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• The rotator cuff is a key stabilizer of the shoulder.  Patients may have severe loss of rotator cuff function from massive rotator cuff tear, previous surgery, or a previous fracture.  In many of these cases, shoulder arthritis develops. 

  • Dynamic instability of the glenohumeral joint occurs often in this scenario and the humeral head no longer remains centered in the shoulder socket. 

 

 

 

 

 

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• Symptoms  

  • Limitation of motion and the inability to raise the arm in the forward plane.  It may become more difficult to lift your arm to comb your hair or reach up to a shelf.

  • The patient may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.

  • As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may become difficult.

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• Examination

  • Clinical findings of rotator cuff tear arthropathy include signs of limitation of motion, atrophy or wasting of muscles, swelling, crepitus (clicking,popping, or crunching sound) and tenderness to touch.

  • Discomfort to all planes of motion and tenderness to touch along the biceps tendon in the front of the shoulder are also common clinical findings.

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• Conservative Treatment

  •  Non-operative management of rotator cuff tears consists of a combination of activity modification, physical therapy, anti-inflammatory medications, and cortisone injections. 

 

• Surgical Treatment

  • The Reverse Shoulder Replacement is an exciting breakthrough in shoulder surgery.  It is a new treatment option for patients who have suffered with shoulder arthritis and rotator cuff dysfunction.  Until now, there were limited surgical options for patients with this combination of problems.  Patients were offered procedures that were unreliable in achieving and maintaining pain relief and functional improvements.  The Reverse Shoulder Replacement has been used successfully in Europe for over 10 years, and has been approved for use in the United States since 2005.  Excellent results have been demonstrated with significant improvements in function over the past 12 years in the United States. 1

  • What is a Reverse Shoulder Replacement?

    • The Reverse Shoulder Replacement differs from a traditional Total Shoulder Replacement in that the ball and socket are reversed.  The ball (glenosphere) is placed onto the glenoid (socket), and the socket is placed on the ball (humerus).  The Reverse Shoulder Replacement provides the additional shoulder stability needed when the rotator cuff is not functional.  Once the shoulder regains stability, improvements are seen in both pain relief and shoulder function.

  • What are the benefits of a Reverse Shoulder Replacement?

    • If the rotator cuff is functioning properly, you do not need a Reverse Shoulder Replacement.  Your function will be much better with a Total Shoulder Replacement, as normal anatomy is reconstructed.  The Reverse Shoulder Replacement is used only when the rotator cuff cannot be reconstructed.

    • Dramatic improvements have been seen in pain relief, range of motion, and ability to perform daily activities (ie, eating, drinking, grooming).  The return of independence is probably the key benefit that patients experience, as they are able to regain function and use of the arm.

 

                      1. Frankle, MA et al.   Reverse shoulder arthroplasty in patients younger than 55 years: 2- to 12-year follow-up.  JSES 2017; 26, 792-797.