Author: University of Washington Orthopaedics and Sports Medicine Seattle, WA 2008-08-13
Shoulder rotator cuff tear arthropathy treatment with shoulder replacement surgery Rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear) is a devastating condition that seriously compromises the comfort and function of the shoulder. This condition is characterized by the permanent loss of the rotator cuff tendons and the normal surface of the shoulder joint. These tissues cannot be restored to their normal condition and the lost comfort and function of the shoulder cannot be totally regained. However, in the hands of an experienced surgeon and in a well-motivated individual, shoulder replacement surgery with a cuff tear arthropathy (CTA) head prosthesis along with post-surgical rehabilitation can help restore substantial comfort and function to shoulders damaged by cuff tear arthropathy.
Rotator cuff tear
arthropathy (arthritis with a massive rotator cuff tear) is a
devastating condition that seriously compromises the comfort and
function of the shoulder. This condition is characterized by the
permanent loss of the rotator cuff tendons and the normal surface of the
shoulder joint. These tissues cannot be restored to their normal
condition and the lost comfort and function of the shoulder cannot be
totally regained. However, in the hands of an experienced surgeon and in
a well-motivated individual, shoulder replacement surgery with a cuff
tear arthropathy (CTA) head prosthesis along with post-surgical
rehabilitation can help restore substantial comfort and function to
shoulders damaged by cuff tear arthropathy.
When the rotator cuff is essentially intact, shoulder arthritis is often best treated by total shoulder replacement.
Consultation
by the Shoulder and Elbow Service at the University of Washington
regarding the diagnosis and treatment of shoulder arthritis may be
requested by using our online referrals website.
You can also call 206-598-0312 to make an appointment.
More detail about shoulder arthritis with a massive rotator cuff tear and the treatment options can be found below.
In
the normal shoulder, the rotator cuff muscles, including the
supraspinatus, help balance the ball of the arm bone (humeral head) in
the socket against the upward pull of the deltoid muscle. [Figure 1].
In
rotator cuff tear arthropathy, the rotator cuff tendons that normally
are interposed between the humeral head and the overlying coracoacromial
arch become progressively thinned until the humeral head moves upwards
and rubs against the bone of the arch. [Figure 2].
In stage 1A of
rotator cuff tear arthropathy the humeral head remains centered in the
socket (glenoid) in spite of a large rotator cuff tear [Figure 3]. In
stage 1B of rotator cuff tear arthropathy the humeral head migrates
medially into the socket (glenoid) [Figure 4]. In stage 2A of rotator
cuff tear arthropathy the humeral head migrates upwards, but is
stabilized by the overlying coracoacromial arch in spite of the lack of
rotator cuff. [Figures 5 and 6]. In stage 2B of rotator cuff tear
arthropathy the humeral head migrates upwards and forwards because it is
no longer stabilized by the coracoacromial arch. This condition often
arises after previous procedures such as an acromioplasty when it is
performed in the presence of a large cuff tear. [Figure 7]
After
performing a clinical exam, a shoulder surgeon experienced with rotator
cuff tear arthropathy can suggest what type of surgery is most likely to
be helpful to the individual with the condition. Individuals are most
likely to benefit from this surgery if they are well motivated and in
good health.
Shoulders demonstrating changes of Stages 1A, 1B,
and 2A with substantial loss of comfort and function are considered for
shoulder arthroplasty using a cuff tear arthropathy (CTA) prosthesis as
described in this article.
Shoulders with stage 2B cuff tear
arthropathy with substantial loss of comfort and function are considered
for the reversed (reverse Delta) prosthesis because the cuff tear
arthropathy (CTA) prosthesis may not provide sufficient stability for
the humeral head (ball of the shoulder joint). The reversed (reverse Delta) prosthesis
is designed with a socket where the ball (head of the humerus) is
normally located and a ball where the socket (glenoid) is usually
located.
The goal of shoulder replacement arthroplasty with a
cuff tear arthropathy (CTA) prosthesis is to restore the best possible
function to the joint by removing scar tissue, balancing muscles, and
replacing the destroyed joint surface of the humerus (arm bone) [figure
8] with an artificial one especially designed for that purpose [figure
9]. The humeral ball is fixed to the humerus (arm bone) by press fitting
its stem inside the bone.
Shoulder joint replacement
arthroplasty with a cuff tear arthropathy head is a highly technical
procedure and is best performed by a surgical team who performs this
surgery often. Such a team can maximize the benefit and minimize the
risks.
The two-hour procedure is performed under general (or
nerve block) anesthesia. Shoulder motion is started immediately after
the procedure. Individuals having this procedure learn to do their own
physical therapy and are usually discharged three days after surgery if
they are comfortable and have a good range of passive motion. The
recovery of strength and function may continue for up to a year after
surgery.