Rotator Cuff Arthropathy

Rotator cuff arthropathy occurs when the rotator cuff fails to such an extent that it allows the humeral head to migrate up so that It eventually contacts the acromion.

Over time this can result in the development of arthritis in the shoulder joint. This rotator cuff failure is typically due to two or more of the rotator cuff muscles being torn.

Symptoms range from minor weakness overhead and occasional discomfort to profound weakness and constant pain. Diagnosis is based on clinical signs such as weakness overhead or an inability to elevate the arm in the presence of a working deltoid. Investigations such as xrays in more advanced cases or MRI in earlier cases can confirm the diagnosis.

The natural history is for this to progress slowly often over years. If pain is not a problem and the individual tolerates the loss of ability to work overhead they may not be too inconvenienced. If however pain or loss of function deteriorates they might consider surgical treatment.
Treatment depends on whether you are trying to address pain, loss of function or both.

If function is maintained and pain is the problem then arthroscopy, biceps release or tenodesis and a partial rotator cuff repair may resolve symptoms. In this setting complete repair is not feasible due to the longstanding damage to the rotator cuff. In younger patients it may be possible to insert a soft tissue graft between the head and the acromion to help symptoms (superior capsular reconstruction).

If you have loss of function, pain or established arthritis then replacement with a reverse geometry total shoulder is the best option. Replacement restores function and deals with the pain.