Natural History

  • Eraclio Siuni


The severe degenerative alterations of the glenohumeral joint resulting from the inveterate rupture of the rotator cuff associated with marked functional limitations and intense patient pain had already been described in the nineteenth century. However, it was only in 1983 that the term rotator cuff tear arthropathy of the glenohumeral joint was coined by Charles S. Neer.

While other authors in the same years proposed a crystal-mediated theory with the term “Milwaukee shoulder syndrome”—which is still a similar pathology—he explained etiopathogenesis as a combination of mechanical and nutritional factors.

Several authors have later on supported mechanical theory with the concepts of “force coupling” and “concavity compression” acting on the shoulder joint.

An imbalance of these myotendinal forces following the rotator cuff tear would lead to progressive articular degeneration characterized by the proximal migration of the humeral head with wear of the top of the glena and the humeral head and the lower part of acromion with recurrent joint effusions and subacromial space.

Since only a small part of rotator cuff tear cases, especially older women and the dominant side shoulders, into joint articular degeneration, it was attempted to understand what risk factors could be involved in the progressive evolution of this severe pathology.


Rotator cuff tear Natural history Tear progression Massive tear Irreparable tear Pseudoparalytic shoulder Cuff tear arthropaty Degenerative arthritis Glenohumeral joint 


  1. 1.
    Smith RW. Observations upon chronic rheumatic arthritis of the shoulder (part I). Dublin Quart J Med Sci. 1853;15:1–16.CrossRefGoogle Scholar
  2. 2.
    Smith RW. Observations upon chronic rheumatic arthritis of the shoulder (part II). Dublin Quart J Med Sci. 1853;15:343–58.CrossRefGoogle Scholar
  3. 3.
    Adams R. A treatise on rheumatic gout or chronic rheumatic arthritis of all the joints. London: John Churchill & Sons; 1873. p. 91–175.Google Scholar
  4. 4.
    Codman E. Rupture of the supraspinatus tendon and others lesions in or about the subacromial bursa. In: Codman E, editor. The shoulder. Boston: Thomas Todd; 1934. p. 478–80.Google Scholar
  5. 5.
    Galmiche P, Deshayes P. Hemarthrose essentielle récidivante. Rev Rhumat. 1958;25:57–9.Google Scholar
  6. 6.
    Shephard E. Swelling of the subacromial bursa: a report on 16 cases. Proc R Soc Med. 1963;56:162–3.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Snook GA. Pigmented villonodular synovitis with bony invasion. A report of two cases. JAMA. 1963;184:424–5.CrossRefGoogle Scholar
  8. 8.
    Burman M, Sutro C, Guariglia E. Spontaneous hemorrhage of bursae and joint in the elderly. Bull Hosp Joint Dis. 1964;25:217–39.PubMedGoogle Scholar
  9. 9.
    Banna A, Hume KP. Spontaneous hemarthrosis of the shoulder joint. Ann Phys Med. 1964;7:180–4.Google Scholar
  10. 10.
    Bauduin MP, Famaey JP. A propos d’un cas d’épaule sénile hémorragique. Belge Rhum Med Phys. 1969;24:135–40.Google Scholar
  11. 11.
    DeSeze S, Hubault A, Rampon S. L’épaule sénile hémorragique. L’actualité rhumatologique. Paris: Expansion Scientifique Francaise; 1967. p. 107–15.Google Scholar
  12. 12.
    Lamboley C, Bataille R, Rosenberg F, Sany J, Serre H. L’épaule sénile hémorragique. A propos de 9 observations. Rhumatologie. 1977;29:323–30.Google Scholar
  13. 13.
    Neer CS, Watson K, Stanton F. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982;64:319–37.CrossRefGoogle Scholar
  14. 14.
    Garancis JC, Cheung HS, Halverson PB, McCarty DJ. “Milwaukee shoulder”—association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. III. Morphologic and biochemical studies of an excised synovium showing chondromatosis. Arthritis Rheum. 1981;24:484–91.CrossRefGoogle Scholar
  15. 15.
    Halverson PB, Cheung HS, McCarty DJ, Garancis J, Mandel N. “Milwaukee shoulder”—association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. II. Synovial fluid studies. Arthritis Rheum. 1981;24:474–83.CrossRefGoogle Scholar
  16. 16.
    McCarty DJ, Halverson PB, Carrera GF, Brewer BJ, Kozin F. “Milwaukee shoulder”—association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I. Clinical aspects. Arthritis Rheum. 1981;24:464–73.CrossRefGoogle Scholar
  17. 17.
    Halverson PB, Garancis JC, McCarty DJ. Histopathological and ultrastructural studies of synovium in Milwaukee shoulder syndrome a basic calcium phosphate crystal arthropathy. Ann Rheum Dis. 1984;43:734–41.CrossRefGoogle Scholar
  18. 18.
    Halverson PB, Carrera GF, McCarty DJ. Milwaukee shoulder syndrome: fifteen additional cases and a description of contributing factors. Arch Intern Med. 1990;150:677–82.CrossRefGoogle Scholar
  19. 19.
    McCarty DJ. Milwaukee shoulder syndrome. Trans Am Clin Climatol Assoc. 1991;102:271–84.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Cheung HS, Ryan LM. Role of crystal deposition in matrix degradation. In: Woessner FJ, Howell DS, editors. Joint cartilage degradation: basic and clinical aspects, vol. 209. New York: Marcel Dekker; 1995.Google Scholar
  21. 21.
    Zeman C, Arcand M, Cantrell J, et al. The rotator cuff deficient arthritic shoulder: diagnosis and surgical management. J Am Acad Orthop Surg. 1998;6:337–48.CrossRefGoogle Scholar
  22. 22.
    Dieppe PA, Doherty M, Macfarlane DG, Hutton CW, Bradfield JW, Watt I. Apatite associated destructive arthritis. Br J Rheumatol. 1984;23:84–91.CrossRefGoogle Scholar
  23. 23.
    Dieppe P, Watt I. Crystal deposition in osteoarthritis: an opportunistic event? Clin Rheum Dis. 1985;11:367–92.PubMedGoogle Scholar
  24. 24.
    Campion GV, McCrae F, Alwan W, Watt I, Bradfield J, Dieppe PA. Idiopathic destructive arthritis of the shoulder. Semin Arthritis Rheum. 1988;17:232–45.CrossRefGoogle Scholar
  25. 25.
    Neer CS, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am. 1983;65:1232–44.CrossRefGoogle Scholar
  26. 26.
    Burkhart SS. Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res. 1992;284:144–52.Google Scholar
  27. 27.
    Hurov J. Anatomy and mechanics of the shoulder: review of current concepts. J Hand Ther. 2009;22:328–42.CrossRefGoogle Scholar
  28. 28.
    Nam D, Maak TG, Raphael BS, et al. Rotator cuff tear arthropathy: evaluation, diagnosis, and treatment: AAOS exhibit selection. J Bone Joint Surg Am. 2012;94(6):e34.CrossRefGoogle Scholar
  29. 29.
    Aumiller WD, Kleuser TM. Diagnosis and treatment of cuff tear arthropathy. JAAPA. 2015;28(8):33–8.CrossRefGoogle Scholar
  30. 30.
    Eajazi A, Kussman S, LeBedis C, Guermazi A, Kompel A, Jawa A, Murakami AM. Rotator cuff tear arthropathy: pathophysiology, imaging characteristics, and treatment options. AJR. 2015;205:W502–11.CrossRefGoogle Scholar
  31. 31.
    Oh JH, Jun BJ, McGarry MH, Lee TQ. Does a critical rotator cuff tear stage exist? A biomechanical study of rotator cuff tear progression in human cadaver shoulders. J Bone Joint Surg Am. 2011;93:2100–9.CrossRefGoogle Scholar
  32. 32.
    Collins DN, Harryman DTI. Arthroplasty for arthritis and rotator cuff deficiency. Orthop Clin North Am. 1997;28:225–39.CrossRefGoogle Scholar
  33. 33.
    Gotoh M, Hamada K, Yamakawa H, Nakamura M, Yamazaki H, Ueyama Y, Tamaoki N, Inoue A, Fukuda H. Perforation of rotator cuff increases interleukin 1beta production in the synovium of glenohumeral joint in rotator cuff diseases. J Rheumatol. 2000;27:2886–92.PubMedGoogle Scholar
  34. 34.
    Osawa T, Shinozaki T, Takagishi K. Multivariate analysis of biochemical markers in synovial fluid from the shoulder joint for diagnosis of rotator cuff tears. Rheumatol Int. 2005;25:436–41.CrossRefGoogle Scholar
  35. 35.
    Yoshihara Y, Hamada K, Nakajima T, Fujikawa K, Fukuda H. Biochemical markers in the synovial fluid of glenohumeral joints from patients with rotator cuff tear. J Orthop Res. 2001;19:573–9.CrossRefGoogle Scholar
  36. 36.
    Kramer EJ, Bodendorfer BM, Laron D, Wong J, Kim HT, Liu X, Feeley BT. Evaluation of cartilage degeneration in a rat model of rotator cuff tear arthropathy. J Shoulder Elbow Surg. 2013;22:1702–9.CrossRefGoogle Scholar
  37. 37.
    Tashjian RZ. The natural history of rotator cuff disease: evidence in 2016. Tech Should Elb Surg. 2016;17(4):132–8.CrossRefGoogle Scholar
  38. 38.
    Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. J Orthop. 2013;10(1):8–12.CrossRefGoogle Scholar
  39. 39.
    Gumina S, Carbone S, Campagna V, Candela V, Sacchetti FM, Giannicola G. The impact of aging on rotator cuff tear size. Musculoskelet Surg. 2013;97(Suppl 1):69–72.CrossRefGoogle Scholar
  40. 40.
    Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296–9.CrossRefGoogle Scholar
  41. 41.
    Jeong J, Shin DC, Kim TH, et al. Prevalence of asymptomatic rotator cuff tear and their related factors in the Korean population. J Shoulder Elbow Surg. 2017;26(1):30–5.CrossRefGoogle Scholar
  42. 42.
    Ecklund KJ, Lee TQ, Tibone J, Gupta R. Rotator cuff tear arthropathy. J Am Acad Orthop Surg. 2007;15(6):340–9.CrossRefGoogle Scholar
  43. 43.
    Lashgari C, Rediniaki D. Upper extremity. The natural history of RTC tears. Current Orthop Pract. 2012;1:10–3.CrossRefGoogle Scholar
  44. 44.
    Moosmayer S, Tariq R, Stiris M, Smith HJ. The natural history of asymptomatic rotator cuff tears: a three-year follow-up of fifty cases. J Bone Joint Surg Am. 2013;95(14):1249–55.CrossRefGoogle Scholar
  45. 45.
    Keener JD, Galatz LM, Teefey SA, Middleton WD, Steger-May K, Stobbs-Cucchi G, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015;97:89–98.CrossRefGoogle Scholar
  46. 46.
    Ranebo MC, Björnsson Hallgren HB, Norlin R, Adolfsson LE. Clinical and structural outcome 22 years after acromioplasty without tendon repair in patients with subacromial pain and cuff tears. J Shoulder Elbow Surg. 2017;26:1262–70.CrossRefGoogle Scholar
  47. 47.
    Schmidt CC, Jarrett CJ, Brown BT. Management of rotator cuff tears. J Hand Surg Am. 2015;40:399–408.CrossRefGoogle Scholar
  48. 48.
    Abboud JA, Kim JS. The effect of hypercholesterolemia on rotator cuff disease. Clin Orthop Relat Res. 2010;468:1493–7.CrossRefGoogle Scholar
  49. 49.
    Gumina S, Arceri V, Carbone S, Albino P, Passaretti D, Campagna V, et al. The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2013;22:229–32.CrossRefGoogle Scholar
  50. 50.
    Djerbi I, Chammas M, Mirous MP, Lazerges C, Coulet B. Impact of cardiovascular risk factor on the prevalence and severity of symptomatic full-thickness rotator cuff tears. Orthop Traumatol Surg Res. 2015;101(6 Suppl):S269–73.CrossRefGoogle Scholar
  51. 51.
    Kane SM, Dave A, Haque A, Langston K. The incidence of rotator cuff disease in smoking and non-smoking patients: a cadaveric study. Orthopedics. 2006;29(4):363–6.PubMedGoogle Scholar
  52. 52.
    Carbone S, Gumina S, Arceri V, Campagna V, Fagnani C, Postacchini F. The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes. J Shoulder Elbow Surg. 2012;21:56–60.CrossRefGoogle Scholar
  53. 53.
    Chalmers PN, Salazar DH, Steger-May K, Chamberlain AM, Stobbs-Cucchi G, Yamaguchi K, Keener D, D J. Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears. J Shoulder Elbow Surg. 2016;25(11):1749–55.CrossRefGoogle Scholar
  54. 54.
    Samitier G, Alentorn-Geli E, Torrens C, Wright TW. Reverse shoulder arthroplasty. Part 1: systematic review of clinical and functional outcomes. Int J Shoulder Surg. 2015;9:24–31.CrossRefGoogle Scholar
  55. 55.
    Jensen KL, Williams GR Jr, Russell IJ, Rockwood CA Jr. Rotator cuff tear arthropathy. J Bone Joint Surg Am. 1999;81(9):1312–24.CrossRefGoogle Scholar
  56. 56.
    Gumina S, Candela V. Rotator cuff arthropathy. What is it? In: Gumina S, editor. Rotator cuff tear, pathogenesis, evaluation and treatment. New York: Springer; 2017. p. 383–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Eraclio Siuni
    • 1
  1. 1.Responsible “Shoulder Surgery Unit”SCOMR Marino HospitalCagliari Ats SardiniaItaly

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