Rotator Cuff Tear Arthropathy: Clinical Evaluation

  • Alessandro Marinelli
  • Marco Cavallo
  • Alice Ritali
  • Roberto Rotini


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.


Irreparable rotator cuff tear Degenerative arthritis Clinical evaluation Shoulder pain Physical examination Shoulder impingement 


  1. 1.
    Funk L, Haines J, Trail I. Rotator cuff arthropathy. Curr Orthop. 2007;21:415–21.CrossRefGoogle Scholar
  2. 2.
    Visotsky JL, Basamania C, Seebauer L, Rockwood CA, Jensen KL. Cuff tear arthropathy: pathogenesis, classification, and algorithm for treatment. J Bone Joint Surg Am. 2004;86-A(Suppl 2):35–40.CrossRefGoogle Scholar
  3. 3.
    Aumiller WD, Kleuser TM. Diagnosis and treatment of cuff tear arthropathy. JAAPA. 2015;28(8):33–8.CrossRefGoogle Scholar
  4. 4.
    Jensen KL, Williams GR Jr, Russell IJ, Rockwood CA Jr. Rotator cuff tear arthropathy. J Bone Joint Surg Am. 1999;81:1312–24.CrossRefGoogle Scholar
  5. 5.
    Ecklund KJ, Lee TQ, Tibone J, Gupta R. Rotator cuff tear arthropathy. J Am Acad Orthop Surg. 2007;15(6):340–9.CrossRefGoogle Scholar
  6. 6.
    Feeley BT, Gallo RA, Craig EV. Cuff tear arthropathy: current trends in diagnosis and surgical management. J Shoulder Elb Surg. 2009;18(3):484–94.CrossRefGoogle Scholar
  7. 7.
    Macaulay AA, Greiwe RM, Bigliani LU. Rotator cuff deficient arthritis of the glenohumeral joint. Clin Orthop Surg. 2010;2(4):196–202.CrossRefGoogle Scholar
  8. 8.
    Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998;80(4):624–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alessandro Marinelli
    • 1
  • Marco Cavallo
    • 1
  • Alice Ritali
    • 1
  • Roberto Rotini
    • 1
  1. 1.Shoulder and Elbow UnitIstituto Ortopedico Rizzoli, IRCSBolognaItaly

Personalised recommendations