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The Journal of Bone and Joint Surgery, Vol 65, Issue 9 1232-1244, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Cuff-tear arthropathy
CS Neer, EV Craig and H Fukuda
In this report we describe the clinical and pathological findings of
cuff-tear arthropathy in twenty-six patients and discuss the differential
diagnosis and a hypothesis on the pathomechanics that lead to its
development. This lesion is thought to be peculiar to the glenohumeral
joint because of the unique anatomy of the rotator cuff. Following a
massive tear of the rotator cuff there is inactivity and disuse of the
shoulder, leaking of the synovial fluid, and instability of the humeral
head. These events in turn result in both nutritional and mechanical
factors that cause atrophy of the glenohumeral articular cartilage and
osteoporosis of the subchondral bone of the humeral head. A massive tear
also allows the humeral head to be displaced upward, causing subacromial
impingement that in time erodes the anterior portion of the acromion and
the acromioclavicular joint. Eventually the soft, atrophic head collapses,
producing the complete syndrome of cuff-tear arthropathy. The incongruous
head may eventually erode the glenoid so deeply that the coracoid becomes
eroded as well. Although treatment of cuff-tear arthropathy is extremely
difficult, the preferred method appears to be a resurfacing total shoulder
replacement with rotator-cuff reconstruction and special rehabilitation. We
think that it is important to recognize cuff-tear arthropathy as a distinct
pathological entity, as such recognition enhances our understanding of the
more common impingement lesions. Cuff-tear arthropathy is especially
difficult to treat, and although many tears of the rotator cuff do not
enlarge sufficiently to allow this condition to develop, it is a factor to
consider when deciding whether or not a documented tear of the rotator cuff
should be surgically repaired.
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