Rotator cuff insufficiency in the arthritic shoulder: treatment alternatives

Shoulder arthroplasty can relieve the pain and improve the functional status of an arthritic shoulder. Because of the unique anatomic characteristics of the glenohumeral joint, the rotator cuff provides stability and control of shoulder motion. Thus, an intact, functioning rotator cuff is necessary for successful shoulder arthroplasty. There are clinical situations where the rotator cuff is torn, absent, or incompetent and an arthritic condition affects the shoulder. The patient must understand that, when confronted with rotator cuff insufficiency and shoulder arthritis, the goal of surgical treatment is limited to pain relief, with shoulder function often limited by the condition of the rotator cuff. We will discuss the incidence of rotator cuff disease associated with differing arthritic conditions, the treatment options available, and expected outcomes in these difficult and challenging clinical situations.