summary Rotator cuff arthropathy is a specific pattern of shoulder degenerative joint disease that results from a rotator cuff tear leading to abnormal glenohumeral wear and subsequent superior migration of the humeral head. Diagnosis can be made primarily with shoulder radiographs showing glenohumeral arthritis with a decreased acromiohumeral interval. Treatment for minimally symptomatic patients involves activity modification, subacromial steroid injections, and physical therapy. Shoulder arthroplasty (most commonly reverse total shoulder arthroplasty) is indicated for patients with progressive pain and deterioration of shoulder function. Epidemiology Demographics females > males 7th decade most common Anatomic location more common in dominant shoulder Risk factors rotator cuff tear rheumatoid arthritis crystalline-induced arthropathy hemorrhagic shoulder (hemophiliacs and elderly on anticoagulants) Etiology Pathophysiology cuff tear arthropathy mechanical factors login to view 4 more bullets nutritional factors login to view 3 more bullets crystalline-induced arthropathy login to view 2 more bullets Rotator cuff arthropathy is characterized by the combination of rotator cuff insufficiency glenohumeral cartilage destruction superior migration of the humeral head subchondral osteoporosis humeral head collapse Anatomy Glenohumeral joint Classification Seebauer Classification of Rotator Cuff Arthropathy Type IA Centered, stable Intact anterior restraints Minimal superior migration Dynamic joint stabilization Femoralization of the humeral head and acetabularization of coracoacromial arch Type IB Centered, medialized Intact or compensated anterior restraints Minimal superior migration Compromised joint stabilization Medial erosion of the glenoid Type IIA Decentered, limited stability Compromised anterior restraints Superior translation Minimum stabilization by coracoacromial arch Type IIB Decentered, unstable Incompetent anterior restraints Anterosuperior escape Nonexistent dynamic stabilization No coracoacromial arch stabilization Hamada Classification of Rotator Cuff Arthropathy Grade 1 Acromiohumeral interval ≥ 6mm Grade 2 Acromiohumeral interval≤ 5mm Grade 3 Acromiohumeral interval ≤ 5mm, with acetabularization of acromion Grade 4 4A: Glenohumeral arthritis without acetabularization, AHI < 7mm 4B: Glenohumeral arthritis with acetabularization, AHI ≤ 5mm Grade 5 Humeral head collapse Presentation Symptoms pain, including night-pain subjective weakness subjective stiffness Physical exam inspection & palpation supraspinatus/infraspinatus atrophy prominence of humeral head anteriorly (anterosuperior escape) with elevation of arm subcutaneous effusion from loss of fluid from capsule range of motion limitations in active and passive ROM crepitus in glenohumeral and/or subacromial joints with ROM pseudoparalysis login to view 1 more bullet provocative tests external rotation lag sign login to view 2 more bullets Hornblower sign login to view 2 more bullets Imaging Radiographs recommended views complete shoulder series; AP, axillary, Grashey (true AP) findings acromial acetabularization (true AP) femoralization of humeral head (true AP) asymmetric superior glenoid wear lack of osteophytes osteopenia "snowcap sign" due to subchondral sclerosis anterosuperior escape MRI indications not necessary if humeral head is already showing anterosuperior escape on x-rays findings shows an irreparable rotator cuff tear with login to view 2 more bullets Treatment Nonoperative activity modification, subacromial steroid injection, physical therapy indications login to view 1 more bullet technique login to view 3 more bullets Operative arthroscopic debridement indications login to view 1 more bullet outcomes login to view 2 more bullets hemiarthroplasty indications login to view 4 more bullets outcomes login to view 1 more bullet reverse shoulder arthroplasty indications login to view 5 more bullets outcomes (short and intermediate at this point) login to view 2 more bullets latissimus dorsi transfer indications login to view 2 more bullets pectoralis transfer indications login to view 1 more bullet techniques login to view 1 more bullet complications login to view 1 more bullet resection arthroplasty indications login to view 1 more bullet glenoid resurfacing contraindicated login to view 1 more bullet TSA contraindicated Complications Infection Neurovascular injury Deltoid dysfunction Instability (more common after hemiarthroplasty, rare after RTSA)