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New option in shoulder treatment: reverse total replacement changes anatomy of joint, can often restore full range of motion for athletes.

Traveling to handball tournaments and listening to players' complaints, I have encountered many players with shoulder problems.

Younger players sustain acute injuries such as torn rotator cuffs, sometimes requiring surgery and therapy. Older players have had these injuries and recovered but eventually begin having pain and loss of use, especially when going to the ceiling.

Total or partial shoulder joint replacement has become a more common treatment to relieve pain and restore independence.

Most joint replacements are done for hips and knees, but shoulder replacement is becoming more and more popular as a remedy for arthritis and fractures of the shoulder.

Total shoulder replacement, also known as total shoulder arthroplasty (TSA), is a tremendously successful procedure for treating the severe pain and stiffness that often result at the end stage of various forms of arthritis or degenerative joint disease of the shoulder.

The primary goal of shoulder replacement surgery is pain relief, with a secondary benefit of restoring motion, strength and function. Each year, thousands of TSAs are performed successfully in the U.S. This type of surgery, however, is not as beneficial for patients with large rotator cuff tears who have developed a complex type of shoulder arthritis called rotator cuff tear arthropathy.

Rotator cuff tear arthropathy is a devastating condition that seriously compromises the comfort and function of the shoulder. This condition is characterized by the irreparable loss of the rotator cuff tendons and destruction of the normal joint surface of the shoulder.

Usually X-rays and an MRI scan are needed to diagnose this. These tissues cannot be restored, so the shoulder is often weak, painful and unstable.

A patient suffering from this condition tries to alleviate the pain and weakness with other options, such as rest, medications, cortisone injections and physical therapy. Once these options have been exhausted, we may recommend surgery.

For patients with rotator cuff tear arthropathy, conventional total shoulder replacement may result in pain and limited motion. Therefore, reverse total shoulder replacement may be an option.

In a healthy shoulder, the upper arm bone, or humerus, ends in a ball shape. The ball fits into a socket formed by the shoulder blade, or scapula. Together this ball and socket form the shoulder.

In a reverse total shoulder replacement, the anatomy of the healthy shoulder is reversed. The implant is designed so the ball portion is attached to the scapula and the socket is placed at the upper end of the humerus.

Reverse total shoulder replacement works well for people with rotator cuff tear arthropathy because it relies on different muscles to move the arm. It relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.

Using this special technique and a reversed total shoulder design, one can improve the stability of the shoulder and enable the deltoid muscle to power it, even in the absence of a normal rotator cuff.

Doctors in Europe have been using this surgery for over 20 years. It received FDA approval in 2004, so it is a fairly new procedure in the U.S.

With this form of joint replacement, stability and function depend on the healing of soft tissues. When implanted by trained surgeons in the appropriate patients, the prosthesis provides restored motion, pain relief and increased stability.

I have personally observed handball players with a reverse THR. Watching them play, it is difficult to tell which side their surgery was on, even hitting overhead ceiling shots.

Patients see a drastic difference in their range of mobility and their ability to perform daily activities, such as eating, drinking and combing their hair. Patients who have had the procedure go from having severe shoulder dysfunction to sometimes full range of motion.

As always, consult a specialist who has experience in a reverse TSR.

Bob Snyder acknowledges the help of his partner, Martin R. Coleman, in writing this article. Dr. Coleman is also a board-certified orthopaedic specialist with Orthopaedic and Spine Center in Newport News, Va. His area of specialty is the treatment of shoulder injuries and arthritis, with a focus on traditional and reverse shoulder replacements. To learn more about Dr. Coleman, go to To make an appointment, call 757-596-1900.
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Author:Snyder, Bob
Date:May 1, 2014
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