When Reverse Shoulder Replacement Surgery is the Best Option

Think about all the movements your shoulders can make. You can shrug them, roll them to the back and roll them to the front, or pull them down to stretch your neck. Movements that usually feel really good.

Thanks to your shoulders, you can also pick up your grandchildren, hoist a bag of mulch for the garden, drive a tennis ball over the net, slap that black fly, swim your morning laps, or simply wave hello to a friend.

The shoulder is the body’s most flexible joint, but…

The shoulder is the body’s most flexible joint, but unfortunately, it is often the least stable, and is more prone to injury than other joints. It’s made up of three bones: the shoulder blade (scapula), collarbone (clavicle), and upper arm bone (humerus). The top part of the upper arm bone rests in a hollow socket in the shoulder blade. The shoulder blade extends around the joint creating a cover of sorts and then connects with the collarbone. To keep it stable, a ring of cartilage surrounds the joint. Ligaments connect the three bones and tendons join them to surrounding tissues.

Imagine the shoulder, which is a ball and socket joint, as a golf ball on a tee. It doesn’t take much for the ball to get knocked off the tee, and it doesn’t take much to injure your shoulder. That said, many shoulder problems are due to arthritis and the wear and tear that accumulates with age.

Shoulder replacement surgery

Every year in the United States about 53,000 people have their shoulders replaced making it the third most common joint replacement surgery after knees and hips.

Before surgery is considered, most people have already tried several other treatments, including rest, medications, cortisone injections and physical therapy. It is usually when a person’s quality of life has diminished because the arm doesn't move as it should or the pain is severe and unrelenting that surgery is recommended.

Reverse shoulder replacement

Traditional shoulder replacement surgery may not be a good option for people with advanced arthritis, and irreparable rotator cuff tears. It may relieve pain but usually can’t restore range of motion.

The rotator cuff consists of four muscles and several tendons, which protect and support the shoulder and allow it to move freely. Injury, repetitive motion, aging, and other conditions can tear or wear down the rotator cuff to the point that it can’t be repaired. When it doesn’t function properly, the top of the arm bone may move up and out of the socket, making it difficult or even impossible to raise the arm. At the same time, protective cartilage may also wear away or be damaged. Without that cushion, joint movement quite literally becomes a grind. Bone moving on bone. It’s painful.

A relatively new option for individuals who aren’t candidates for a traditional procedure because of the issues outlined above, is a reverse shoulder replacement. The Food and Drug Administration approved reverse shoulder replacement surgery in November 2004. Doctors have been performing it in Europe for the past 20 years.

The traditional procedure copies normal anatomy. The damaged parts are removed, and an artificial metal ball replaces the top of the upper arm while a plastic cup replaces the socket in the shoulder blade. With reverse shoulder replacement, the ball and socket pieces are reversed. The ball is attached to the shoulder blade instead of the upper arm and the socket is attached to the upper arm instead of the shoulder blade. The reversed positioning allows the deltoid muscle, also in the shoulder, to compensate for the damaged rotator cuff. Successful reverse shoulder replacement surgery combined with appropriate physical therapy — generally for about three months — can relieve pain and restore range of motion.

The best candidates for reverse shoulder replacement surgery

Older people with significant pain and little or no movement in their shoulder are the best candidates for reverse shoulder replacement. It is not recommended for someone with an infection, an inadequate scapula, or deltoid muscles that do not function properly. It is also not recommended for younger patients.