This leaves a patient with pain and/or loss of function of the shoulder, which can be very frustrating for both the patient and the orthopaedic surgeon as these patients have typically had multiple surgeries to attempt to fix the problem. In the past, there was not much that could be done to address this problem. Now there is a surgery designed to fix this particular situation, and it’s known as a reverse shoulder replacement.
In general, a reverse shoulder replacement is a “work around” to substitute for the lack of a normal rotator cuff.
WHY IS IT CALLED A REVERSE SHOULDER REPLACEMENT?
The difference between a standard shoulder replacement and a reverse shoulder replacement is that in a reverse shoulder replacement the ball and socket parts of the shoulder joint are switched. This means their natural position is reversed. Reverse total shoulder replacement is a complex procedure and is warranted by certain conditions.
A regular total shoulder replacement depends upon the muscles and tendons around the shoulder joint to be intact. There are four muscles that comprise the rotator cuff. They attach to the shoulder blade and their tendons attach to the humerus (upper arm bone). These muscles and their tendons function to move the shoulder and are together called the rotator cuff. When these tendons become extensively torn so that they do not attach to the bone any longer, the shoulder no longer functions normally. A rotator cuff tear can produce pain and loss of motion. A normal shoulder replacement is designed to work only if the rotator cuff is intact and functioning normally. In contrast, a reverse shoulder replacement is designed for situations where the rotator cuff is torn or malfunctioning.
The reverse shoulder replacement places tension on the deltoid muscle (outer shoulder muscle) thereby increasing its lever arm. The deltoid then becomes a substitute for the rotator cuff and allows the patient without a functioning rotator cuff the ability to lift his or her arm.
Who Are Candidates for This Type of Surgery?
The main reason to consider a reverse shoulder replacement is when there is arthritis of the shoulder joint and the rotator cuff tendons are torn or gone. This is the most common surgical indication for a patient considering a reverse prosthesis. In this situation, the operation will give the patient significant pain relief and may also help with range of motion of the shoulder. While range of motion after a reverse prosthesis may not be completely normal, it is typically improved over the motion previously lost due to the arthritis and pain.
Another reason to have a reverse shoulder replacement is if the rotator cuff tendons are all torn and can no longer be repaired and the individual cannot lift the arm high enough to function. In this case the shoulder may not painful, but the inability to lift the arm is very disrupting to the ability to function in life. In these instances, pain may or may not be a major factor, but the main reason for the replacement is to regain motion and function.
Other reasons to have a reverse prosthesis are some fractures of the shoulder area, particularly ones that involve the proximal humerus (arm bone) where the ball attaches to the shaft of the bone. In some instances, the bone is broken into many pieces or the ball may be split into parts.
What Else to Know?
With the continuous advancement of technology, reverse shoulder replacements are becoming more common. Regardless of your age or condition of your rotator cuff, this surgery could be a great option if you’re suffering from chronic pain in your shoulder. We’re experts in orthopaedic care from head to toe and everything in between, so schedule an appointment and let us help you feel better.
Written by David Yakin, MD