Rotator cuff tear arthropathy is a term coined by Neer in 1983, and it encompasses a broad spectrum of pathology. All patients with rotator cuff tear arthropathy possess at least three critical features: (1) rotator cuff insufficiency, (2) degenerative changes of the glenohumeral joint, and (3) superior migration of the humeral head.
The glenohumeral joint lacks substantial intrinsic osseous restraints, and thus the joint’s stability relies heavily on the rotator cuff’s ability to center the humeral head within the glenoid fossa. This key concept has been coined concavity-compression. Through this mechanism, the shoulder musculature—including the rotator cuff—becomes the primary stabilizer of the glenohumeral joint as the arm moves through positions in which the capsule ligamentous structures are lax.
Patients with a massive rotator cuff tear may present with a clinical pattern of combined loss of active elevation and external rotation (CLEER). Their daily activities may be reversely limited due to a muscle imbalance in both the horizontal and vertical planes.
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