Osteoarthritis with Massive Rotator Cuff-Tear: The Limitation of its Current Definitions

Summary

Forty-six shoulders were analysed to define characteristic elements in order to better understand osteoarthritis with massive cuff-tear. The population presenting with this pathology is usually elderly (74 years) and female (80%). The population can be subdivided into three groups: Group 1 (23 cases) have a progressive evolution of the shoulder towards acetabulisation. This consists of long-standing, evolving cuff-tears. This type corresponds to Neer’s ‘cuff-tear arthropathy’. Group 2 (9 cases) is distinctive and somewhat different from that of destructive arthropathies. This disorder corresponds to an osteoarthritis because of the centralized narrowing of the glenohumeral joint. These arthropathies are particular in presenting with an associated unrepairable cuff-tear. In group 3 (14 cases) lysis and bone destruction are the dominant elements. In contrast to group 1, there are no signs of this having evolved from an old cuff-tear, and the cuff-tear is probably contemporary to, or has shortly preceded, the bony destruction. This group corresponds to rheumatological shoulders (senile haemorrhagic shoulder, Milwaukee shoulder, rapidly destructive arthropathy).