Rotator cuff arthropathy most commonly occurs in patients over the age of 65 and is more commonly seen in women. The diagnosis is made by a careful history and physical. The patients usually report progressive loss of shoulder function and many have had an attempt at a rotator cuff repair, which failed.
The examination reveals poor shoulder motion, crepitance (grinding you can feel from the bones rubbing together) and loss of rotator cuff strength. Imaging studies show the humeral head (see anatomy section) to have migrated upwards and also show arthritis in the joint. By the time I see these patients a lot of them have an MRI or CT scan of their shoulder. This shows clear evidence of the large tear and the arthritic joint.
In the early stages of rotator cuff tear arthropathy, medication and physical therapy may lessen the symptoms. As the problem progresses, the pain and the range of motion will worsen. In some patients in need of surgery a standard hemiarthroplasty (half a joint replacement) will be sufficient. This is a fancy word for replacement of the humeral head with a metal implant. This procedure has been performed for decades, but has its limitations. It helps with the pain, but does very little for your range of motion. In the later stages of the condition the only way to help improve the mechanics of the shoulder is with the "Reversed Shoulder Prosthesis." It is called the "reversed" prosthesis because the ball and socket are reversed from the standard shoulder replacement. This new design helps restore motion and strength to the shoulder. It is the only prosthesis we have in orthopaedics which can literally replace the missing rotator cuff muscle as well as the articular cartilage from the joint. Because the torn tendons are not repairable, normal strength and function of the shoulder should not be expected. In most cases, however, it helps markedly decrease or eliminate your shoulder pain. The greatest improvements are in the ability of the individual to sleep and to perform some of the normal activities of daily living.
Reversed Post Op
As in any complex shoulder procedure, shoulder joint replacement with a reversed shoulder prosthesis is a highly technical procedure and is best performed by a surgical team who has experience with this surgery.
The procedure does an excellent job of restoring the shoulder range of motion and strength. As in any surgery, there are risks and benefits to any procedure.
This procedure is covered by Medicare and insurance companies.
Joint replacements such as this one are performed at major medical centers and I keep my patients in the hospital for about two days. The patients then go home with a sling and pain medications. I will start with some early range of motion exercises about one week after surgery. Formal physical therapy usually begins about 4 weeks after surgery. Recovery in function and comfort continues for many months after the procedure.