Rotator cuff dysfunction in patients with rheumatoid arthritis.

Periarticular shoulder problems, particularly those involving the rotator cuff, are commonly found in the general population. Although synovitis of the glenohumeral and acromioclavicular joints may be seen in rheumatiod arthritis (RA), periarticular shoulder problems may also occur. The objective of this study was to define the prevalence of shoulder symptoms and periarticular shoulder abnormalities in a group of RA patients and to correlate findings on physical examination with those obtained with magnetic resonance imaging (MRI).Shoulder function was evaluated by history, physical examination, roentgenogram, and MRI in a group of older, male RA patients; 82% of the 40 patients evaluated had a history of shoulder pain, and 88% had an abnormal physical examination. The most frequent abnormality involved the rotator cuff musculature. Plain roentgenograms were abnormal in only 10 of the 26 (38%) patients. In contrast, abnormalities were noted on MRI in 13 of 14 patients studied (93%). The most frequent MRI abnormalities related to the rotator cuff, with a spectrum of abnormalities ranging from mild inflammatory changes through compete tendon tears. Of note, in all 14 patients undergoing MRI, physical examination findings correlated with abnormalities noted on MRI.Problems referred to the shoulder may be very common in RA patients. Rotator cuff dysfunction was the most common cause of shoulder problems in a population of older, male RA patients. A thorough physical examination often establishes the cause of these problems.