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Reversing the Course of Shoulder Disability

Reverse total shoulder replacement surgery - a new option for shoulder degeneration.

By: Uma Srikumaran, M.D.

x-ray showing typical shoulder replacement
Figure 1 - Typical Shoulder Replacement

Like other joints in the body, the shoulder is susceptible to degeneration, or wear and tear, over time. Wear and tear of the shoulder is quite common as we age and typically takes the form of rotator cuff disease or arthritis. While there are many treatment options for these conditions, surgical reconstruction may be required if the symptoms (pain and limited function) are not relieved by conservative measures (rest, ice, pain medications, physical therapy, cortisone injections).

In some cases, the rotator cuff tear can be so significant that it is not surgically repairable or would be unlikely to heal even if surgically repaired (Learn more by reading our Failed Rotator Cuff Repairs FAQs). When the rotator cuff is not functioning effectively, accelerated degeneration of the joint can occur. This can leave an individual with both an arthritic joint and rotator cuff tears. This can be a very debilitating condition, causing significant pain and inability to lift the arm.

A new technology called “reverse total shoulder replacement” has been developed to address this unique and challenging problem. This new type of shoulder replacement has been in use in Europe since the 1980s. The “reverse” prosthesis was FDA approved for use in the United States since 2004. This type of shoulder replacement is called a reverse because it “reverses” the normal orientation of the ball and socket joint (Figure 2).

x-ray showing reverse total shoulder replacement
Figure 2 - Reverse Total Shoulder Replacement

In a typical shoulder replacement, the arthritic humeral head (ball) is replaced by a metal ball and stem on the arm side, while the socket (shoulder blade side) is replaced with a plastic component (Figure 1). This shoulder replacement requires a functioning rotator cuff to work effectively. Because some patients have both rotator cuff tears and arthritis the “reverse” shoulder allows the replacement to function without the rotator cuff by “reversing” the ball and the socket (Figure 2). The ball is now placed on the socket (shoulder blade) side and the socket or cup is placed on the arm (humeral) side.

The reverse total shoulder replacement has provided significant pain relief and improved function to many patients with debilitating shoulder dysfunction.  The procedure has allowed patients to return to basic activities of daily living, such as combing your hair or reaching into a cupboard, as well as returning to recreational activities such as golf.

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