Question
A 76 year old man has a painful shoulder and cannot lift his arm above shoulder height. Radiographs show superior migration of the humeral head with acetabularisation of the acromion.
- What is the diagnosis and how is it classified?
- What are the treatment options?
- What are the complications of your preferred operation?
Answer
Diagnosis
- Rotator cuff tear arthropathy
- Massive cuff tear with loss of the force couple, superior migration of the head and secondary arthritis
- Hamada classification grades 1 to 5, from narrowed acromiohumeral interval to humeral head collapse
Treatment options
- Analgesia, injection and anterior deltoid strengthening program
- Arthroscopic debridement and biceps tenotomy for pain in low demand patients
- Reverse total shoulder arthroplasty for pain and pseudoparalysis, the treatment of choice when the deltoid works
- Hemiarthroplasty with an extended head gives pain relief but poor elevation
Complications of reverse shoulder arthroplasty
- Scapular notching
- Instability and dislocation
- Acromial and scapular spine stress fractures
- Infection, often Cutibacterium acnes
- Glenoid baseplate loosening and nerve injury, especially the axillary nerve
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.