Các triệu chứng rotator cuffÐdeficient, liên glenohumeral viêm khớp gây ra một vấn đề phức tạp cho các bác sĩ phẫu thuật chỉnh hình. Quản lý có thể phẫu thuật được tạo điều kiện bằng cách phân loại các rối loạn tại một trong ba loại chẩn đoán: (1) rotator cuffÐtear bệnh khớp | The Rotator Cuff-Deficient Arthritic Shoulder Diagnosis and Surgical Management Craig A. Zeman MD Michel A. Arcand MD Jeffery S. Cantrell MD John G. Skedros MD and Wayne Z. Bulkhead Jr MD Abstract The symptomatic rotator cuff-deficient arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories 1 rotator cuff-tear arthropathy 2 rheumatoid arthritic shoulder with cuff deficiency or 3 degenerative arthritic osteoarthritic shoulder with cuff deficiency. If it is not possible to repair the cuff defect surgical management may include prosthetic arthroplasty with the recognition that only limited goals are attainable particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis resection arthroplasty and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to overstuff the glenohumeral joint with a prosthetic component. In cases of significant internal rotation contracture subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer s limited goals rehabilitation are followed approximately 80 to 90 of patients treated with humeral hemiarthroplasty can have satisfactory results. J Am Acad Orthop Surg 1998 6 337-348 localized shoulder arthritis associated with a large swelling about the shoulder rotator cuff tear biceps tendon rupture and erosion of the superior portion of the humeral head acromion and distal clavicle. In his classic 1934 text Codman described the case of a 51-year-old woman
