What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

This study analyses the preoperative radiological (AP-view, (Artro-)CT-scan or MRI-scan) and clinical characteristics (Constant-Murley-score plus active and passive mobility testing) and the peroperative findings in a cohort of 307 patients. These patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006). All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse-(84%) or hemi-(8%) or double cup-bipolar prosthesis (8%)).A positive significancy could be found for the relationship between clinical testing and the rotator cuff quality; between acromiohumeral distance and posterior rotator cuff quality; between femoralization and posterior rotator cuff quality.A conventional antero-posterior radiograph can not provide any predictive information on the clinical status of the patient.The subscapular muscle can be well tested by the press belly test and the teres minor muscle can be well tested by the hornblower' sign and by the exorotation lag signs.The upward migration index and the presence of femoralization are good indicators for the evaluation of the posterior rotator cuff.An inferior coracoid tip positioning suggests rotator cuff disease.Painful cuff tear arthropathy (CTA) affects the independence of the elderly [1,2] by altering the biomechanics [3] and bony characteristics of the normal glenohumeral joint [4,5]. CTA is a progressive disease which presents a unique therapeutical challenge necessitating an algorithm for treatment based on clinical and radiological parameters [6].The seriousness of the disease is evaluated clinically and radiologically.The Constant and Murley score [7] is a well accepted clinical method to evaluate pain, activities of daily living, passive motion, and active motion. Clinical lag signs seem to have an important predictive value in the assessment of the location and the size of the tea