Rheumatological Management of Osteoarthritis with Massive Cuff-Tear

Osteoarthritis with massive cuff-tear can be defined as the combination of glenohumeral osteoarthritis, characterised by narrowing of the gleno-humeral joint line with upward migration of the head, which can be demonstrated on an AP radiograph of the shoulder in neutral rotation by a reduction of the sub-acromial space to less than 7 mm. Osteoarthritis with massive cuff-tear usually presents with: inconsistent pain, severe episodes of shoulder stiffness affecting both active and passive movements and a functional disability, effecting all the activities of daily living. Various complications can occur with the evolution of a cuff-tear arthritis: a synovial fluid swelling, a spontaneous haemarthrosis (or “senile haemorrhagic shoulder”), the appearance of an acromiclavicular cyst. Medical treatment is purely symptomatic and varies depending on the clinical presentation. Pain can be treated by simple analgesics or by intra-articular steroid injections. Non-steroidal anti-inflammatory agents are not efficient here and are poorly tolerated in this elderly age group. A significant disability, secondary to joint stiffness, might lead to rehabilitation being suggested while realising that the chances of improving mobility are often small, and that any functional gain comes from adapting to the handicap.