袖状关节病

Patients › Shoulder

Rotator cuff arthropathy: shoulder arthritis following a long-standing, massive rotator cuff tear and its impact on function.

Updated Jun 2026

一幅手绘插图，描绘了一位年长的无面人物因肩部疼痛而难以将手臂向侧面抬起。 — 肩袖关节病：长期肩袖撕裂后发生的关节炎。 Kieran Hirpara 4.0

您的感受

您可能会感到肩部疼痛，在抬臂或伸手过头时疼痛加重。这种情况涉及肩关节的退行性关节炎合并肩袖撕裂。由于袖带肌肉无法稳定关节，您的上臂骨顶部可能会向上移位。这种运动会引起摩擦、僵硬和酸痛。疼痛常在夜间发作，导致难以侧卧睡眠。您可能还会注意到在日常活动后或早晨醒来时不适感加重。

简单的任务可能会变得困难或无法完成。您可能难以伸手到背后扣上胸罩或塞好衬衫。提举物体时感觉沉重且不稳定。您的肩部可能感觉无力，并且为了避免疼痛而避免使用该部位。这种功能下降是因为撕裂的袖带不再能够支持正常运动。随着时间的推移，关节炎进展，导致活动度和力量进一步丧失。

如果您尚未接受手术，您的外科医生可能会首先推荐非手术治疗，特别是如果您的病情属于中度或轻度。这些选项旨在减轻疼痛并改善功能。然而，如果您的关节炎严重，则可能需要进行手术。对于许多肩袖完整的患者，解剖型全肩关节置换术是首选且成本较低的选择。在最初几年内，它提供的益处与反式肩关节置换术相似。

如果您的肩袖撕裂，可能会推荐反式全肩关节置换术。这种手术对于这种特定类型的关节炎变得越来越普遍。它为大多数患者提供了显著的临床益处。事实上，超过 90% 因关节炎（肩袖完整）接受该手术的患者报告有显著改善。即使肩袖撕裂，许多患者也在日常功能方面经历了具有临床意义的改变。您的外科医生将帮助您决定哪种方法最适合您的具体解剖结构和疼痛程度。

实际发生了什么

您的肩关节是一个球窝关节。球部是您的上臂骨（肱骨）的顶端。窝部位于您的肩胛骨上。光滑的软骨覆盖着这两个表面。它起到减震器的作用，使骨骼能够顺畅滑动。

在肩袖关节病中，这一系统发生退变。您可能患有磨损性关节炎。这意味着软骨已经磨损。同时，肩袖肌腱撕裂或受损。这些肌腱就像将肱骨头固定在关节盂中的绳索。失去这些肌腱的约束后，肱骨头会位置过高。它会与肩胛骨发生摩擦。这会导致疼痛并限制您的活动范围。

您的身体会尝试进行代偿。肩胛骨以复杂的方式运动，以帮助您抬起手臂。甚至在您开始抬臂之前，肩胛骨就会进行反向旋转。这改变了您肩关节的正常运动节律。肩胛骨承担了超出其正常范围的工作。这种额外的运动随着时间的推移可能导致进一步的磨损。

肌肉健康也起着关键作用。脂肪可能积聚在肩袖肌肉内部。这种脂肪浸润会削弱肌肉力量。即使肌腱仍然附着，肌肉力量也会下降。这种不平衡使关节稳定性降低。它还会影响您对手臂在空间中位置的本体感觉。

您的外科医生会评估这些变化以制定治疗方案。他们可能会使用一种称为腋位（axillary view）的X线投照体位。这能清晰地显示关节解剖结构。与CT扫描相比，它使用的辐射剂量更少。它有助于您的外科医生观察骨骼的移位情况。

了解这种损伤有助于解释您的症状。疼痛源于骨与骨之间的摩擦。无力源于受损的肌腱和肌肉。僵硬源于身体试图稳定关节的努力。了解病理机制使您的外科医生能够选择合适的治疗方案。这可能涉及置换关节表面以恢复平滑的运动。

我们能做什么

我们从自我护理和物理治疗开始。非手术疗法是大多数患者的第一步，尤其是那些患有轻中度疾病的患者。您的物理治疗师将指导您进行锻炼，以维持活动度并增强肩部周围肌肉的力量。这种方法有助于大多数患者管理如肩锁关节问题等疾病引起的疼痛。如果您患有骨质溶解，可能需要调整某些活动以避免进一步刺激。在考虑更具侵入性的选项之前，请给这种保守治疗一个公平的机会。

如果简单措施不够，我们会考虑药物治疗。对于患有肩袖关节病且年龄 60 岁及以上的患者，我们可以提供肩峰下球囊间隔物。这涉及将一个小球囊经皮插入肩关节上方的空间。该手术可显著减轻疼痛。然而，在至少 1 年的随访中，它并未改善功能。肩峰下间隔物可能为患有巨大不可修复肩袖撕裂的患者提供一种安全、有效且具有成本效益的选择。我们还考虑使用止痛药和抗炎药，以帮助您在愈合或恢复力量期间管理症状。

当保守治疗达到极限时，会考虑手术。如果您的疼痛仍然严重或功能受到显著限制，我们会讨论关节置换术（关节成形术）。解剖型和反式全肩关节置换术的选择取决于您的肩袖健康状况和关节骨的状态。对于肩袖完整的关节炎患者，解剖型全肩关节置换术仍然是首选方法。反式全肩关节置换术在涉及肩袖撕裂或特定骨畸形的病例中很受欢迎。超过 90% 因肩胛盂肱骨关节炎接受反式肩关节置换术且肩袖完整的患者经历了显著的临床获益。您的外科医生将根据您的解剖结构和目标选择最合适的方案。

预期情况

您的预后主要取决于肩袖是否完整或撕裂。如果肩袖健康，解剖型和反式关节置换在四年时的疗效相似。超过 90% 的肩袖完整患者会获得显著的临床获益。您可以预期疼痛明显缓解，功能得到改善。

如果肩袖撕裂，反式肩关节置换仍是首选方案。它在短期内能提供最佳疗效，且并发症发生率低。大多数患者早期即可看到显著的改善。然而，您应注意，与解剖型置换相比，内旋和外旋功能可能略低。您的外科医生将权衡这些因素，为您选择最佳的治疗方案。

康复是一个渐进的过程。您的肩关节评分至少需提高 9 分，才能感受到具有临床意义的变化。评分提高 23 分则标志着显著的获益。这些改善通常在数月内趋于稳定。长期成功率很高，桥接重建术在七年时的假体存活率为 98%。

若不进行治疗，疼痛和僵硬往往会持续或加重。放任病情发展很少能带来自发改善。您可能会发现日常活动越来越困难。手术干预为恢复功能和减轻疼痛提供了明确的路径。

请注意，既往的肩关节手术会增加风险。既往有肩袖修补史会增加置换术后感染的风险。在这些情况下，您的外科医生会将您视为高风险患者。精心规划对于确保安全和成功的手术结果至关重要。

何时就医

若肩部疼痛持续且休息后无改善，请咨询全科医生。若出现无力、不稳定感或锁定感及关节错动感，请要求专科医生评估。这些症状可能提示肩袖撕裂性关节病，该病涉及磨损性关节炎及肩部稳定肌群的损伤。若症状影响睡眠或工作，请及时就医。疼痛或功能突然加重也是咨询外科医生的指征。早期评估有助于确定非手术治疗是否足够，或是否需要手术。

Evidence & references

Overview

Reverse total shoulder arthroplasty (RTSA) utilization has increased due to more RTSAs performed for rotator cuff tear arthropathy and expanding surgical indications for RTSA [1].
Primary anatomic total shoulder arthroplasty (aTSA) and rTSA patients with osteoarthritis and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty experience a clinically important change with at least a nine-point improvement in their American Shoulder and Elbow Surgeons (ASES) score [3].
Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty experience a substantial clinical benefit with at least a 23-point improvement in their ASES score [3].
There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, total shoulder arthroplasty (TSA) is favored to hemiarthroplasty (HA) in terms of clinical outcome, risk of revision surgery, and postoperative complications [6].
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 [7].
In patients with rotator cuff-intact glenohumeral osteoarthritis with no bone loss, treatment with reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction [9].
Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis [10].
More studies critically analyzing the value of health-care expenditures are needed in shoulder arthroplasty [10].
Over 90% of patients who underwent reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff experienced substantial clinical benefit [15].
Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes [17].
Reverse total shoulder arthroplasty is popular for indications beyond rotator cuff-tear arthropathy despite concerns regarding high complication rates and limited implant longevity [28].
The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is recommended for continued use in shoulder arthroplasty registries and observational studies [30].

Anatomy & Pathophysiology

Scapulothoracic motion is more complex in patients with rotator cuff arthropathy than previously reported, featuring a dynamically changing scapulohumeral rhythm [5].
Patients with rotator cuff arthropathy exhibit counter-directed scapular rotation before clinically visible arm elevation [5].
The scapulothoracic contribution to overall shoulder movement is significantly increased in patients with reverse total shoulder arthroplasty compared with a healthy shoulder [34].
Scapular kinematics in patients with shoulder arthroplasty are influenced by the implementation of external loads, but not by the type of load [33].
MR imaging-derived rotator cuff muscle proton density fat-fraction is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes [31].
Imbalance in axial-plane rotator cuff fatty infiltration occurs in posteriorly worn glenoids in primary glenohumeral osteoarthritis [44].
These imbalances in fatty infiltration may contribute to higher rates of failure after anatomic total shoulder arthroplasty in patients with posterior wear compared with those with concentric wear [44].
Performing shoulder arthroplasty did not positively affect the component of proprioception evaluated by the active angle-reproduction test [47].
The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan [45].
The medial margin of the scapula demonstrated the best intraobserver and interobserver reliability for assessing glenoid component inclination compared with other landmarks when the scapula is tilted [48].

Classification

Rotator cuff tear arthropathy is characterized by rotator cuff insufficiency [22].
Rotator cuff tear arthropathy involves degenerative changes of the glenohumeral joint [22].
Rotator cuff tear arthropathy is associated with superior migration of the humeral head [22].
Rotator cuff tear arthropathy represents a spectrum of shoulder pathology [22].
Scapulothoracic motion in patients with rotator cuff arthropathy is more complex than previously reported [5].
Patients with rotator cuff arthropathy exhibit a dynamically changing scapulohumeral rhythm [5].
Patients with rotator cuff arthropathy demonstrate counter-directed scapular rotation before clinically visible arm elevation [5].

Clinical Presentation

Rotator cuff tear arthropathy is characterized by rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head [22].
Scapulothoracic motion in patients with rotator cuff arthropathy involves a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation [5].
Rotator cuff repairs fail at an alarmingly high rate during long-term follow-up, particularly in cases with advanced fatty infiltration, atrophy, and large-to-massive tear size [26].
Rotator cuff repair failure leads to functional deterioration and progression of glenohumeral arthritis [26].
Osteoarthritis patients undergo contralateral shoulder arthroplasty sooner than cuff tear arthropathy patients [11].
Osteoarthritis patients with radiographic changes on the contralateral shoulder prior to the first surgery undergo contralateral arthroplasty sooner than those without such changes [11].
Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly for patients with moderate-to-mild disease [27].
Surgical treatments like arthroplasty are considered effective for severe cases of shoulder osteoarthritis [27].
The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider based on clinical presentations and anatomic pathologies [14].
There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis [10].
There is a need for standardization of outcome assessment following treatment of shoulder arthritis [16].

Investigations

Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff had similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
Scapulothoracic motion is more complex in patients with rotator cuff arthropathy, featuring a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation [5].
Arthroscopy is a powerful tool in the management of painful total shoulder arthroplasty and should be considered when evaluating cases with no clear cause of pain [8].
In patients with rotator cuff-intact glenohumeral osteoarthritis and no bone loss, reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction [9].
Osteoarthritis patients had their contralateral shoulder arthroplasty sooner than cuff tear arthropathy patients [11].
Osteoarthritis patients with radiographic changes on the contralateral shoulder prior to the first surgery had their contralateral arthroplasty sooner than those without [11].
The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider based on clinical presentations and anatomic pathologies [14].
Over 90% of patients who underwent reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff experienced substantial clinical benefit [15].
There is a need for standardization of outcome assessment following treatment of shoulder arthritis [16].
Reverse total shoulder arthroplasty should be considered for glenohumeral osteoarthritis when rotator cuff dysfunction, glenoid bone deformity, or preoperative stiffness are present [18].
Preventive arthroscopic distal clavicle resection in patients with rotator cuff tears and concomitant asymptomatic radiological acromioclavicular joint arthritis did not result in better clinical or structural outcomes and led to symptomatic acromioclavicular joint instability in some patients [20].
MR imaging-derived rotator cuff muscle proton density fat-fraction is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes [31].
Biologic resurfacing of the arthritic glenohumeral joint is reviewed for historical basis and current applications in young, active individuals with glenohumeral arthritis [32].
Computed tomography underestimates the infraspinatus area compared with MRI, but the difference is less than 1 cm² and likely clinically insignificant [41].
Reverse total shoulder arthroplasty performed in patients with glenohumeral osteoarthritis and an intact rotator cuff is associated with improved functional and clinical outcomes compared with patients treated for cuff tear arthropathy [49].
A semi-automated quantitative CT method allows for quantitatively and reproducibly measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis [53].
Performing selective MRI to assess rotator cuff integrity to indicate reverse or anatomic total shoulder arthroplasty is cost-effective if surgical preparedness, patient expectations, and implant availability preclude the ability to switch implants intraoperatively [54].
Early results for glenoid bone grafting with a reverse design prosthesis are encouraging, but further clinical and radiologic assessment is necessary [57].

Treatment

Non-Operative Management

Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly in patients with moderate-to-mild disease [27].
Nonoperative treatment is helpful for most patients with painful conditions of the acromioclavicular joint, although those with osteolysis may need to modify their activities [52].
Percutaneous insertion of a subacromial balloon spacer results in a significant reduction of pain in patients aged 60 years and older with rotator cuff arthropathy [38].
Percutaneous insertion of a subacromial balloon spacer does not improve function in patients aged 60 years and older with rotator cuff arthropathy at a minimum 1-year follow-up [38].
The subacromial spacer is likely to provide a safe, effective, and cost-effective option for patients with massive irreparable rotator cuff tears based on available evidence and conservative assumptions [39].

Surgical Management: Arthroplasty Indications and Selection

Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis [10].
More studies critically analyzing the value of health-care expenditures in shoulder arthroplasty are needed [10].
Knowledge of the array of shoulder prostheses currently available, their indications, and the use of treatment algorithms can lead to optimized patient outcomes [17].
The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider based on clinical presentations and anatomic pathologies [14].
There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
The increase in reverse total shoulder arthroplasty (RTSA) utilization is due to both an increase in RTSAs performed for rotator cuff tear arthropathy and expanding surgical indications for RTSA [1].
Reverse total shoulder arthroplasty is popular for indications beyond rotator cuff-tear arthropathy despite concerns regarding high complication rates and limited implant longevity [28].
The use of a reverse total shoulder arthroplasty in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture must remain cautious, although patients may perform well at 2 years' follow-up [19].

Surgical Management: Anatomic vs. Reverse Arthroplasty Outcomes

Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
In patients with rotator cuff-intact glenohumeral osteoarthritis with no bone loss, treatment with reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction [9].
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 [7].
At short-term follow-up, preservation of the rotator cuff in reverse shoulder arthroplasty demonstrated similarly excellent outcomes and low complication rates compared with reverse shoulder arthroplasty with a deficient rotator cuff and anatomic total shoulder arthroplasty, except for slightly lower internal and external rotation compared with anatomic total shoulder arthroplasty [12].
Over 90% of patients who underwent reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff experienced substantial clinical benefit [15].
In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, total shoulder arthroplasty is favored to hemiarthroplasty in terms of clinical outcome, risk of revision surgery, and postoperative complications [6].

Surgical Management: Painful Arthroplasty and Adjunct Procedures

Arthroscopy is a powerful tool in the management of the painful total shoulder arthroplasty and should be considered when evaluating cases in which a clear cause of pain is not present [8].
Preventive arthroscopic distal clavicle resection in patients with rotator cuff tears and concomitant asymptomatic radiological acromioclavicular joint arthritis did not result in better clinical or structural outcomes and led to symptomatic acromioclavicular joint instability in some patients [20].

Outcome Assessment

Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their American Shoulder and Elbow Surgeons (ASES) score experience a clinically important change [3].
Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a 23-point improvement in their ASES score experience a substantial clinical benefit [3].
The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis [16].
The authors recommend the continued use of the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) in shoulder arthroplasty registries and observational studies [30].

Complications

Reverse total shoulder arthroplasty (RTSA) in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture requires cautious use [19].
A history of previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty [56].
Patients with a previous rotator cuff repair should be regarded as high-risk patients when considering reverse shoulder arthroplasty [56].

Recovery

Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff have similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short-term follow-up for glenohumeral osteoarthritis with an intact rotator cuff [7].
At short-term follow-up, reverse shoulder arthroplasty with preservation of the rotator cuff demonstrates similarly excellent outcomes and low complication rates compared with reverse shoulder arthroplasty for cuff arthropathy and anatomic total shoulder arthroplasty, except for slightly lower internal and external rotation compared with anatomic total shoulder arthroplasty [12].
Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their American Shoulder and Elbow Surgeons (ASES) score experience a clinically important change [3].
Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a 23-point improvement in their ASES score experience a substantial clinical benefit [3].
Reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients at early follow-up [13].
Outcomes of reverse total shoulder arthroplasty are impacted by both the etiology of shoulder dysfunction and the time since implantation [21].
Bridging reconstruction for large-to-massive rotator cuff tears has a 98% survivorship rate with a low rate of conversion to reverse total shoulder arthroplasty and a low progression of cuff arthropathy at a minimum five-year follow-up with a mean of 7.3 years [24].
Bridging reconstruction for large-to-massive rotator cuff tears has a 98% survivorship rate with a low rate of conversion to reverse total shoulder arthroplasty and a low progression of cuff arthropathy at a minimum five-year follow-up with a mean of 7.3 years [25].
The use of reverse total shoulder arthroplasty in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture must remain cautious, although the patient performed well at 2 years' follow-up [19].
Copeland surface replacement shoulder arthroplasty survival analysis shows no variance from acceptable standards for shoulder replacement for the period of study [59].
Lower surgical volume is associated with higher all-cause revision rates in the early postoperative period in total shoulder arthroplasty and reverse total shoulder arthroplasty for osteoarthritis and throughout the follow-up period in reverse total shoulder arthroplasty for cuff arthropathy [60].

Key Evidence

[L4] This increase is due to both an increase in the number of RTSAs performed for rotator cuff tear arthropathy as well as expanding surgical indications for RTSA. [1] (10.5435/jaaos-d-17-00075)
[L3] At a mean of 41 month follow-up, primary aTSA and rTSA patients with OA and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes. [2] (10.5435/jaaos-d-22-00014)
[L3] Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their ASES score experience a clinically important change, whereas those who have at least a 23-point improvement in their ASES score experience a substantial clinical benefit. [3] (10.1007/s11999-016-4968-z)
[L4] There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff. [4] (10.1177/17585732251319977)
[L3] Scapulothoracic motion is more complex than previously reported, especially in patients with rotator cuff arthropathy, with a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation. [5] (10.1097/corr.0000000000001406)
[L1] In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, TSA is favored to HA in terms of clinical outcome, risk of revision surgery, and postoperative complications. [6] (10.1016/j.jse.2022.07.012)
[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. [7] (10.1016/j.jse.2021.06.010)
[Commentary] Arthroscopy is a powerful tool in the management of the painful total shoulder arthroplasty and should be considered when evaluating cases in which a clear cause of pain is not present. [8] (10.1016/j.arthro.2020.02.031)
[L3] In patients with rotator cuff-intact glenohumeral osteoarthritis with no bone loss, treatment with reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction. [9] (10.1016/j.jse.2025.01.038)
[L5] Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis, and more studies critically analyzing the value of health-care expenditures are needed. [10] (10.2106/jbjs.21.00034)
[L3] Osteoarthritis patients had their contralateral shoulder arthroplasty sooner than cuff tear arthropathy patients, and OA patients with radiographic changes on the contralateral shoulder prior to the first surgery had their contralateral arthroplasty sooner than those without. [11] (10.1016/j.jse.2020.12.023)
[L3] At short-term follow-up, preservation of the rotator cuff in RSA demonstrated similarly excellent outcomes and low complication rates compared with RSA with a deficient rotator cuff and TSA, except for slightly lower internal and external rotation compared with TSA. [12] (10.1016/j.jse.2023.02.005)
[L4] At early follow-up, reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients. [13] (10.1016/j.jhsa.2012.05.015)
[L5] The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, and there are many treatment options to consider when responding to the variety of clinical presentations and anatomic pathologies. [14] (10.1016/j.jse.2023.01.009)
[L3] Over 90% of patients who underwent RSA for GHOA with an intact rotator cuff experienced substantial clinical benefit. [15] (10.1016/j.jse.2024.01.027)
[L1] The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis. [16] (10.1177/1758573215622385)
[L5] Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes. [17] (10.5435/00124635-200907000-00002)
[L4] The article describes conditions under which RSA should be considered for glenohumeral osteoarthritis, specifically when rotator cuff dysfunction, glenoid bone deformity, or preoperative stiffness are present, noting that RSA has shown good results comparable with anatomical TSA in these scenarios. [18] (10.5397/cise.2021.00633)
[L4] Although the patient performed well at 2 years' follow-up, the use of a reverse total shoulder arthroplasty in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture must still remain cautious. [19] (10.1016/j.jse.2011.03.013)
[L1] Preventive arthroscopic DCR in patients with rotator cuff tears and concomitant asymptomatic radiological ACJ arthritis did not result in better clinical or structural outcomes, and it did lead to symptomatic ACJ instability in some patients. [20] (10.1177/0363546514547254)
[L3] The study acknowledges that outcomes are impacted by both the etiology of shoulder dysfunction and the time since implantation. [21] (10.2106/jbjs.16.00223)
[L5] Rotator cuff tear arthropathy is a spectrum of shoulder pathology characterized by rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. [22] (10.5435/00124635-200706000-00003)
[L4] At a minimum 5-year follow-up with a mean of 7.3 years, bridging reconstruction showed a 98% survivorship rate with a low rate of conversion to rTSA and a low progression of cuff arthropathy. [24] (10.1016/j.jisako.2023.03.403)
[L3] At a minimum 5-year follow-up with a mean of 7.3 years, bridging reconstruction showed a 98% survivorship rate with a low rate of conversion to reverse total shoulder arthroplasty and a low progression of cuff arthropathy. [25] (10.1177/2325967123s00074)
[L5] Rotator cuff repairs fail at an alarmingly high rate during long-term follow-up, particularly in cases with advanced fatty infiltration, atrophy, and large-to-massive tear size, leading to functional deterioration and progression of glenohumeral arthritis. [26] (10.1016/j.arthro.2022.04.002)
[L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. [27] (10.1155/2013/370231)
[L5] The paper reviews current concepts, results, and component wear analysis of reverse total shoulder arthroplasty, noting its popularity for indications beyond rotator cuff-tear arthropathy despite concerns regarding high complication rates and limited implant longevity. [28] (10.2106/jbjs.j.00769)
[L4] The authors recommend the continued use of WOOS in shoulder arthroplasty registries and observational studies. [30] (10.1186/s12891-023-06578-5)
[L3] MR imaging–derived RC muscle PDFF is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes. [31] (10.1177/0363546517703086)
[L5] The article reviews the historical basis and current applications of this procedure for young, active individuals with glenohumeral arthritis. [32] (10.1016/j.jse.2007.03.006)
[L4] Scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. [33] (10.1016/j.clinbiomech.2012.04.009)
[L4] The ST contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder. [34] (10.1016/j.jse.2024.12.018)
[L5] Percutaneous insertion of subacromial balloon spacer results in a significant reduction of pain in patients aged 60 years and older with rotator cuff arthropathy but does not improve their function at a minimum 1-year follow-up. [38] (10.1016/j.asmr.2025.101254)
[L2] Based on the available evidence and reasonably conservative assumptions, subacromial spacer is likely to provide a safe, effective, and cost-effective option for patients with massive irreparable rotator cuff tears. [39] (10.1007/s00264-018-4065-x)
[L3] While CT underestimates the infraspinatus area as compared with MRI, the difference is less than 1 cm2 and thus likely clinically insignificant. [41] (10.1016/j.jse.2018.03.015)
[L3] These imbalances may contribute to the higher rates of failure after anatomic total shoulder arthroplasty in patients with posterior wear compared with those with concentric wear. [44] (10.1097/corr.0000000000001798)
[L4] The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan. [45] (10.1007/s11999-013-3327-6)
[L3] Performing shoulder arthroplasty did not positively affect the component of proprioception that was evaluated by the active angle-reproduction test. [47] (10.1007/s00264-008-0666-0)
[L5] The medial margin of the scapula demonstrated the best intraobserver and interobserver reliability for assessing glenoid component inclination compared with other landmarks when the scapula is tilted. [48] (10.1016/j.jse.2015.09.001)
[L3] RTSA performed in patients with GHOA and an intact rotator cuff is associated with improved functional and clinical outcomes compared with those patients treated for CTA. [49] (10.5435/jaaos-d-21-00797)
[L5] Nonoperative treatment is helpful for most patients, although those with osteolysis may have to modify their activities. [52] (10.5435/00124635-199905000-00004)
[L4] This new semi-automated CT method allows to quantitatively and reproducibly measure rotator cuff muscle degeneration in shoulders with primary osteoarthritis. [53] (10.1016/j.otsr.2016.12.006)
[L3] However, performing selective MRI to assess rotator cuff integrity to indicate RSA or TSA is cost-effective if surgical preparedness, patient expectations, and implant availability preclude the ability to switch implants intraoperatively. [54] (10.1097/corr.0000000000002110)
[L3] Patients with previous rotator cuff repair should be regarded as high-risk patients when considering reverse shoulder arthroplasty. [56] (10.1016/j.jse.2022.07.001)
[L4] Early results are encouraging, but further clinical and radiologic assessment is necessary. [57] (10.1016/j.jse.2006.02.002)
[L4] Survival analysis shows no variance from acceptable standards for shoulder replacement for the period of study. [59] (10.1016/j.jse.2005.02.011)
[L3] Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. [60] (10.1016/j.jse.2019.10.026)

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