Article:
The Reverse Total Shoulder: What to do when you have a rotator cuff tear and arthritis

By Gita Pillai, MD

The ball and socket of the shoulder are most similar to a golf ball sitting on a golf tee. The muscles of your shoulder, the rotator cuff, hold the ball in place and allow you to move your arm in all sorts of positions.

Some patients who have a very large tear of the rotator cuff that does not get repaired can go on to develop a particular type of arthritis called cuff tear arthropathy. When the ball and socket of the shoulder isn’t stabilized by the rotator cuff, the ball moves in the socket in an atypical way. This atypical movement can result in arthritis developing in the joint. Arthritis is a process in which the smooth cartilage that covers the ball and socket is damaged, often times resulting in bone rubbing on bone.

The symptoms of cuff tear arthropathy differ from traditional arthritis. While both patients have pain, patients with cuff tear arthropathy often cannot lift their arm to shoulder level and with physical examination it is clear that the rotator cuff muscles are weak. Xrays and MRI show us that these patients have an irreparable rotator cuff tear as well as arthritis.

Not too long ago we didn’t have a very good solution for this problem. If we replaced the damaged ball and socket with a traditional shoulder replacement, the patient still could not move the arm because the rotator cuff muscles were deficient. The shoulder lacked stability. A new innovation, the reverse total shoulder, was developed recently. The replacement switched the ball and socket components so that the ball was actually on the socket side and the cup was on the ball side. The biomechanics of this replacement allows patients who previously had a nonfunctional arm to begin to raise their arm—and, typically, to raise it over their head.

Arthritis is a tough problem. The decision to proceed with surgery is based entirely upon quality of life. Unfortunately, we have no way to surgically correct arthritis without a joint replacement. Activity modifications and anti-inflammatory medications can control pain for many people, allowing them to continue with the activities they love. But when your life is truly being limited by your condition, we have good surgical options for you with the traditional total shoulder replacement as well as the reverse total shoulder replacement.

Orthopaedic Associates of Southern Delaware
Offices in Lewes, Millsboro, Milton and Ocean View
302-644-3311