What is Rotator Cuff Arthropathy: Signs, Risk Factors, Treatment, Diagnosis

A rotator cuff arthropathy is a condition that happens when there is a serious tear in the rotator cuff muscles. Rotator cuff is actually a group of four muscles and tendons which surround the ball and socket joint. The major function of these groups of these muscles is to assist movement and provide strength to the shoulder joint, along with providing a comprehensive force which helps to hold the ball inside the socket of the shoulder. In order to diagnose rotator cuff arthropathy, 3 clinical features are looked for and they are:

• Inadequate function of the rotator cuff (typically a substantial tear)
• Ball-and-socket (glenohumeral) joint arthritis
• Shifting of the ball from its normal position inside the socket.

The indications of rotator cuff arthropathy are like typical shoulder joint inflammation, yet there is frequently more weakness of the shoulder. Other signs of rotator cuff arthropathy include:

• Pain in the shoulder
• Loss of mobility
• Shoulder joint weakness
• Swelling around the shoulder
• Muscle atrophy around the shoulder.

The risk factors for having rotator cuff arthropathy include:

• Age
• Body Mass Index or BMI
• Height
• Recurrent lifting of heavy objects
• Recurrent overhead movements
• Work-related injuries.

Diagnosis of rotator cuff arthropathy includes patient history and physical assessment which also includes description of activities done and acute and chronic symptoms. A proper diagnosis will includes detailed physical examination of the shoulder by checking for tenderness and deformity, palpation, range of motion, neurological evaluation, tests to reproduce the symptoms, and strength evaluation. The diagnostic tests which help for evaluation of rotator cuff arthropathy are:

• X-ray
• Ultrasound
• MRI
• MR Arthrography
• Double-contrast Arthrography.

Treatment for rotator cuff arthropathy can sometimes be really challenging. The treatments are decided based on the extent of injury and damage and also by evaluating the pros and cons of each treatment method and its expected outcome. The ways of treatment for rotator cuff arthropathy include:

• Physical Therapy: Physical therapy is the most important way in treating rotator cuff arthropathy. It is important to strengthen the rotator cuff muscles in order to normalize the shoulder function. Exercises taught by the physical therapist can help to alleviate and prevent recurrent shoulder pain. Treatment methods opted by a physical therapist to relieve the pain and inflammation include ultrasound, electrical stimulation like IFT and TENS etc.
• Cold Compression to the Rotator Cuff: Cold compressions help to reduce pain and inflammation of the shoulder. Cold compressions can be done using ice packs or ice wraps found in the market. It should be applied intermittently for 3-4 times in a day or every time after doing an activity that increases the pain.
• Aqua Therapy: It is really helpful for patients who are experiencing extremes of pain and are unable to do exercises. Movements done underwater reduce the efforts to be put by the muscles for doing an exercise.
• Anti-inflammatory Medications for Rotator Cuff Arthropathy: Anti-inflammatory medicines help in controlling the pain and inflammation experienced in cases of rotator cuff arthropathy. However, it must be only taken under the supervision of a doctor.
• Cortisone Injections: Cortisone injections are given directly on the shoulder joint so that it acts locally on the inflamed area and the reaction is faster. Cortisone injections are well tolerated and have insignificant reactions. In patients with diabetes, cortisone shots may briefly raise the glucose levels and hence, one must observe the glucose levels closely for the first few days.

The 3 different surgical methods for rotator cuff arthroscopy are arthroscopic, mini open and open surgery. In the earlier days, arthroscopy was done for patients who had small tears; while for large tears of the rotator cuff, open surgeries were done. However, with the advancement of science and research, today, even for large tears, arthroscopic repairs are done. Moreover, arthroscopy allows short recovery period while the benefits of it is same as an open surgery.

Surgery alone can only help in suturing the muscles together. Post-surgical rehabilitation is something very important to improve the muscle strength and increase the range of motion while bringing the shoulder back to its normal functional state. The rehabilitation is done is 3 stages. At first, the arm is kept immobilized for a period of time so as to let the muscles heal. Secondly, a physical therapist assists with passive exercises to slowly regain the range of movement of the shoulder. The third stage includes gradual active movement exercises of the arm and shoulder to regain and enhance strength.

The severity of rotator cuff arthropathy depends on the extent of tear of the rotator cuff muscles and the pain experienced. However, it must not be neglected at any time since the condition might worsen causing severe pain and discomfort.

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