Rotator cuff tears are common, especially in adults over 40 and athletes who use their arms a lot, like baseball pitchers, tennis players and swimmers. When your rotator cuff tear is coupled with shoulder arthritis, you may be a candidate for a reverse shoulder replacement.
A total shoulder replacement is only considered necessary when arthritis has worn all the cartilage between your bones away and your rotator cuff is still intact.
However, if you also have a torn rotator cuff, the plastic socket implant placed on your shoulder blade (scapula) is likely to loosen because there is no rotator cuff to keep the metal ball (replacing the humeral head) in place, making the joint move abnormal.
OrthoIndy shoulder surgeon, Dr. Jeffery Soldatis, discusses when a reverse shoulder replacement is used, surgery risks and the recovery process.
What is the difference between a shoulder replacement and a reverse shoulder replacement?
“A reverse shoulder ‘reverses’ the mechanics of the regular anatomy of the shoulder,” Dr. Soldatis said. “A standard shoulder replacement or anatomic shoulder replacement just exchanges an anatomic replica of the shoulder joint. In a reverse (replacement), the place of the ball and the socket are switched or ‘reversed’ to function differently mechanically.”
There are two joints that make up the shoulder. Your acromioclavicular joint connects your shoulder blade (scapula) to your collarbone (clavicle). This joint allows you to raise your arm above your head.
Your glenohumeral joint is a ball and socket joint that connects the top of your upper arm, your humeral head (ball), to part of the scapula called the glenoid (socket). It gives you the ability to rotate your shoulder in a circle and move it up and out from your body.
Soft tissue like ligaments, cartilage and tendons surround your glenohumeral joint. They help cushion the joint’s movement and keep the large humeral head in the shallow socket cavity.
Your rotator cuff is a group of tendons and muscles surrounding the top of the humerus to keep the head in place and allow your arm to rotate.
When the rotator cuff is torn, the tendons can’t keep the humeral head in the socket and your arm won’t rotate properly. So instead of placing a plastic socket on your scapula, a ball is attached and a plastic “cup” is placed at the end of your humerus where your humeral head was previously. This reverses the mechanics of how a normal shoulder would operate.
Why would you need a reverse shoulder replacement?
“Reverse shoulder replacement (rTSA) is done in the case of severe rotator cuff failure, (rotator cuff arthropathy) or severe arthritic deformity of the shoulder, where an anatomic shoulder replacement will not fit well,” Dr. Soldatis said.
Instead of relying on the rotator cuff to power your arm’s range of motion and movement, a reverse shoulder replacement reassigns those functions to the deltoid muscle.
The deltoid muscle is the largest and strongest muscle in your shoulder. Tendons attach it to the clavicle and humerus and its normal function is to provide you the strength to lift your arm.
How long does it take to recover from reverse total shoulder replacement?
“Recovery for a total shoulder replacement is the same whether anatomic shoulder replacement or reverse shoulder replacement,” said Dr. Soldatis. The patient will be in a sling for six weeks and another six weeks of physical therapy, at which point function is about 70%.”
Dr. Soldatis explained. “It takes another two months or so to feel about 90 to 100% recovered and get strength and confidence.”
What are the risks of reverse shoulder replacement surgery?
“Risks include infection, blood clot and nerve injury,” Dr. Soldatis said. “However, these are quite low as we have been performing TSA’s (total shoulder replacements) for about 35 years.
Risks of complication are half of a percent or less. Good patient selection and pre-operative preparation lessen the risks to make the potential gains of a very functional shoulder with minimal pain the expected outcome.”
Learn more about shoulder treatment at OrthoIndy.
To schedule an appointment with Dr. Soldatis, please call 317.569.2515 or request an appointment at OrthoIndy/request.
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