Cuff Tear Arthropathy Humeral Head Replacement: When More Is Better

When confronted with the diagnosis of shoulder arthritis, it is incumbent on the treating physician to discern the complete nature of the pathology. Arthritic processes about the shoulder predictably involve disease both to the bony elements and to the soft tissues about the joint. While there are many options available for the surgical management of shoulder arthritis, the exact type of shoulder replacement depends on both the bone issues and the soft tissue issues as well. For the patient with a massive and irreparable rotator cuff tear, a cuff tear arthropathy (CTA) head may be most appropriate. Indications for humeral head replacement with the CTA head depend on specific anatomic and physiologic factors. For the patient with a massive and irreparable cuff tear who retains an intact coracoacromial arch, this type of prosthetic replacement provides predictable relief of pain while allowing significant improvement in function. Recovery of function requires a structured muscle re-education program.