The shoulder bears a lot of responsibility when it comes to movement and range of motion. Whether it's used in lifting a child into your arms, pulling weeds out of the garden or reaching up to get something off of a high shelf, shoulders are put to work many times throughout an average day, even more than most of us realize. When pain interferes with normal activities, it's good to know there are options available.
The rotator cuff is essentially a cushion that prevents cartilage from rubbing on bone while at the same time providing an attachment for four muscles that are necessary for raising the arm. Basically, the rotator cuff kept things moving easily and intact. When that becomes damaged, it causes pain and loss of mobility.
People with severe shoulder arthritis combined with damage to the rotator cuff are generally not good candidates for total shoulder replacements because the socket of the implant is prone to loosening. Thankfully, a relatively new procedure is available: the reverse shoulder replacement.
The absence of a rotator cuff causes a traditional shoulder surgery implant to move abnormally, resulting in unsatisfactory results for the patient. "The shoulder is the most mobile of all the joints, so it's imperative to regain as much mobility as possible," said Geoff Collins, MD, orthopaedic surgeon with the Center for Orthopaedics. "Many of my patients have found relief and increased mobility after they've had a reverse shoulder replacement."
This procedure has been used for over ten years in Europe, and was approved by the United States' Federal Drug Administration in 2004. The studies show positive results from the data collected to this point. Dr. Collins explained that he has ten years of experience in shoulder surgery, and is specifically trained in reverse shoulder replacement. "Some people mistakenly think that they have to travel to Houston to get relief from shoulder pain. With traditional shoulder replacement and this relatively new reverse shoulder option, I've seen great results in my patients' mobility and quality of life. When they realize they don't have to go through the hassle of traveling in order to feel better, it makes it that much easier on them," he said.
To understand the reverse shoulder replacement procedure, a brief description of the traditional method will help. Dr. Collins said the conventional way uses a metal ball on the top of the arm bone, and a plastic socket on the shoulder blade; thus the ball-and-socket joints are replaced. The reverse shoulder replacement uses a ball-and-socket joint as well, but the ball is placed on the shoulder blade and the socket is placed on top of the arm bone; opposite of the normal anatomy which explains why it is known as "reverse" shoulder replacement.
By reversing the socket and metal ball, the center of rotation is changed. This shifts the strength needed to move the arm away from the damaged rotator cuff muscles and is instead shifted to the healthier deltoid muscle, solving the problem of what to do with the problematic rotator cuff.
"Before reverse shoulder replacement, we could relieve pain but normal motion was not restored to satisfactory levels. With a reverse procedure, we're able to relieve pain and restore motion," said Dr. Collins. "Patients report a big improvement and are able to return to normal activities and enjoy life again."
Patients who are candidates for this procedure are usually over age 60 and have both a damaged rotator cuff and arthritis in the shoulder. They usually report severe pain and limited function in their shoulder. "Because there wasn't much we could do for these individuals, it makes having this newer option even better. They can finally get some relief, and get it close to home," said Dr. Collins.