Rotator Cuff Tear Arthropathy: Clinical Evaluation

Abstract

Rotator cuff tear arthropathy (RCTA) includes a wide spectrum of clinical signs and symptoms caused by the contemporary presence of three main features: rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. Patients with RCTA are typically elderly, more commonly female with the dominant side involved. They typically complain a history of long-standing pain, progressive loss of motion, and chronic joint effusion, with recurrent and painful swelling episodes. During the examination, muscular atrophy of the supraspinatus and infraspinatus tendon and a “Popeye” biceps sign can be noticed. Rarely a geyser sign can be present. The tests for rotator cuff rupture are clearly positive. The patients affected by RCTA may present varying degrees of active range of motion: if the glenohumeral fulcrum is compensated by a preserved deltoid muscle, a functional movement can be preserved. However, in the majority of severe cases, a pseudoparalysis, in abduction and forward flexion, is present. In these cases, the attempt of active shoulder abduction or elevation reveals the typical superior subluxation or escape of the humeral head. The doctor, at the end of the visit, after an accurate clinical examination, completed by the medical history and a correct imaging (X-rays, MRI, and/or CT scan), is usually able to address the patient to the more appropriate treatment.