Reverse shoulder surgery

Jun 23 2008

When Gary Meyewski fell and shattered his humerus in three places in 2006, his quality of life was shattered as well. With the ball and socket in his shoulder severely damaged, he lost all function in his shoulder, experiencing a drastic loss of mobility, and eventually severe, chronic pain.

As little as five years ago, an injury this severe would have meant a lifetime of pain and an irreversible loss of mobility. But a relatively new revolutionary shoulder reconstruction technique helped to reverse this trend for Meyewski. Called "Reverse Shoulder Surgery," the surgical procedure was first approved by the Federal Drug Administration in 2004, though it's been performed in Europe for nearly 25 years.

Reverse shoulder surgery is the answer for those patients who have exhausted all other means of repair of their degenerated shoulder. Often, patients with large tears in their rotator cuff, who also have severe arthritis, are the best candidates. Most are in significant pain and have little to no movement in their shoulder. After the procedure, patients typically regain 90 to 150 degrees of full elevation.

"The impact this surgery has on these patients' lifestyle is amazing," said Ilya Voloshin, M.D., assistant professor of Orthopaedics at the University of Rochester Medical Center, and one of the few surgeons in the region who perform this surgery. "I've seen people with large tears in their rotator cuff and severe arthritis living with pain so debilitating they can't even lift their arms. It truly is a remarkable transformation, considering that before this procedure was approved, these patients had no good alternative treatments."

The name reverse shoulder surgery aptly describes the technique, as it actually reverses the anatomic structure of the shoulder. It uses a metal and plastic implant that works the opposite of a normal shoulder by placing the ball onto the shoulder blade and socket onto the top of the upper arm. The reversed position of the ball and socket alters the mechanics of the shoulder.

"This placement in effect creates a new center of rotation, so that the strength needed to move the arm is shifted away from the damaged rotator cuff muscles and to the healthier deltoid muscle," Voloshin explained. "Amazingly, the general shape of the shoulder remains the same even though the ball and socket are reversed."

After the surgery, patients start physical therapy in two weeks. A full recovery usually takes about six months.

For Meyewski, the surgery made all the difference in the world. He's regained most of his shoulder mobility and no longer suffers from the pain that was so intense, he was seeing pain specialists.

"I thought I was going to be in pain and disabled forever," he said. "I am so grateful to have my life back."

Did you know….

• About 60 percent of all people over 60 have rotator cuff tears based on MRI findings.
• About 50 percent of patients with asymptomatic rotator cuff tears are likely to have an increase in tear size and become symptomatic within three years.
• Patients with symptomatic full thickness rotator cuff tear in one shoulder have a 30 percent chance of having full thickness rotator cuff tear in the other shoulder.
• All-arthroscopic rotator cuff repair results in less post-operative pain, faster recovery, easier rehabilitation, and less chance of developing stiffness and infection. The cosmetic result is also better.