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Reverse Total Shoulder Replacement


About Reverse Total Shoulder Replacement:

The shoulder is the most mobile joint in the human body. This mobility is provided by the many muscles-including the rotator cuff-surrounding the shoulder joint working in concert. The shoulder joint also has a very shallow bony socket, which means that keeping the shoulder stable is also primarily the job of all the soft tissues (including the rotator cuff) surrounding the shoulder. The soft tissues surrounding the shoulder allow for a well coordinated range of movement which includes rotation and gliding of the shoulder ball and socket joint and the shoulder blade.

When the normally smooth surface of the shoulder joint becomes rough and painful-as with shoulder arthritis– a total shoulder replacement can restore the smooth surface, providing much needed pain relief. The soft tissues surrounding the shoulder are then able to resume their work in providing a well coordinated range of movement.

Unfortunately, sometimes shoulder arthritis can coexist or be the result of an unstable shoulder. One reason for this can be a large rotator cuff tear that cannot be repaired leading to a high riding shoulder joint.

This situation typically provides minimal or unpredictable pain relief and persistent limitation in shoulder function. A standard shoulder replacement addresses arthritis but doesn’t answer the problem of a high riding or unstable shoulder. Note that in a standard shoulder replacement the shoulder hosts the “socket” and the arm has the “ball”.

The reasons for this are both complex and simple. Muscles can only shorten to do their work. In order to shorten a muscle needs to be stretched out to an optimal length. All motion of our joints including the shoulder joint is provided by muscles. Normally, we have one muscle that shortens while another lengthens to provide a stable balance and ability to move a joint in many directions. For instance, think about moving your elbow-when you bend your elbow, the biceps shortens while the triceps becomes longer. To then straighten your elbow, the triceps shortens while the biceps lengthens. This balance also exists in the shoulder but in many different directions. When the shoulder is high riding or unstable, the muscles that move the shoulder aren’t able to do their work because they either can’t shorten or be pulled out to the optimal length.

A reverse total shoulder replacement helps experienced shoulder surgeons provide an answer for the debilitating shoulder pain due to this combination of arthritis and instability. Note that we “reverse” the ball to the shoulder and the socket to the arm, which gives the procedure its name, the Reverse Total Shoulder Replacement. See the Reverse Total Shoulder in Motion.

The reverse total shoulder replacement provides the shoulder with a stable center of rotation allowing the muscles of the shoulder to resume their optimal length. As it is a type of total shoulder replacement, it replaces the arthritic and painful joint as well. This combination of stability and pain relief can provide patients with remarkable pain relief and function.

Invented in France by Dr. Paul Grammont in 1985, the Reverse Total Shoulder Replacement has been used in Europe since then with promising results. The Reverse Total Shoulder Replacement was approved by the FDA for use in the United States in November 2003. The first case in the United States was performed in April 2004. Dr. Agrawal had the opportunity to go to France to study with Drs. Pascal Boileau and Gilles Walch and learn the technique from experienced world renowned experts. He performed the first case in Indiana in June 2004. Since then Dr. Agrawal of Arizona Center for Hand to Shoulder Surgery has become one of the leading providers for the Reverse Total Shoulder Replacement in the United States.

The Reverse Total Shoulder Replacement can have significant complications, as with any surgical procedure. It is important to have a detailed and thorough evaluation by a shoulder specialist to determine the best treatment option for you personally. To have a shoulder specialist evaluate your condition and recommend the best solution contact us.

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