Rotator Cuff Arthritis
Rotator cuff arthropathy is a type of shoulder arthritis caused by massive tearing of the rotator cuff and disturbed shoulder mechanics. The ball of the humerus is normally centred on the socket of the shoulder blade by the action of the 4 small muscles of the rotator cuff. If more than half of the rotator cuff tendon is torn from the ball, the ball will slowly rise up the socket and rub against the shoulder blade acromion. This will strip the ball of cartilage and gradually destroy the joint. The rotator cuff tendons are not able to be repaired as they are retracted too far and the chronically detached muscles are replaced by fat.
Rotator cuff arthropathy may or may not be painful. What makes the slow, chronic process become painful is not well understood. Most people would have noticed for some time:
- Noise within the shoulder on movement
- Weakness in lifting objects away from the body (even a kettle)
- Difficulty performing overhead tasks
Most people with painful rotator cuff arthopathy are elderly. The initial focus of management is non-operative:
- Activity modification- adjusting home environment eg. re-organising shelves and washing line
- Pain management. Analgesics and anti-inflammatories have to be used cautiously due to side effects, such as constipation and gastric bleeding. Unfortunately steroid injections provide only temporary relief
- Physiotherapy. An anterior deltoid strengthening program can restore function
Should non-operative treatment fail to restore adequate quality of life, surgical options are available. This can only be considered if one's general-health makes the risks acceptable. The surgical decision-making is complex and needs to be tailored to individual circumstances. Risks, results and rehabilitation vary with procedures. Options include:
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