A Patient S Guide To Cuff (Rotator) Tear Arthropathy
A Patient’s Guide toCuff (Rotator) Tear ArthropathySterling Ridge Orthopaedics & Sports Medicine6767 Lake Woodlands Drive, Suite F, The Woodlands, TX7738220639 Kuykendahl Road, Suite 200, Spring, TX 77379The Woodlands & Spring, TX .Sterling Ridge Orthopaedics & Sports Medicine
DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases,A Patient'sGuideThetoinformationCuff (Rotator)physical conditions,ailments or treatments.should NOT beTearused in Arthropathyplace of a visit with your health care provider, nor should you disregardthe advice of your health care provider because of any information you read in this booklet.Sterling Ridge Orthopaedics & Sports MedicineIf you are experiencing pain, feel symptoms of an orthopedic condition or you've just beendiagnosed, we encourage you to use our online patient education library to learn about thecondition and what can be done. This can help you prepare for an appointment and serve as areview of the information your physician shares. Feel free to read the information online ordownload a PDF to print or share.At Sterling Ridge Orthopaedics & Sports Medicine we provide each patient with the highestlevel of care by board certified physicians. Please schedule an appointment with one of ourspecialists if you have any questions or concerns about symptoms you may be experiencing.Two convenient locations:THE WOODLANDS281-364-11226767 Lake Woodlands Drive, Suite FThe Woodlands, TX 77382SPRING832-698-011120639 Kuykendahl Road, Suite 200Spring, TX 77379Sterling Ridge Orthopaedics & Sports Medicine6767 Lake Woodlands Drive, Suite F, The Woodlands, TX7738220639 Kuykendahl Road, Suite 200, Spring, TX 77379The Woodlands & Spring, TX .Phone: 281-364-1122 832-698-011All materials within these pages are the sole property of Medical Multimedia Group, LLC and are used herein by permission. eOrthopod is aregistered trademark of Medical Multimedia Group, LLC.Compliments of: Sterling Ridge Orthopaedics & Sports Medicine2
A Patient's Guide to Cuff (Rotator) Tear ArthropathyIntroductionThe rotator cuff is a unique structure in theshoulder that is formed by four tendons.These four tendons attach to four musclesthat help keep the shoulder stabilized in thesocket (or glenoid) and help rotate the upperarm inward and outward. If the rotatorcuff is torn and is not repaired, a typeof wear and tear arthritis of the shouldercan develop over time. This condition issometimes called arthropathy and the termcuff tear arthropathy is used to describethis type of arthritis of the shoulder thatdevelops when the rotator cuff is damaged.If you develop this condition, your shoulderwill be painful. Movement and strength ofthe shoulder will be decreased. Moving thearm away from the body and raising it overyour head can be especially difficult.joint is also called the glenohumeral joint.One of the bones of the glenohumeral joint isthe humerus (the long bone of the upper arm).It has a ball, called the humeral head on thetop end. The humeral head fits into a small,shallow cup called the glenoid fossa. It makesup the other part of the glenohumeral joint.The glenoid fossa is part of the shoulder blade.A large ligament runs from the front of theacromion to another part of the shoulder bladecalled the coracoid process. This ligament iscalled the coracoacromial ligament. It addsstability to the front of the shoulder.This guide will help you understand: what parts of the shoulder are involved what causes this condition how doctors diagnose the condition what treatment options are availableAnatomyWhat parts of the shoulder are involved?The bones of the shoulder are the humerus (theupper arm bone), the scapula (the shoulderblade), and the clavicle (the collar bone). Theroof of the shoulder is formed by a part of thescapula called the acromion. The shoulderThe rotator cuff is made up of tough, fibroustissue. It forms a cuff (or capsule) coveringthe shoulder joint. There are four tendonsthat help form the rotator cuff. The musclesthat form the tendons are the supraspinatus,infraspinatus, teres minor, and subscapularis.These muscles rotate the shoulder outwardand inward. Along with another muscle, thedeltoid, they also help lift the arm away fromthe body.Compliments of: Sterling Ridge Orthopaedics & Sports Medicine3
A Patient's Guide to Cuff (Rotator) Tear ArthropathyThe rotator cuff slides between the humeralhead and the acromion as we raise our arm. Asthis sliding occurs over and over, the rotatorcuff tendons will often be pinched as you usethe shoulder everyday. This pinching is calledimpingement. Over time this pinching can leadto damage and weakening of the rotator cufftendons.CausesWhat causes this condition?Dr. Charles Neer actually described rotatorcuff tear arthropathy (RCTA) in 1977. Today,doctors generally refer to this as simply cufftear arthropathy. Cuff tear arthropathy isactually a type of wear and tear, or degenerative arthritis of the shoulder that develops overtime after the rotator cuff is damaged.Normally, when the rotator cuff musclescontract, they pull the head of the humerustightly into the socket of the shoulder. Thisstabilizes the shoulder and allows the the largedeltoid muscle to raise the arm over the headas it rotates the humeral head like a pulley.This motion needs the rotator cuff and deltoidmuscles to work together - in balance. Whenthe rotator cuff is torn, the shoulder becomesunbalanced. The deltoid muscle pulls thehead of the humerus up into the acromion in asliding motion. When the top of the humerushits the underside of the acromion, the deltoidmay be able to pull the arm part way up as itlevers against the underside of the acromion.But, over time this abnormal sliding motioncauses wear and tear on the joint surfaces.Arthritis develops and any motion becomespainful. The shoulder becomes weaker andweaker until you can no longer raise the armabove the head.Rotator cuff tears are very common. Trauma,such as falls, lifting, and pulling forcefullycan also cause a rotator cuff tear. When thishappens, it is called an acute tear. Although therotator cuff can be damaged from a single traumatic injury, damage to the rotator cuff usuallyoccurs gradually. Age can be a factor. As weage, the tendons of the rotator cuff becomeweaker and more likely to be injured. Theblood supply to the tendons diminishes withage. Rotator cuff tears are much more likely tooccur after the age of 40.Certain activities can increase the wear andtear on the rotator cuff. Repetitive overheadactivity such as painting, plastering, racquetball, weightlifting, and swimming can causewear and tear of the rotator cuff.Surgeons generally will recommend surgeryto repair a rotator cuff tear when it occurs. Asuccessful surgical repair of a torn rotator cufftear can make the development of cuff teararthropathy much less likely. But, sometimesa rotator cuff tear cannot be repaired. Thetissue is simply too damaged and cannot fixed.This is not an uncommon situation in olderCompliments of: Sterling Ridge Orthopaedics & Sports Medicine4
A Patient's Guide to Cuff (Rotator) Tear Arthropathypatients with rotator cuff tears. In other cases,the patient simply elects not to have surgery torepair a rotator cuff tear and chooses to simplylive with the discomfort. Over several years,both of these situations can result in the laterdevelopment of rotator cuff arthropathy.SymptomsDiagnosisHow will my doctor diagnose this condition?Your doctor will want to do a history andphysical examination. He will ask you aboutactivities or trauma that could have injuredyour shoulder. He will want to know the levelof your pain, and what limitations you have. Aphysical examination is done. Range of motionand strength of the shoulder muscles will beevaluated. Your doctor will want to look atyour shoulder to see if there is bony deformity,or atrophy (shrinkage) of the muscles. Witha complete rotator cuff tear, moving the armaway from the body can be nearly impossible.If your doctor lifts your arm for you, and youcannot hold it up, this is called a positive DropArm Test. This usually means the rotator cuffis torn.What does this condition feel like?The most common symptom of rotator cufftear arthropathy is pain in and around theshoulder. The pain can also radiate into yourneck, arm, even into your wrist or hand. Theshoulder can be especially painful when tryingto lift the arm, or rotate it outward. The painis usually worse at night. It can interrupt yoursleep, especially if you try to sleep on theaffected shoulder. If untreated, the pain can benearly continuous and can be severe.Weakness of the shoulder makes it difficult,if not impossible to lift the arm overhead.Often, even starting this motion can be difficult. The tendency is to shrug the shoulderin order to lift the arm part of the way. Withtime, weakness of the rotator cuff muscleswill worsen. Range of motion can be quitelimited. You will often find it difficult todo routine things, like reaching behind yourback, reaching into a cabinet, or combing yourhair. You may notice a crackling or poppingsensation. When there is arthritis of theglenohumeral joint, there is often a creaking orgrating sound.Other areas such as the neck may also needevaluation. A pinched nerve in the neck canmimic a rotator cuff tear. A neurologicalexamination to include checking reflexes andsensation may be included. Your doctor maywant you to have an electromyogram (EMG).This checks the function of the muscles of theshoulder. An EMG uses a small needle in themuscle being tested. It measures the electricalactivity of the muscle at rest, and when tightened.Your doctor will request X-rays of yourshoulder. X-rays show the shape of the bonesand joints. When the rotator cuff is torn, theshoulder will often ride high, meaning that itCompliments of: Sterling Ridge Orthopaedics & Sports Medicine5
A Patient's Guide to Cuff (Rotator) Tear Arthropathysits higher in the joint than it should. It canalso show how much damage ahs occurred tothe joint surfaces.Magnetic resonance imaging (MRI) allowsyour doctor to look at slices of the area inquestion. The MRI machine uses magneticwaves, not X-rays to show the muscle,tendons, and ligaments of the shoulder. MRIswill show tears of the rotator cuff tendons.Atrophy of the muscles can also be evaluatedwith MRI. A computerized tomography (CT)scan shows slices of bone. Like X-rays, it usesradiation. A CT scan can help to more accurately determine the degree of damage of theglenohumeral joint. A CT scan is especiallyuseful to plan surgery if an artificial shoulderreplacement is considered for treatment.TreatmentDuring a debridement, the surgeon willsurgically remove (debride) any inflammedtissue, bones spurs and loose flaps of tendontissue that may be catching in the joint andcausing pain. This procedure may reduce pain,however, it does not always improve range ofmotion, strength, or function of the shoulder.What treatment options are available?Nonsurgical TreatmentConservative care that includes physicaltherapy, ice, heat, and anti-inflammatoriesis tried first. The goal of treatment is toreduce pain, and increase range of motionand function. Corticosteroid injection intothe shoulder joint is also sometimes helpful.Steroids are very powerful anti-inflammatorymedications that can reduce pain temporarily.These injections will not heal the tear but maygive pain relief for several weeks to months. Ifarthritis of the shoulder is advanced, and painis continuous and severe, surgery may be thebest option available.SurgeryCuff tear arthropathy is the result of longstanding lack of rotator cuff function. Inalmost all cases, repair of the rotator cuff tearis no longer an option. Surgery for cuff teararthropathy is done when pain and decreasedmotion continue after conservative care. Thesimplest surgical procedure to try and improvethe situation is a debridement.Patients with this type of arthritis would seemto be good candidates for a shoulder replacement, but replacing the shoulder in the typicalfashion has not been successful. Replacingthe shoulder with a special type of artficialshoulder joint is becoming more popular. Thisprocedure is called a reverse shoulder replacement.The "normal" artificial shoulder was designedto copy our real shoulder. The glenoid component (the socket) was designed to replace ournormal shoulder socket with a thin, shallowplastic cup. The humeral head component wasdesigned to replace the ball of the humeruswith a metal ball that sits on top of the glenoid.Compliments of: Sterling Ridge Orthopaedics & Sports Medicine6
A Patient's Guide to Cuff (Rotator) Tear ArthropathyThis situation has been compared to placing aball on a shallow saucer. Without somethingto hold it in place, the metal ball simply slidesaround on the saucer. In the shoulder thatsomething is the rotator cuff and the musclesthat attach to the tendons. Without a rotatorcuff to hold the metal ball centered in theplastic socket, the metal quickly wore out theplastic socket and the joint became painfulonce again. The answer to this dilemma was torethink the mechanics of the shoulder joint anddesign an artificial shoulder that worked differently than the real shoulder joint.The solution was to reverse the socket and theball, placing the ball portion of the shoulderwhere the socket use to be and the socketwhere the ball or humeral head use to be.This new design led to a much more stableshoulder joint that could function without arotator cuff. The artificial joint itself providedmore stability by creating a deeper socket thatprevented the ball from sliding up and downas the shoulder was raised. The large deltoidmuscle that covers the shoulder could be usedto more effectively lift the arm, providingbetter function of the shoulder. The finalresult is a shoulder that functions better, is lesspainful and can last for years without loosening.RehabilitationWhat should I expect after treatment?Nonsurgical RehabilitationYour physical therapist will show you how touse ice or heat to help with pain. You will alsobe instructed in exercises to strengthen yourshoulder girdle as much as possible. Showingyou joint protection tips, or motion that youcan expect to do safely without causing moreharm to your shoulder is also important. Thegoal is to reduce pain, increase range of motionand function, and prevent further arthritis.After SurgeryA physical or occupational therapist will seeyou the day after surgery to begin your rehabilitation program. Therapy treatments willgradually improve the movement in yourshoulder. Your therapist will go over yourexercises and make sure you are safe gettingin and out of bed and moving about in yourroom.When you go home, you may get hometherapy visits. By visiting your home, yourtherapist can check to see that you are safegetting around in your home. Treatments willalso be done to help improve your range ofmotion and strength. In some cases, you mayrequire up to three visits at home before beginning outpatient therapy.Out patient therapy at a facility can oftenmore effective and is often preferred overhome physical therapy. The first few outpatient treatments will focus on controllingpain and swelling. Ice and electrical stimulation treatments may help. Your therapistmay also use massage and other types ofhands-on treatments to ease muscle spasm andpain. Continue to use your shoulder sling asprescribed.As the rehabilitation program evolves, morechallenging exercises are chosen to safelyadvance the shoulder's strength and function.Finally, a select group of exercises can be usedto simulate day-to-day activities, like groomingyour hair or getting dressed.Compliments of: Sterling Ridge Orthopaedics & Sports Medicine7
A Patient's Guide to Cuff (Rotator) Tear ArthropathyNotesCompliments of: Sterling Ridge Orthopaedics & Sports Medicine8
Rotator cuff tears are very common. Trauma, such as falls, lifting, and pulling forcefully can also cause a rotator cuff tear. When this happens, it is called an acute tear. Although the rotator cuff can be damaged from a single trau-matic injury, damage to the rotator cuff usually occurs gradually. Age can be
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