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related talks: rotator cuff tearshoulder arthritis AC joint arthritis; biceps tendon tearadhesive capsulitis

What is Rotator Cuff Arthritis?

The rotator cuff is the stabilizer of the shoulder.  Arthritis can develop after its torn because the shoulder isn’t properly stabilized without a functional rotator cuff.  The rotator cuff sits over the humeral head (arm bone), when its torn, theres no roof over the arm bone, and therefore itdrifts upward.  Also with a tear, theres a leak in the shoulder joint capsule, so joint fluid slowly leaks out, and with less fluid, theres less lubrication for the joint and theres more friction causing more wear.


How is Rotator Cuff Arthritis diagnosed?

Over time, arthritis develops the severity is classified.  In the early stages the humeral head is in place, with some signs that the cartilage is eroding, but the shoulder is stable.  Slowly the shoulder drifts medially, the shoulder becomes less stable and more decentralized.  We mainly use x-rays to classify this.  But we also use the MRI to look at the rotator cuff, see if its torn, and also the rotator cuff muscles, if they haven’t been working for a long time, fat cells infiltrate the muscle and that shows up on MRI.  When examining the shoulder you can see thinning of the rotator cuff muscles, and the humeral head moves anterior, superior and swelling develops (effusion).  


How is Rotator Cuff Arthritis treated?

Treatment of arthritis always starts with noninvasive treatments: physical therapy (strengthening of the scapula and rotator cuff) and anti-inflammatory medications.  The next step would be steroid injections if the pain persists.

Eventually the pain will persist, and these treatment options no longer have the same effect they once had.  At this time, it is up to you the patient to determine when the pain is too much and when to consider a surgical treatment.

The rotator cuff cannot be repaired in RC Arthritis.  This is because the damage has progressed for too long without treatment (we are talking years, not months or weeks).  As soon as the RC muscles show signs of atrophy (aka looking like a bunch of couch potatoes), the rotator cuff cannot be repaired.  Essentially the cuff no longer works.  The surgery consists of cleaning the shoulder joint with inflamed synovial tissue and fraying RC and bursa can help relieve pain but its not a long term treatment.  A hemiarthroplasty or partial replacement of the shoulder joint is good for younger patients because it will decrease their pain.  A reverse shoulder replacement is best in elderly with low activity level and their deltoid muscle is functional, but these patients cannot get a total shoulder replacement, like in normal arthritis, because the rotator cuff doesn’t work.  

What is the long term outcome?

The patients do great.