This 1983 landmark paper by Neer, Craig, and Fukuda formally defines cuff-tear arthropathy as a distinct glenohumeral pathology following massive rotator cuff tears. It describes clinical, radiographic, and histological features in 26 surgically explored shoulders and proposes a dual nutritional-mechanical pathomechanical hypothesis. The paper establishes diagnostic criteria, a differential diagnosis framework, and treatment principles that remain foundational today.
The term 'cuff-tear arthropathy' did not exist before 1977, and this 1983 paper is the definitive description that established it as irreducible to osteoarthritis, rheumatoid arthritis, or avascular necrosis — each requiring fundamentally different treatment.
When you see a patient with shoulder pain, a massive cuff tear, and humeral head collapse on X-ray, the diagnosis is cuff-tear arthropathy. Do not treat it like OA (the cuff is gone) and do not treat it like AVN (the glenoid is involved and there is no predisposing factor).
The practical decision rules from this paper: use unconstrained resurfacing arthroplasty with cuff reconstruction, never a fixed-fulcrum prosthesis (eroded scapula will fail fixation), and never radical acromionectomy (weakens the deltoid and makes reconstruction impossible).
This paper's description of the mechanical failure mode. Absent rotator cuff force couple allowing superior humeral migration. Is precisely the problem Grammont's reverse total shoulder arthroplasty (1987) was designed to solve by medialization and distalization of the center of rotation.
This 1983 landmark paper by Neer, Craig, and Fukuda formally defines cuff-tear arthropathy as a distinct glenohumeral pathology following massive rotator cuff tears. It describes clinical, radiographic, and histological features in 26 surgically explored shoulders and proposes a dual nutritional-mechanical pathomechanical hypothesis. The paper establishes diagnostic criteria, a differential diagnosis framework, and treatment principles that remain foundational today.
The term 'cuff-tear arthropathy' did not exist before 1977, and this 1983 paper is the definitive description that established it as irreducible to osteoarthritis, rheumatoid arthritis, or avascular necrosis — each requiring fundamentally different treatment.
When you see a patient with shoulder pain, a massive cuff tear, and humeral head collapse on X-ray, the diagnosis is cuff-tear arthropathy. Do not treat it like OA (the cuff is gone) and do not treat it like AVN (the glenoid is involved and there is no predisposing factor).
The practical decision rules from this paper: use unconstrained resurfacing arthroplasty with cuff reconstruction, never a fixed-fulcrum prosthesis (eroded scapula will fail fixation), and never radical acromionectomy (weakens the deltoid and makes reconstruction impossible).
This paper's description of the mechanical failure mode. Absent rotator cuff force couple allowing superior humeral migration. Is precisely the problem Grammont's reverse total shoulder arthroplasty (1987) was designed to solve by medialization and distalization of the center of rotation.