Chronic

Rotator Cuff Arthropathy

Combination of massive irreparable cuff tear and secondary glenohumeral arthritis. Hamada classification. Reverse replacement.

Rotator cuff arthropathy is the combination of a massive irreparable rotator cuff tear and secondary glenohumeral arthritis resulting from pathological biomechanics. The massive cuff tear (≥ 2 tendons) causes superior migration of the humeral head (loss of the centering function of the rotator cuff), creating a neo-articulation with the acromion (acetabularization). This eccentric loading leads to progressive glenohumeral cartilage destruction. The Hamada classification describes 5 stages based on the acromiohumeral interval and the presence of arthritis. Treatment is mainly surgical in the advanced stages: reverse shoulder replacement (Grammont concept) which allows arm elevation using the deltoid alone.

Characteristics

  • Pseudo-paralytic shoulder: inability to actively raise the arm above 90° despite preserved passive mobility. Pain variably present. Anterior humeral head prominence.
  • Radiographs: superior humeral head migration (acromiohumeral interval < 7 mm), acetabularization of the undersurface of the acromion, glenohumeral joint space narrowing, inferior osteophytes.
  • CT scan + arthro-CT: assessment of glenoid bone stock (crucial for reverse replacement planning). Fatty degeneration of the cuff muscles (irreparability).
  • Hamada classification: stage 1 (AHI ≥ 6 mm), stage 2 (AHI ≤ 5 mm), stage 3 (acetabularization), stage 4a (glenohumeral narrowing without acetabularization), stage 4b (with acetabularization), stage 5 (humeral head necrosis).

Medical and surgical management

  • Early stages: conservative treatment. Physiotherapy, corticosteroid injections, activity adaptation. Tendon transfer possible (latissimus dorsi, lower trapezius).
  • Advanced stages (Hamada 3-5): reverse shoulder replacement (Grammont concept). Inversion of concavity-convexity: sphere on the glenoid, cup on the humerus. Medialization of the center of rotation.
  • Reverse replacement results: significant pain improvement and recovery of active elevation to 120-140°. Limited external rotation (tendon transfer possible). 90% survival at 10 years.

Physiotherapy rehabilitation

  • Early stages (Hamada 1-2): anterior deltoid rehabilitation. Strengthening of remaining cuff tendons. Scapulothoracic stabilization.
  • Post-operative reverse replacement: specific rehabilitation. Passive mobilization 4-6 weeks, then deltoid activation. No resisted external rotation.
  • Progressive strengthening from W8-12: deltoid work in flexion and abduction. Functional reintegration. Avoid heavy loads.

Average duration

12 to 24 weeks post-operative

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.