This current concepts review synthesizes the many historical names and theories for rotator cuff tear arthropathy into one clinical syndrome. It examines the etiology, biomechanics, diagnosis, and treatment of end-stage cuff-deficient glenohumeral arthritis. The review clarifies why glenoid resurfacing fails and how hemiarthroplasty and rehabilitation goals should be structured.
When you see an elderly woman with a painful, pseudoparalytic shoulder, superior humeral head migration articulating with the acromion, and a rounded greater tuberosity, think cuff tear arthropathy.
The central teaching point is mechanical. A cuff-deficient shoulder cannot center the humeral head, so a fixed glenoid component gets eccentrically loaded on its superior rim and rocks loose. This is why hemiarthroplasty, not total shoulder replacement, is the historical procedure of choice in this era of the literature.
Two prerequisites determine success. The anterior deltoid must function and the coracoacromial arch must be intact to provide a stable superior fulcrum. Prior acromioplasty with coracoacromial release predicts anterosuperior escape and failure.
Set expectations using limited-goals criteria: pain relief with roughly 90 degrees of elevation and 20 degrees of external rotation. Avoid oversizing the humeral head, which overstuffs the joint.
This current concepts review synthesizes the many historical names and theories for rotator cuff tear arthropathy into one clinical syndrome. It examines the etiology, biomechanics, diagnosis, and treatment of end-stage cuff-deficient glenohumeral arthritis. The review clarifies why glenoid resurfacing fails and how hemiarthroplasty and rehabilitation goals should be structured.
When you see an elderly woman with a painful, pseudoparalytic shoulder, superior humeral head migration articulating with the acromion, and a rounded greater tuberosity, think cuff tear arthropathy.
The central teaching point is mechanical. A cuff-deficient shoulder cannot center the humeral head, so a fixed glenoid component gets eccentrically loaded on its superior rim and rocks loose. This is why hemiarthroplasty, not total shoulder replacement, is the historical procedure of choice in this era of the literature.
Two prerequisites determine success. The anterior deltoid must function and the coracoacromial arch must be intact to provide a stable superior fulcrum. Prior acromioplasty with coracoacromial release predicts anterosuperior escape and failure.
Set expectations using limited-goals criteria: pain relief with roughly 90 degrees of elevation and 20 degrees of external rotation. Avoid oversizing the humeral head, which overstuffs the joint.