What is Reverse Shoulder Replacement Surgery?

The complications of this procedure are similar to those of joint replacements of any joint in the body.

The most common complication is that the humerus or arm portion (the socket) can become dislodged from the ball (the shoulder blade part) and the prosthesis is “dislocated.”

Dr. Patrick Chin, MD, MBA, FRCSC, Orthopedic Surgeon, discusses what is reverse shoulder replacement surgery.

Dr. Patrick Chin, MD, MBA, FRCSC, Orthopedic Surgeon, discusses arthroscopic shoulder surgery.

Quiz: Do You Understand Shoulder Surgery?

Test your knowledge by answering the following questions:

Questions
True
False
1

The usual treatment for shoulder injuries is surgical options.

Explanation:
The usual treatment for shoulder injuries is non-surgical options such as medications, bracing and physiotherapy. Shoulder surgery is generally only explored if the non-operative options fail.
2

Arthroscopic shoulder surgery is often performed to repair soft tissue injuries.

Explanation:
Arthroscopic shoulder surgery (otherwise known as keyhole surgery) can be a good option for some patients. It is often performed to repair soft tissue injuries, and enables surgeons to introduce a fiber optic camera through a two- to three- millimeter incision.
3

For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery.

Explanation:
For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery. It is often done to repair rotator cuff tendons that have been damaged, often by arthritis.
4

Patients with recurrent shoulder dislocations may won't benefit from surgical reconstruction, only from non-surgical options.

Explanation:
Patients with recurrent shoulder dislocations may benefit from surgical reconstruction of the damaged tissues in the shoulder joint. This usually involves an arthroscopic day procedure, where the surgeon identifies the torn labrum or ligaments that have occurred with each shoulder dislocation.
5

Following shoulder surgery, most patients will benefit from physiotherapy.

Explanation:
Following shoulder surgery, most patients will benefit from physiotherapy to get their range of motion back, decrease pain and increase strength.
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What is Reverse Shoulder Replacement Surgery - Orthopedic Surgery

What is Reverse Shoulder Replacement Surgery – Orthopedic Surgery Duration: 2 minutes, 33 seconds

Reverse shoulder replacement surgery is fairly new in the last 10 to 20 years.

It’s become more popular again. It has to do with a specific type of arthritis. So these rotator cuff tendons rotate the shoulder around and keeps the ball and socket centered.

When these tendons are no longer present or deemed irreparable, then the ball no longer is depressed down against the socket and as a result it will slide upward like that.

And when you slide upward like that then the head and socket no longer is aligned, it changes the joint reaction forces, resulting in a different type of arthritis known as the cuff tear arthropathy.

The conventional shoulder replacement requires the availability and the presence of these tendons for it to work. Otherwise the prosthesis will dislocate or sublux or partially dislocate upward.

As a result the reverse prosthesis basically reverses the ball and socket joint so that we can then go without these tendons and now use a different muscle configuration and it has to be a biomechanical change in the center rotation to allow the patient now to elevate their arm using the big muscle called the deltoid muscle which you don’t see in this model.

So using the deltoid muscle the patient will then be able to elevate their arm without the rotator cuff tendons being intact. It allows the patient now to to elevate the arm without dislocating the shoulder and without pain.

The prognosis of patients from a reverse prosthesis is good in terms of pain relief and improvement in function, especially in the ability to elevate their arm. Local Orthopedic Surgeon

In terms of the survivability of these implants, it is still difficult to predict, or a bit unknown only because over the last 10 years the reverse prosthesis designs have evolved quite rapidly. Local Physiotherapist 

As a result we still hope that these implants will provide better longevity for our patients in terms of improving their pain and more long lasting functionality of the shoulder. Local Orthopedic Surgeon.

Presenter: Dr. Patrick Chin, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon

MRI Scans for Shoulder Injuries

Shoulder injuries are very common in sport, and we see injuries in hockey players, other contact sports, in rugby and football, skiing injuries, and sometimes with tennis or other racquet sports.

And the main areas that are visualized beautifully with MRI are the tendons and also the labrum. In fact, the labrum can only be visualized with MRI, with no other imaging modality.

Here is an example of the labrum, which is a fibrous cuff that holds the shoulder in place, and in this particular instance gadolinium has been given to help highlight the labrum. Gadolinium is a contrast agent that we use, and we can see that there is gadolinium undercutting here, consistent with a tear in the labrum.

So normally the labrum is closely applied to the bone here, which is the bony cuff of the shoulder, and we can see that it’s been detached and the gadolinium is extending underneath it here, indicating that it’s been torn, both in the front and in the back. This can cause a lot of shoulder pain, and is only identified with MRI.

If you have any other questions, as far as the benefit of MRI for shoulder injury, contact your family doctor, your sports medicine physician or an imaging referral centre. Local Orthopedic Surgeon

Presenter: Dr. Audrey Spielmann, Radiologist, Vancouver, BC

Local Practitioners: Radiologist

Local Orthopedic Surgeons

James Dreese

James Dreese

Orthopaedic Surgeon
Lutherville, MD
Dr. Jack Rocco

Dr. Jack Rocco

MD
Orthopaedic Surgeon
Hollidaysburg, PA
Dr. Jamal Rakem

Dr. Jamal Rakem

Orthopaedic Surgeon
Welland, ON
Dr. Bryan Rittenhouse

Dr. Bryan Rittenhouse

Orthopaedic Surgeon
Welland, ON

Local Physiotherapists

Anneliese Ruggeri

Anneliese Ruggeri

Physiotherapist
Middlebury, CT
Mr. Trevor Kwolek

Mr. Trevor Kwolek

Physiotherapist
Fonthill, ON
Chritine Bridle

Chritine Bridle

FCAMPT, CAFCI
Physiotherapist
St Catherines, ON

Handout Shoulder Surgery – Post Operative Information

For patients that have currently undergone an orthopaedic shoulder surgery it is important to follow key instructions from your Orthopeadic Surgeon carefully. To help you in your recovery, the following is a list of commonly asked questions and answers.

  1. How long do I keep the bandages on after surgery? ANSWER: 3 – 4 days
  2. Can I shower after surgery? ANSWER: Yes, you may shower as long as you keep the wounds dry. After 7-10 days when the wounds are healed you can then shower without worrying about keeping the wounds dry.
  3. Should I put ice on the joint after surgery? ANSWER: Yes, you should ice the affected joint regularly, 10 -15 minutes on and then off. You may re-apply the ice once the skin returns to room temperature.
  4. Should I wear a sling after surgery? ANSWER: Yes, you should wear a sling to protect the shoulder from sudden movements or falling. It should be worn most of the time if there is a risk to the shoulder. If you are in a safe environment where there is no risk to the shoulder then you can remove the sling. However, you should not move the arm without the assistnace of the other arm and not through any pain.
  5. Should I be doing the pendulum swing? ANSWER: You may begin gentle pendulum swings if it is not uncomfortable for you.
  6. What exercises do I do? ANSWER: Prior to your first follow up appointment you should begin to move the arm with the other arm only through pain free ranges. You should not lift or reach for anything.
  7. How often do I do the exercises? ANSWER: You can work on your motion as many times as possible during the day without causing pain or discomfort.
  8. How soon after surgery can I drive? ANSWER: You are able to drive when you have full control and movement of both arms that will allow you to steer the vehicle rapidly to avoid a collision with another vehicle or pedestrian.

General Shoulder Information

The usual treatment for shoulder injuries is non-surgical options such as medications, bracing and physiotherapy. Shoulder surgery is generally only explored if the non-operative options fail, and the type the orthopaedic surgeon performs depends on the severity of your issue.

Arthroscopic Shoulder Surgery & Shoulder Replacement Surgery

Arthroscopic shoulder surgery (otherwise known as keyhole surgery) can be a good option for some patients. It is often performed to repair soft tissue injuries. In the past, orthopaedic surgeons had to make a large incision in an attempt to gain access into the joint. Arthroscopic surgery has enabled surgeons to introduce a fiber optic camera through a two- to three- millimeter incision. That allows the orthopaedic surgeon to magnify the structures on a TV screen and perform the procedure in finer detail. The benefits of arthroscopic shoulder surgery include a potentially shorter healing time, which means you can start rehab sooner.

For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery. It is often done to repair rotator cuff tendons that have been damaged, often by arthritis. These rotator cuff tendons rotate the shoulder around and keep the ball and socket centered, but when they are no longer present or are deemed irreparable, the ball can slide upwards. When the head and socket are longer aligned, it changes the joint reaction forces, resulting in a different type of arthritis known as cuff tear arthropathy. These artificial shoulder implants last between 10 and 15 years.

Surgery for Shoulder Dislocations

shoulder-physioPatients with recurrent shoulder dislocations may benefit from surgical reconstruction of the damaged tissues in the shoulder joint. This usually involves an arthroscopic day procedure, where the surgeon identifies the torn labrum or ligaments that have occurred with each shoulder dislocation. The orthopaedic surgeon passes sutures through the ligaments and reattaches them to keep the ball in the socket. Following shoulder surgery, most patients will benefit from physiotherapy to get their range of motion back, decrease pain and increase strength.

Talk to your healthcare provider if you’d like more information on shoulder surgery.

Visit HealthChoicesFirst.com for more videos and resources on orthopedics.

Print this Action Plan and check off items that you want to discuss with your healthcare provider

  • The usual treatment for shoulder injuries is non-surgical options such as medications, bracing and physiotherapy. Shoulder surgery is generally only explored if the non-operative options fail.
  • Arthroscopic shoulder surgery (otherwise known as keyhole surgery) can be a good option for some patients. It is often performed to repair soft tissue injuries, and enables surgeons to introduce a fiber optic camera through a two- to three- millimeter incision.
  • For more severe shoulder injuries, surgeons may recommend a reverse shoulder replacement surgery. It is often done to repair rotator cuff tendons that have been damaged, often by arthritis.
  • Patients with recurrent shoulder dislocations may benefit from surgical reconstruction of the damaged tissues in the shoulder joint. This usually involves an arthroscopic day procedure, where the surgeon identifies the torn labrum or ligaments that have occurred with each shoulder dislocation.
  • Following shoulder surgery, most patients will benefit from physiotherapy to get their range of motion back, decrease pain and increase strength.

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