Rotator cuff arthropathy: Insights into this under-recognized entity

Rotator cuff tears are commonly seen in athletes and older adults. Rotator cuff arthropathy (RCA), the end stage of untreated or neglected massive rotator cuff tears, leads to debilitating restriction of shoulder movements. The condition typically occurs in the seventh decade of life. While the entity can be suspected clinically, imaging clinches the diagnosis and guides the appropriate management. However, it may be missed by the radiologist on a radiograph, and sometimes on magnetic resonance imaging as well, where the findings of cuff tears take apparent priority in the impression over those of arthropathy. The inexperienced radiologist may also fail to mention findings important for surgical decision-making, such as muscle atrophy, fatty infiltration of muscles, and the location of the retracted end of the cuff tendons. This review article aims to provide teaching points on the correct diagnosis, and the importance of relevant and comprehensive reporting of such cases for timely management.