Arthropatiya ng Cuff Impormasyon

Ano ang nararamdaman mo

Maaaring karanasan mo ang malalim, masakit na pananakit sa iyong balikat na hindi nawawala kahit magpahinga. Karaniwang galing ang sakit na ito sa arthritis na dulot ng pagkasira sa paglipas ng panahon na kasama ang sugat sa rotator cuff, isang kondisyon na kilala bilang rotator cuff tear arthropathy. Maaaring parang galing sa malalim sa loob ng kasu-kasuan o sumasaklaw pababa sa iyong itaas na braso ang hindi komportableng pakiramdam. Maaaring mapansin mo na mas malala ang sakit sa gabi, na nagiging sanhi ng hirap sa pagtulog o pagpapanatili ng tulog. Karaniwang napakasakit ang paghiga sa apektadong gilid, kaya maaaring matuklasan mong nakahiga ka sa iyong likod o sa kabilang gilid.

Ang mga pang-araw-araw na gawain na nangangailangan ng pagtaas ng iyong braso ay nagiging nakakairita na mahirap. Maaaring mahirapan kang umabot pataas, tulad ng pagkuha ng plato mula sa mataas na kabinet o paghuhugas ng iyong buhok. Ang mga simpleng galaw tulad ng pagtutukoy ng iyong kamiseta o pagkakabit ng bra sa likod ng iyong likod ay maaaring maging imposible o magdulot ng matulis na sakit. Maaari ring mapansin mo ang kahinaan kapag sinusubukan mong itaas ang kahit anong magaan na bagay, tulad ng tasa ng kape o remote control. Maaaring maging matigas ang balikat, na nagbabawal sa kung gaano ka kalayo ang paggalaw nito. Ang katigasan na ito ay madalas na nagiging sanhi ng hirap sa pag-abot sa likod ng iyong likod o sa ibabaw ng iyong katawan.

Ang sakit at katigasan ay kadalasang lumala pagkatapos ng aktibidad. Ang paggamit ng iyong braso para sa paulit-ulit na mga gawain ay maaaring mag-iwan ng kasu-kasuan na masakit at pamamaga ng ilang oras pagkatapos. Maaari ring maramdaman ang biglaang pagdapa o pagkagiling sa balikat habang ang mga buto ay nagkikiskisan. Sa paglipas ng panahon, ang pagkasirang ito ay maaaring magdulot ng pagkawala ng kakayahan na nakakaapekto sa iyong kalayaan. Maaaring matuklasan mong hindi na kayang gawin ang mga karaniwang gawain nang walang tulong o malaking hindi komportableng pakiramdam.

Mahalagang bigyang-pansin ang anumang biglaang pagbabago. Kung karanasan mo ang biglaang pagtaas ng sakit o biglaang pagkawala ng kakayahan, maaaring ito ay senyales ng komplikasyon tulad ng fracture sa paligid ng implant. Ang bagong sakit sa base ng iyong scapula o tenderness sa itaas ng iyong balikat ay dapat iulat sa iyong surgeon. Ang mga sintomas na ito ay maaaring magpahiwatig ng stress sa buto o pagbabago sa katatagan ng kasu-kasuan. Habang maraming pasyente ang nakakakuha ng ginhawa sa pamamagitan ng operasyon, ang pag-unawa sa mga sintomas na ito ay tumutulong sa iyong pamamahala ng iyong kondisyon at paghahanda para sa paggamot. Ang iyong surgeon ay nililimitahan ang mga senyales na ito upang matukoy ang pinakamainam na landas patungo sa iyong partikular na sitwasyon.

Ano ang nangyayari talaga

Ang iyong balikat ay isang ball-and-socket joint. Ang bola ay nakaupo sa isang mababaw na socket. Isang grupo ng mga tendon, na tinatawag na rotator cuff, ay nakabalot sa paligid ng bola upang panatilihin ito sa gitna. Sa cuff arthropathy, ang mga tendon na ito ay napuputol at napapagod sa paglipas ng panahon. Kung walang suportang ito, ang bola ay magkukuskos sa buto ng socket. Ito ay nagdudulot ng sakit at stiffness. Ang makinis na patong ng cartilage ay napapagod. Ang mga buto ay magkukuskosan sa isa't isa.

Habang umuunlad ang kondisyon, ang hugis ng joint ay nagbabago. Ang bola ay maaaring umakyat pataas. Ito ay lumilikha ng puwang kung saan hindi dapat mayroon. Nawawalan ng iyong balikat ang natural na pattern ng galaw. Maaaring maramdaman mo ang pakiramdam ng pagkukuskos o marinig ang mga tunog ng pag-click. Ang mga simpleng gawain tulad ng pag-abot pataas ay nagiging mahirap. Karaniwang lumalala ang sakit sa gabi. Nangyayari ito dahil hindi na stable ang mekaniks ng joint.

Ginagamit namin ang reverse shoulder replacement upang ayusin ito. Palitan namin ang mga posisyon ng bola at socket. Ang metal na bola ay ilalagay sa iyong arm bone. Ang plastic na socket ay ilalagay sa iyong shoulder blade. Ang disenyo na ito ay hindi umaasa sa iyong naputol na rotator cuff. Sa halip, ginagamit nito ang iyong deltoid muscle upang itaas ang iyong braso. Iba ang paggalaw ng bagong joint kumpara sa natural na isa. Magagamit mo ang mas maraming bahagi ng iyong shoulder blade upang galawin ang iyong braso. Ito ay nagkukumpensa sa nawawalang mga tendon.

Ibinabalik ng operasyon ang stability at binabawasan ang sakit. Pinapayagan ito na itaas mo muli ang iyong braso. Gayunpaman, hindi pareho ang joint sa isang malusog na isa. Nangangailangan ito ng maingat na paggalaw upang protektahan ang mga bagong bahagi. Gabayin ng iyong surgeon ang iyong paggaling upang matiyak na tumatagal ang implant. Ang layunin ay bigyan ka ng functional, walang sakit na balikat para sa pang-araw-araw na buhay.

Mga maitutulong namin dito

Ang gabay na ito ay sumasalamin sa paraan ni Dr. Kieran Hirpara, isang surgeon sa itaas na bahagi ng katawan sa Mater Private Hospital Rockhampton, sa pagharap sa kondisyong ito sa aming klinika. Dumadating ang mga pasyente sa aming klinika sa pamamagitan ng referral mula sa GP o physiotherapist. Isang pagsusuri sa klinika ang nagtatakda ng diagnosis. Para sa mga degenerative o matagal nang problema, karaniwan naming sinusubukan muna ang non-operative na paggamot. Kasama rito ang pagbabago sa aktibidad, physiotherapy, at mga injection. Pinag-iisipan namin ang operasyon kapag hindi ito nagbigay ng sapat na pagpapabuti. Para sa mga structural o acute na problema, maaaring irekomenda agad ang operasyon.

Maaari kang magsimula sa self-management at physiotherapy. Ang aming layunin ay bawasan ang sakit at panatilihin ang galaw. Layunin ng physiotherapy na palakasin ang mga kalamnan sa paligid ng iyong balikat upang suportahan ang joint. Dapat mong bigyan ang pamamaraang ito ng oras upang maging epektibo. Kung ang iyong sakit ay matindi, maaaring kailanganin mo ng gamot. Inirerekomenda naming subukan muna ang ibang mga opsyon para bawasan ang sakit bago gumamit ng opioid na gamot para sa sakit. Ang mga anti-inflammatories ay makakatulong sa pamamaga at sakit. Maaari ring magbigay ng ginhawa ang mga injection. Ang mga injection ng cortisone ay nagbabawas ng pamamaga at maaaring tumagal ng ilang buwan. Ang mga injection ng hyaluronic acid ay layuning maglubricate ng joint. Ang mga injection ng platelet-rich plasma (PRP) ay gumagamit ng iyong sariling mga cell ng dugo upang itaguyod ang paggaling. Nag-iiba ang mga epektong ito depende sa tao.

Isinasalang-aling ang operasyon kapag naabot na ng conservative na paggamot ang hangganan nito. Ang pangunahing opsyon ay reverse total shoulder arthroplasty. Ang prosedurang ito ay nagpapalit ng ball at socket upang ibalik ang function. Ito ay partikular na kapaki-pakinabang kapag sira ang rotator cuff o kapag may malubhang arthritis. Ang reverse na disenyo ay nagbibigay-daan sa deltoid muscle na itaas ang iyong braso, kahit hindi gumagana nang maayos ang rotator cuff. Nagbibigay ito ng matatag na pivot para sa galaw.

Pinag-uusapan namin ang mga panganib at benepisyo sa iyo. Halimbawa, ang revision reverse shoulder arthroplasty ay nagpapakita ng implant survival rate na 85% sa loob ng sampung taon. Gayunpaman, ang mga pasyenteng mas bata sa 60 taong gulang ay nakakaranas ng mas mataas na rates ng 90-araw na surgical complications kumpara sa mga mas matandang pasyente. Kung mayroon kang nakaraang shoulder replacement na nabigo, maaaring mas masama ang mga resulta kumpara sa unang operasyon. Binabanggit din namin na ang mga pasyenteng may magandang resulta pagkatapos ng unang reverse total shoulder arthroplasty ay maaaring payuhan tungkol sa operasyon para sa kabilang balikat nang maaga, sa loob ng 3 buwan pagkatapos ng operasyon.

Para sa mga acute na fractures, ang reverse shoulder arthroplasty ay nagbibigay ng mas mahusay na functional outcomes kumpara sa conservative na paggamot. Ito rin ang pinipiling opsyon para sa mga kumplikadong fractures sa mga matandang pasyente. Ang pamamaraang ito ay nag-aalok ng mas consistent at predictable na mga resulta kumpara sa ibang mga paraan. Inaangkop namin ang plano sa iyong partikular na anatomy at kalusugan. Ikaw at kami ay magkakaroon ng shared decision tungkol sa pinakamainam na landas na susundin.

Ano ang inaasahan

Ang iyong prognosis para sa balikat ay nakadepende sa malaking bahagi kung ito ba ay iyong unang operasyon o isang revision. Kung ikaw ay mayroong primary reverse shoulder replacement, ang karamihan sa mga tao ay nakakakita ng malaking pag-unlad sa pangmatagalan. Ang implant ay nananatiling functional sa 85% ng mga kaso sa loob ng sampung taon. Malamang na makamit mo ang maximum medical improvement isang taon pagkatapos ng operasyon. Ang pagbawas ng sakit at pag-andar ay patuloy na nagiging mas maganda sa loob ng unang taon.

Kung ikaw ay mayroong revision surgery pagkatapos ng isang naunang nabigo na shoulder replacement, ang landas ay mas kumplikado. Ang mga resulta ay karaniwang mas masama kaysa sa unang pagkakataon na operasyon. Maaari kang maranasan ang mas kaunting pagbawas ng sakit, mas mababang kasiyahan, at bawas na galaw ng balikat. Ang panganib ng pagkakaroon ng kailangan ng karagdagang operasyon ay mas mataas din. Ang iyong surgeon ay talakayin ang mga partikular na panganit na ito sa iyo batay sa iyong kasaysayan.

Ang paggaling ay magkaiba-iba sa bawat isa. Humigit-kumulang 84% ng mga pasyente ay nakakahanap na ang kanilang sakit ay bumababa sa napakababang antas sa loob lamang ng dalawang linggo. Gayunpaman, ang buong pag-andar ay nangangailangan ng oras. Maaari kang magsimulang maglakad at lumangoy nang maaga. Ang pagbabalik sa mga sports ay karaniwan, ngunit nag-iiba ang oras ayon sa edad at naunang operasyon. Karaniwang inaasahan mong makapagmamaneho muli sa pagitan ng anim at labindalawang linggo pagkatapos ng iyong prosedimiento.

Kung hindi ito gagamutin, ang rotator cuff tear arthropathy ay madalas na nagdudulot ng patuloy na sakit at kahinaan. Ang conservative management ay bihirang magbubalik ng buong lakas o alisin ang sakit. Ang operasyon ay nag-aalok ng pinakamahusay na pagkakataon para sa makabuluhang pagbabago sa pag-andar. Isang pagtaas ng siyam na puntos sa iyong shoulder score ay nagmamarka ng klinikal na mahalagang pagbabago. Isang pagtaas ng dalawampu't tatlong puntos ay nagpapahiwatig ng substansyal na benepisyo sa iyong pang-araw-araw na buhay.

Ang mga mas batang pasyente, lalo na ang mga nasa ilalim ng animnapung taong gulang, ay may mas mataas na rates ng komplikasyon sa unang siyamnapung araw. Ang instability ay isang karaniwang dahilan para sa revision sa mga pasyenteng nasa ilalim ng limampung limang taong gulang. Sa kabila ng mga panganib na ito, ang reverse shoulder replacement ay nananatiling versatile na opsyon para sa pagpapanumbalik ng pag-andar kapag ang ibang mga gamutan ay nabigo. Ang iyong surgeon ay iuukol ang plano sa iyong partikular na anatomiya at mga layunin.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit sa balikat na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung napapansin mo ang bagong kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakasara o pagbagsak. Maaaring makagambala ang mga sintomas na ito sa pagtulog o trabaho. Biglaang paglala ng sakit o pagkawala ng kakayahan ay maaaring magpahiwatig ng komplikasyon, tulad ng fracture o impeksyon. Mahalaga ito lalo na kung mayroon kang naging operasyon sa loob ng nakaraang dalawang taon. Ang bagong sakit sa base ng scapula o pagkapagod sa paligid ng buto ay dapat magdulot ng pagdududa sa stress reaction. Huwag balewalain ang mga senyales na ito. Ang maagang pagsusuri ay tumutulong upang maprotektahan ang iyong kasukasuan at matiyak na makakakuha ka ng angkop na paggamot nang mabilis.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Patients with irreparable massive rotator cuff tears without osteoarthritis have a high likelihood of achieving a painless shoulder and functional improvements after reverse shoulder arthroplasty [1].
Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [2].
Subacromial balloon spacers for massive rotator cuff tears demonstrate clinically relevant improvements in shoulder range of motion and substantial improvements in patient-reported outcome measures in the short term [3].
Arthroscopic repairs of chronic, massive rotator cuff tears, whether complete or partial, are associated with significant improvements in pain, function, and objective outcome scores with a low rate of re-tear [5].
Differences in postoperative patient-reported outcomes and improvement from baseline show a trend toward lower outcomes in patients with prior rotator cuff repair undergoing reverse shoulder arthroplasty, but these differences may be below the minimal clinically important difference [7].
Superior capsular reconstruction serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion irrespective of tissue source [8].
For patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis, graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains [10].
Nonarthroplasty treatment options for irreparable rotator cuff tears result in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty [14].
Anatomic total shoulder arthroplasty displays equal functional results and postoperative complications compared to reverse total shoulder arthroplasty in patients over 70 without a full-thickness rotator cuff tear [17].
Higher revision rates were identified following anatomic total shoulder arthroplasty compared to reverse total shoulder arthroplasty in patients over 70 without a full-thickness rotator cuff tear, although this finding is within retrospective studies [17].
Complications for primary reverse shoulder arthroplasty using augmented baseplates are within an acceptable range, with a low rate of revision [18].
Patients undergoing reverse total shoulder arthroplasty for glenohumeral osteoarthritis, cuff tear arthropathy, or massive rotator cuff tear are generally satisfied with their procedure [24].
The rate of satisfaction is highest in patients undergoing reverse total shoulder arthroplasty for glenohumeral osteoarthritis [24].

Anatomy & Pathophysiology

Reverse total shoulder arthroplasty (RTSA) is indicated for patients with irreparable massive rotator cuff tears who do not have osteoarthritis [1].
RTSA is indicated for patients with rotator cuff arthropathy (RCA) [40].
RTSA yields slightly lower shoulder function, range of motion, and a higher dislocation-related revision risk compared to its use for proximal humerus fractures (PHF) [40].
RTSA results in an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation compared to asymptomatic shoulders [30].
RTSA is associated with no significant deterioration in shoulder function and outcome scores between 5 and 20 years of follow-up [15].
Shoulder scores may decline at mid- to long-term follow-up for patients with large and massive irreparable rotator cuff tears treated with soft tissue reconstruction techniques [4].
Soft tissue reconstruction for irreparable anterosuperior rotator cuff tears is associated with improved clinical outcomes [19].
For patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis, graft interposition repair, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains [10].
Subacromial balloon spacers resist superior humeral head migration and reduce subacromial pressure in cadaveric studies [36].
Subacromial balloon spacer implantation results in improved shoulder function and decreased pain at 24 months post-procedure [44].
The majority of painful complications after RTSA, including instability, fractures, and infection, can be successfully treated to maintain a functional implant [20].
There are no differences in abduction, internal rotation, or external rotation strength after RTSA with or without subscapularis repair [37].
There appears to be a trend suggesting improved postoperative clinical outcomes and active range of motion for patients with a subscapularis repair versus without a repair after primary RTSA [45].
Studies analyzing the impact of subscapularis repair on internal rotation following RTSA report conflicting results [41].
Measures and reporting of shoulder internal rotation after RTSA vary widely, making it difficult to assess associations between postoperative internal rotation limitation and functional abilities [38].
The anterosuperior approach for RTSA offers better forward flexion, while the deltopectoral approach is associated with a lower glenoid loosening rate [35].
Changes in humeral stem inclination in RTSA are accompanied by less scapular notching and dislocations, with no clear impact on functional outcome measures [32].

Classification

Reverse shoulder arthroplasty is indicated for patients with irreparable massive rotator cuff tears without the presence of osteoarthritis [1].
Reverse shoulder arthroplasty provides optimal outcomes with low complication rates for glenohumeral osteoarthritis with an intact rotator cuff [2].
Subacromial balloon spacer implantation is an alternative for patients with massive irreparable rotator cuff tears [3].
Primary arthroscopic repair is a treatment option for massive rotator cuff tears [5].
Osteoporosis is a risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Rheumatoid arthritis is a risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Female sex is a risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Rotator cuff arthropathy is a risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Graft interposition repair techniques are a treatment option for patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis [10].
Superior capsular reconstruction using the long head of the biceps tendon is a treatment option for patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis [10].
Arthroscopic debridement is a treatment option for patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis [10].
Balloon arthroplasty is a treatment option for patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis [10].
Inflammatory arthritis is a risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Female gender is a risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Previous rotator cuff repair is a risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Reverse total shoulder arthroplasty may be required to recover a functional shoulder in cases of complications or revision [12].
Patients with previous rotator cuff repair undergoing reverse shoulder arthroplasty have worse postoperative functional scores and pain scores than those without prior repair [13].
Nonarthroplasty options for massive, irreparable rotator cuff tears include treatments that result in improvements in range of motion and patient-reported outcomes at short-term follow-up [14].
Anatomic total shoulder arthroplasty is a treatment option for patients aged over 70 without a full-thickness rotator cuff tear [17].
Reverse total shoulder arthroplasty is a treatment option for patients aged over 70 without a full-thickness rotator cuff tear [17].
Failed rotator cuff repair prior to reverse shoulder arthroplasty is associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary reverse shoulder arthroplasty without prior rotator cuff repair [21].
Subscapularis repair techniques are relevant for reverse total shoulder arthroplasty [22].
The humeral neck-shaft angle is an important variable in choosing the reverse shoulder arthroplasty implant design for patients with rotator cuff arthropathy [42].
Bridging grafts are a treatment option for large to massive rotator cuff tears [43].

Clinical Presentation

Shoulder scores may decline at mid- to long-term follow-up for interventions such as superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement, or balloon spacers for large and massive irreparable rotator cuff tears [4].
Arthroscopic repairs of chronic, massive rotator cuff tears, whether complete or partial, are associated with significant improvements in pain, function, and objective outcome scores [5].
Osteoporosis is a commonly cited risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Rheumatoid arthritis is a commonly cited risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Female sex is a commonly cited risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Rotator cuff arthropathy is a commonly cited risk factor for acromial stress fractures following reverse total shoulder arthroplasty [6].
Differences in postoperative patient-reported outcomes and improvement from baseline demonstrate a trend toward lower outcomes in patients with prior rotator cuff repair undergoing reverse shoulder arthroplasty, but these differences may be below the minimal clinically important difference [7].
Superior capsule reconstruction serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion irrespective of tissue source [8].
Better evidence from reports with greater detail is necessary to show that patients are realizing progressively better outcomes from shoulder arthroplasty [9].
Osteoporosis is an identified risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Inflammatory arthritis is an identified risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Female gender is an identified risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Previous rotator cuff repair is an identified risk factor for acromial and scapular fractures following reverse shoulder arthroplasty [11].
Although patients may require multiple procedures, it is often possible to conserve or replace the reverse total shoulder arthroplasty to recover a functional shoulder [12].
Patients with prior rotator cuff repair undergoing reverse shoulder arthroplasty have worse postoperative functional scores and pain scores than those without prior repair [13].
Shoulder function and outcome scores showed no significant deterioration between 5 and 20 years of follow-up for reverse total shoulder arthroplasty in patients with rotator cuff dysfunction [15].
The presence of os acromiale does not appear to have a negative impact on the clinical outcomes after reverse total shoulder arthroplasty [16].
Reverse total shoulder arthroplasty remains a safe and effective treatment option for patients with os acromiale [16].
The majority of painful complications after reverse shoulder arthroplasty, including instability, fractures, and infection, can be successfully treated to maintain a functional implant [20].
Reverse total shoulder arthroplasty can provide reliable improvement in clinical outcomes regardless of preoperative diagnosis, with few differences across diagnostic groups regarding preoperative to postoperative improvement [26].
Patients undergoing primary reverse shoulder arthroplasty demonstrated clinically significant improvements in both range of motion and clinical outcome scores [27].
Arthroscopic debridement with a combination of subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy produces good functional outcomes and improvement in pain at mid to long term follow up for the low-demand population greater than 65 years of age looking for pain relief over substantial increase in function [28].
Tuberosity healing may be a major contributing factor to the difference in clinical outcomes between elective indications and acute 3- and 4-part proximal humeral fractures treated with reverse total shoulder arthroplasty [34].

Investigations

Reverse total shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [2].
The most commonly cited risk factors for acromial stress fractures following reverse total shoulder arthroplasty include osteoporosis, rheumatoid arthritis, female sex, and rotator cuff arthropathy [6].
Other risk factors for acromial and scapular fractures following reverse shoulder arthroplasty include osteoporosis, inflammatory arthritis, female gender, and previous rotator cuff repair [11].

Treatment

Reverse Shoulder Arthroplasty (rTSA)

Reverse shoulder arthroplasty provides a high likelihood of achieving a painless shoulder and functional improvements in patients with irreparable massive rotator cuff tears who do not have osteoarthritis [1].
Reverse shoulder arthroplasty provides optimal outcomes with low complication rates in the short term for glenohumeral osteoarthritis with an intact rotator cuff [2].
Patients undergoing reverse total shoulder arthroplasty for glenohumeral osteoarthritis, cuff tear arthropathy, or massive rotator cuff tear are generally satisfied with their procedure, with satisfaction rates being highest in glenohumeral osteoarthritis [24].
Differences in postoperative patient-reported outcomes and improvement from baseline show a trend toward lower outcomes in patients with prior rotator cuff repair, but these differences may be below the minimal clinically important difference [7].
The presence of os acromiale does not appear to have a negative impact on clinical outcomes after reverse total shoulder arthroplasty, which remains a safe and effective treatment option [16].

Non-Arthroplasty Options for Massive Irreparable Rotator Cuff Tears

Subacromial balloon spacer implantation for massive irreparable rotator cuff tears demonstrates clinically relevant improvements in shoulder range of motion and substantial improvements in patient-reported outcome measures in the short term [3].
Subacromial balloon spacer implantation achieves satisfactory clinical outcomes in the short and middle term (between 3 months and 3 years) for massive irreparable rotator cuff tears [31].
Placement of the subacromial balloon spacer is a minimally invasive, technically simple procedure associated with favorable patient-reported outcomes at limited short-term follow-up [33].
Patients undergoing subacromial spacer implantation for massive irreparable rotator cuff tears have satisfactory outcomes at 2- to 3-year follow-up with a low rate of complications [23].
All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year or more, with low rates of revision and conversion to arthroplasty [14].
Arthroscopic debridement with subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy produces good functional outcomes and improvement in pain at mid to long term follow-up for low-demand patients greater than 65 years of age seeking pain relief over substantial increase in function [28].
Primary arthroscopic repair of massive rotator cuff tears results in significant improvements with a low rate of re-tear [5].
Superior capsular reconstruction serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion [8].
Superior capsular reconstruction is associated with significantly improved functional outcome scores and preserved or increased mean acromiohumeral distance [46].

Proximal Humerus Fractures (Elderly Population)

Reverse shoulder arthroplasty is a better option than hemiarthroplasty for proximal humerus fractures in the elderly [39].
Clinical decision for reverse shoulder arthroplasty in proximal humerus fractures should be preferred on the condition that the patient's medical conditions are indicated [39].
Consideration may be given to an initial trial of nonoperative treatment for acute proximal humeral fractures in the elderly, saving reverse total shoulder arthroplasty for those in whom nonoperative treatment fails without compromising the ultimate outcome [47].

Complications

Complications are within an acceptable range for primary reverse shoulder arthroplasty using augmented baseplates, with a low rate of revision [18].
Complications do not appear to be appreciably higher in the reverse shoulder arthroplasty group compared to other treatments for proximal humeral fractures in older adults in existing follow-up [51].
Shoulder scores may decline at mid- to long-term follow-up for treatments including superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement, or balloon spacers for large and massive irreparable rotator cuff tears [4].
Patients undergoing subacromial spacer implantation for massive irreparable rotator cuff tears have a low rate of complications at 2- to 3-year follow-up [23].
Anatomic total shoulder arthroplasty displayed equal postoperative complications compared to reverse total shoulder arthroplasty in patients over 70 without a full-thickness rotator cuff tear [17].
Failed rotator cuff repair prior to reverse shoulder arthroplasty was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary reverse shoulder arthroplasty without prior rotator cuff repair [21].
Further long-term studies are needed to assess the durability of stemless versus stemmed reverse total shoulder arthroplasty as primary treatment in the elderly [25].

Recovery

Shoulder scores may decline at mid- to long-term follow-up for procedures such as superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement, or balloon spacers for large and massive irreparable rotator cuff tears [4].
Differences in postoperative patient-reported outcomes and improvement from baseline demonstrate a trend toward lower outcomes in patients with prior rotator cuff repair, but these differences may be below the minimal clinically important difference [7].
Irrespective of tissue source, superior capsular reconstruction serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion [8].
There was no radiological evidence of humeral loosening at the latest follow-up for stemless reverse total shoulder arthroplasty in short- and mid-term results [29].
Although early results for arthroscopic superior capsular reconstruction are promising, further studies are necessary to determine the long-term success of this technique and to better delineate the clinical indications, survivorship, and risk factors for failure [52].

Key Evidence

[L1] Patients with irreparable massive rotator cuff tears without presence of osteoarthritis have a high likelihood of achieving a painless shoulder and functional improvements after reverse shoulder arthroplasty. [1] (10.1016/j.jse.2017.03.039)
[L4] Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff. [2] (10.1016/j.jse.2021.06.010)
[L4] The short-term results of subacromial balloon spacers for management of massive rotator cuff tears demonstrate clinically relevant improvements in shoulder range of motion and substantial improvements in patient-reported outcome measures. [3] (10.1016/j.arthro.2023.05.028)
[L1] Shoulder scores may decline at mid- to long-term follow-up. [4] (10.1186/s13018-022-03411-y)
[L2] Arthroscopic repairs of chronic, massive RCTs, whether complete or partial, are associated with significant improvements in pain, function and objective outcome scores. [5] (10.1007/s00167-020-06190-3)
[L4] The most commonly cited risk factors for ASFs following rTSA include osteoporosis, rheumatoid arthritis, female sex, and rotator cuff arthropathy. [6] (10.1016/j.jse.2025.02.032)
[L4] Differences in postoperative patient-reported outcomes and improvement from baseline demonstrate a trend toward lower outcomes in patients with prior rotator cuff repair, but these differences may be below the minimal clinically important difference. [7] (10.1177/17585732241268712)
[L1] Irrespective of tissue source, SCR serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion. [8] (10.1016/j.asmr.2020.09.002)
[L2] Better evidence from reports with greater detail will be necessary to show that patients are realizing progressively better outcomes from shoulder arthroplasty. [9] (10.1007/s00264-017-3443-0)
[L3] For patients younger than 70 years with massive irreparable rotator cuff tears without significant arthritis or pseudoparalysis, graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains. [10] (10.1177/03635465231204623)
[L1] Other risk factors identified included osteoporosis, inflammatory arthritis, female gender, and previous rotator cuff repair. [11] (10.1016/j.xrrt.2025.08.015)
[L4] Although patients may require multiple procedures, it is often possible to conserve or replace the RTSA to recover a functional shoulder. [12] (10.1016/j.otsr.2015.06.031)
[L1] Patients with prior rotator cuff repair undergoing reverse shoulder arthroplasty have worse postoperative functional scores and pain scores than those without prior repair. [13] (10.1016/j.xrrt.2023.01.006)
[L4] All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. [14] (10.1007/s00167-022-07099-9)
[L1] Shoulder function and outcome scores also showed no significant deterioration between 5 and 20 years of follow-up. [15] (10.1016/j.jse.2018.10.005)
[L4] The presence of os acromiale does not appear to have a negative impact on the clinical outcomes after surgery and rTSA remains a safe and effective treatment option. [16] (10.1016/j.xrrt.2025.01.002)
[L1] Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. [17] (10.1177/24715492231206685)
[L4] Complications are within an acceptable range for primary reverse shoulder arthroplasty, with a low rate of revision. [18] (10.1016/j.xrrt.2022.08.008)
[Paper] Soft tissue reconstruction for irreparable AS rotator cuff tears is associated with improved clinical outcomes. [19] (10.1177/17585732261431826)
[L4] The majority of painful complications after reverse shoulder arthroplasty, including instability, fractures, and infection, can be successfully treated to maintain a functional implant. [20] (10.1177/1758573217702333)
[L1] Failed rotator cuff repair prior to reverse shoulder arthroplasty was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary reverse shoulder arthroplasty without prior rotator cuff repair. [21] (10.1177/17585732231194785)
[L3] This information can help guide future studies in this area and highlights the need for high quality studies comparing different subscapularis repair techniques. [22] (10.1016/j.jisako.2022.05.001)
[L1] Patients undergoing subacromial spacer implantation for the treatment of massive irreparable rotator cuff tears have satisfactory outcomes at the 2- to 3-year follow-up with a low rate of complications. [23] (10.1016/j.arthro.2018.08.006)
[L4] This systematic review demonstrated that patients who undergo rTSA for either GHOA, cuff tear arthropathy, or massive rotator cuff tear are generally satisfied with their procedure, with the rate of satisfaction highest in GHOA. [24] (10.1016/j.jse.2024.03.036)
[L1] Further long-term studies are needed to assess durability. [25] (10.1177/17585732251388447)
[L4] Reverse total shoulder arthroplasty can provide reliable improvement in clinical outcomes regardless of preoperative diagnosis, with few differences across diagnostic groups regarding preoperative to postoperative improvement. [26] (10.1016/j.jse.2020.10.003)
[L1] Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores. [27] (10.1016/j.jse.2022.06.005)
[L1] Arthroscopic debridement with a combination of subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy produces good functional outcomes and improvement in pain at mid to long term follow up for the low-demand population greater than 65 years of age looking for pain relief over substantial increase in function. [28] (10.1016/j.xrrt.2021.08.012)
[L1] There was no radiological evidence of humeral loosening at the latest follow-up. [29] (10.1177/17585732211013356)
[L1] There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following TSA compared to asymptomatic shoulders. [30] (10.1016/j.jse.2025.08.010)
[L1] Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. [31] (10.1007/s00167-019-05834-3)
[L1] This change in range of motion is accompanied by less scapular notching and dislocations, with no clear impact on functional outcome measures. [32] (10.1016/j.xrrt.2021.02.002)
[L4] Placement of the subacromial balloon spacer is a minimally invasive, technically simple procedure with favorable patient-reported outcomes at limited short-term follow-up. [33] (10.1177/2325967119875717)
[L1] Tuberosity healing may be a major contributing factor to the difference in clinical outcomes. [34] (10.1016/j.jse.2021.07.014)
[L1] One of the two approaches did not bring a better result than the other; one has strength for better forward flexion and the other for a lower glenoid loosening rate. [35] (10.1186/s13018-022-03414-9)
[L1] In cadaveric studies, subacromial balloon spacers resist superior humeral head migration and reduce subacromial pressure. [36] (10.1016/j.asmr.2020.06.011)
[L4] There were no differences in abduction, internal rotation, or external rotation strength after rTSA with or without subscapularis repair. [37] (10.1016/j.xrrt.2021.11.004)
[L4] Measures and reporting of shoulder internal rotation after reverse total shoulder arthroplasty varied widely, making it difficult to assess associations between postoperative internal rotation limitation and functional abilities. [38] (10.1016/j.jses.2019.10.109)
[L1] Clinical decision should be preferred to RSA on the condition that patients ' medical conditions are indicated. [39] (10.1007/s00264-015-2811-x)
[L2] RTSA for PHF yields slightly lower shoulder function, range of motion, and a higher dislocation-related revision risk compared with RCA; though, absolute differences were modest. [40] (10.1016/j.xrrt.2026.100691)
[L4] Studies that analyzed the impact of subscapularis repair reported conflicting results. [41] (10.1016/j.jse.2023.10.006)
[L2] The HNSA represents an important variable in choosing the RSA implant design for patients with rotator cuff arthropathy. [42] (10.3390/jcm11133641)
[L4] Bridging grafts may be considered for this difficult patient population with large to massive rotator cuff tears. [43] (10.1016/j.arthro.2016.08.030)
[L1] Despite overall fair MCMS scores, at 24‐m post‐SBSI, shoulder function improved and pain decreased. [44] (10.1002/ksa.12331)
[L1] However, there appears to be a trend suggesting improved postoperative clinical outcomes and active range of motion for patients with a subscapularis repair vs. without a repair. [45] (10.1016/j.xrrt.2022.01.003)
[L1] This review demonstrates that SCR is a useful treatment modality for patients with irreparable rotator cuff tears, associated with significantly improved functional outcome scores and preserved or increased mean AHD. [46] (10.1016/j.otsr.2019.07.022)
[L1] Given the risks associated with surgery in the elderly population, consideration may be given to an initial trial of nonoperative treatment in these patients, saving RTSA for those in whom nonoperative treatment fails without compromising the ultimate outcome. [47] (10.1016/j.jse.2018.10.004)
[L4] Complications do not appear to be appreciably higher in the RSA group in the existing follow-up. [51] (10.1016/j.jse.2013.08.021)
[L1] Although early results are promising, further studies are necessary to determine the long-term success of this technique and to better delineate the clinical indications, survivorship, and risk factors for failure in this population. [52] (10.1016/j.arthro.2018.09.033)

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