Shoulder Work Ahead

A reverse replacement could provide some much-needed relief

If you’ve been forced to give up golf, swimming, bowling, gardening or other activities you love because of shoulder pain and loss of motion, a reverse shoulder replacement may give you relief, says orthopedic surgeon Dr. Martin R. Coleman of the Orthopaedic and Spine Center in Newport News.

Ideal candidates for this operation are 70 or older and have severe arthritis in their shoulder joint combined with a massive un-repairable rotator cuff tear, Coleman says. Such a patient would get pain relief from a conventional shoulder joint replacement, but very little improved function because the torn rotator cuff still could not do its job helping the shoulder to move, Coleman says.

The reverse shoulder replacement improves shoulder function because the still functioning deltoid muscles take over the job of the non-functioning rotator cuff, Coleman says. In a normal shoulder, the upper arm bone ends in a ball that fits into a socket formed by the shoulder blade. In a reverse shoulder replacement, the prosthetic shoulder’s socket is instead on the upper arm, and the ball is on the shoulder. The reversal moves the shoulder’s pivot point about an inch, giving the deltoid muscles the additional leverage, after physical therapy, to take over for the atrophied rotator cuff, he says.

Most patients stay in the hospital overnight and then have about three months of physical therapy, Coleman says.

The procedure was developed in France in the mid-1980s and approved by the FDA in 2004. Before FDA approval, patients in the United States could choose among living with the pain, pain management, or shoulder fusion—which left them with less pain but limited motion, Coleman says.

Reverse shoulder replacement is still a relatively new technique, and it’s not certain how long the new joint will last. “We know from experience that if you take a young person and put in a new (conventional) shoulder, he or she will beat it up and wear it out,” Coleman says. “The younger you are, the greater chance you have of wearing it out and having to have it redone.”

Because of that, orthopedic surgeons prefer that candidates be over 75, Coleman says. “But we will go younger than that when we have people who have no other choices because they have a terribly stiff, painful shoulder that is useless,” he says.

He cautions patients that reverse shoulder replacement is not a cure all—that even after surgery they may have trouble putting plates on the top shelf.

If the rotator cuff tear is repairable, it’s better to fix it and get a conventional shoulder replacement. To possibly avoid an un-repairable rotator cuff, don’t try to endure long-term shoulder pain, Coleman says.  

“People are stubborn and tough,” he says. “They will put up with a sore shoulder and work around it. By the time they get to us, it’s too late. If you overdo it raking leaves or shoveling snow and get real sore, don’t panic over that. But if you still have pain three or four months later, something should be done.”

But those patients who need a reverse shoulder replacement to reduce pain are usually smiling by the day after surgery. Those who need the operation to restore mobility are usually smiling by their fourth follow-up appointment, Coleman says.

One key question Coleman asks potential reverse shoulder replacement candidates: ‘How does the shoulder pain and lack of mobility interfere with their daily routines?’

“It’s usually one specific thing,” he says. “If your shoulder is killing you and you can’t play golf any more, if your shoulder is killing you and you can’t swim, if your shoulder is killing you and you can’t bowl, if your shoulder is killing you and you can’t garden … If something in their life is missing, we want to give it back to them. We had one guy who was a master’s level swimmer and couldn’t swim. We did a reverse shoulder replacement and now he’s swimming again.”

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