty at the University of Utah Orthopaedic Center is the use of a small catheter that is placed near the nerves in the neck. We have a unique system for placing these so it is done with a high level of accuracy and with minimal discomfort for the patient. These are connected to anesthesia that runs in slowly over a couple of days. Therefore, it is very common for arthroplasty patients to have virtually no pain over their first couple of days after surgery. This allows patients to get off to a very good start, to not be sick from having to take other medicines, to be able to eat well, and overall be very mobile.
Q) What about complications?
A) There are complications that can occur with this procedure as with many other similar magnitude surgeries. Infection can occur, but you are given preoperative antibiotics to try to minimize this potential. Blood loss is a potential, but transfusion for blood loss is very rare. Nerve injury can occur, but is usually temporary, although a permanent neurologic injury is possible but rare. The components that are placed can loosen over time and need to be revised or removed. The shoulder could dislocate and require some type of reduction. It is possible to fracture around the implants as well. There are other complications inherent to this type of surgery so this is not an exhaustive list.
Q) What about therapy and return to activities?
A) Immediate postoperative elbow and wrist motion are emphasized, but minimal shoulder motion is encouraged. The patients typically wears a sling with a slight pillow next to it for approximately 4 weeks. It is felt that there is enough early healing of the surgery at this point and that more active range of motion can be performed by the patient and is supplemented with trips to physical therapy. It is expected by 6 weeks that patients can begin lifting their arm up into the air and can anticipate full recovery by 6 months.
Q) What about limitations?
A) Due to the nature of this type of procedure, postoperative use of the shoulder has to be somewhat cautious. The patient would not be considered a candidate for heavy use of the shoulder such as return to working on a farm or vigorous yard work. The hope for the shoulder would be that activities of daily living and routine light exercise would be very acceptable.
The information provided may be useful for patients to become more knowledgeable about their specific injury, surgery or condition. It is provided for informational purposes only, and does not replace the advice of a physician.
