Reverse Shoulder Replacement

The diagram on the right illustrates how the rotator cuff normally holds the ball on the shallow socket during shoulder motion. The small muscles of the rotator cuff (broad arrows) compress the ball onto the socket, while the large deltoid muscle (long thin arrow) pulls the arm upwards.

Rotator cuff arthropathy occurs when a patient has a massive irreparable rotator cuff tear with subsequent development of shoulder arthritis. When this occurs it is a very disabling problem and patients typically lose nearly all of their shoulder motion and power. A patient with this usually has severe shoulder pain, difficulty sleeping and may not be able even lift their arm away from their side. This situation is called pseudoparalysis because it seems like the arm is nearly paralyzed at the shoulder. This occurs because the rotator cuff no longer centers the ball on the shallow shoulder socket. Any attempt to lift the shoulder causes the ball to slip over the socket and when this happens, the normal pivoting point or fulcrum of the shoulder is lost. This can be seen in the x-ray above, which shows the ball dislocating above the socket (blue arrow) of the shoulder and rubbing on the clavicle and acromion bones above it.

Fortunately, Dr. Nigro has completed fellowship training focusing on reverse and anatomic shoulder replacements. This is a revolutionary surgical procedure restores the pivoting point to the shoulder joint. This allows patients to lift their arm up above shoulder level and with more strength than they could prior to surgery. Because the arthritic portions of the ball and socket are replaced with the smooth gliding surfaces of the prosthesis, patients normally experience substantial improvement in their pain level as well. This procedure has been demonstrated to be safe, reliable and successful for patients.

The image on the far right (above) is an x-ray of a reverse shoulder replacement. A white metal ball is anchored into bone on the socket side of the shoulder joint. A white stem sits in the canal of humerus (arm bone). A plastic liner sits between the ball and stem, but is invisible on x-ray.

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