Shoulder Surgery Pre-Op

The rotator cuff is essential for normal shoulder function. In patients with massive tears of the rotator cuff, the shoulder is no longer stabilized and begins to move out of the socket. This subsequently causes the joint to become arthritic. “Rotator cuff tear arthropathy” is the term given to shoulders with massive rotator cuff tears and arthritis of the glenohumeral joint. These patients will have very poor shoulder range of motion from the torn tendons. They will also have pain from their torn tendons and from their arthritis.

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.

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.

In this procedure there are risks involved when doing a reversed prosthesis. Risks of the surgery include, but are not limited to, infection, pain, bleeding, numbness, nerve or vessel injury, failure of the procedure, need for another procedure, scarring, loss of range of motion, prosthesis instability or loosening and fracture. There are also risks involved from the anesthesia. Each individual is different and special techniques are used to minimize the risks.

This procedure is covered by Medicare and insurance companies. Please ask my staff to give you specific information on your out-of-pocket costs.

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 not start any therapy for four to six weeks after the procedure. Most patients do well without the need for formal physical therapy. Recovery in function and comfort continues for many months after the procedure.