Monday Medical: Reverse procedure relieves major shoulder problem
Tamara Rogach is no stranger to shoulder problems. At one point, putting on a coat felt like torture and raising her arm high enough to hang up her coat was impossible. Rogach’s weak and painful shoulders were the result of severely damaged rotator cuff tendons.
Twelve years ago, there wasn’t a solution to this debilitating problem. Total shoulder replacement surgery is only effective in patients whose rotator cuff tendons still are intact. It’s useless for patients such as Rogach, whose rotator cuff muscles were completely torn. Cortisone injections also tend to be less helpful for pain associated with this problem.
“These are patients I just didn’t know what to do with,” said Dr. Bryan Bomberg, an orthopaedic surgeon who specializes in shoulders and other joints.
Fortunately, a relatively new procedure, which reverses the cup-ball mechanisms used in conventional total shoulder replacement, is helping restore shoulder function and relieving pain in Rogach and others with massive rotator cuff tears.
Bomberg performed the procedure — reverse total shoulder replacement — on Rogach’s left shoulder in 2011 and then on her right shoulder in 2012. Within four months of the second surgery, she was driving a manual-speed car and now accomplishes daily living and low-impact activities, such as swimming, pain free.
“For me, the results have been great,” Rogach, 78, said after an afternoon of gardening and pulling weeds.
In a healthy shoulder, rotator cuff muscles stabilize and help power the arm. Overuse, genetics and other factors can cause these muscles to thin and degenerate. When this happens, the arm bone becomes unbalanced and rubs against bone in the shoulder socket.
This problem can worsen, resulting in a condition called cuff tear arthropathy, a complex type of shoulder arthritis characterized by severe pain and weakness.
In conventional total shoulder replacement, a plastic cup is fitted into the shoulder socket and a metal ball is attached to the upper arm bone. This procedure needs the help of the rotator cuff to function properly. In a reverse total shoulder replacement, the cup and ball are switched, relying on the deltoid muscle to stabilize the arm.
“The mechanism change allows you to work without a rotator cuff,” said Bomberg, who estimates about half of the shoulder replacements he performs are reverse total shoulder replacements.
The reverse technology was developed by French medical researchers in the early 1980s and was refined considerably before being approved by the Food and Drug Administration in 2003. Results of intermediate or 10-year studies are promising and patient satisfaction typically is high, the American Academy of Orthopaedic Surgeons reported.
Bomberg also has seen good results. He has been doing the surgeries since 2007 in older patients who are more able to temper their activity levels. Reverse total shoulder replacement restores some shoulder function, but repaired shoulders cannot sustain heavy lifting. Patients are urged to refrain from risky and strenuous activity that could re-injure the shoulder.
“You still have to be careful. You’ve got to watch it,” said Rogach, who gave up Alpine skiing but still enjoys gentler sports such as cross-country skiing and snowshoeing.
You may be a candidate for reverse total shoulder replacement if you have a completely torn irreparable rotator cuff, cuff tear arthropathy, severe shoulder pain and difficulty lifting your arm away from your side or over your head, a previous unsuccessful shoulder replacement, or other treatments — rest, medications, cortisone injections and physical therapy — have not relieved your pain.
It’s important to see a shoulder specialist to determine the nature of your shoulder problem and the best surgery or treatment for you.
This article includes information from the American Academy of Orthopaedic Surgeons, http://www.aaos.org, and University of Washington Orthopaedics and Sports Medicine, http://www.orthop.washington.edu.
Bryan C. Bomberg, MD, of Steamboat Orthopaedics Associates is a board-certified orthopaedic surgeon.
Tamera Manzanares writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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