Dr. George Trappey IV, Orthopaedic Surgeon and Shoulder Specialist
What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm. Mobility can take a toll, however. Over time, repetitive motion activities on the job or through sports activities may lead to shoulder pain.
For Mable Moore, age 66, of Moss Bluff, it was her years of work in a school cafeteria and as a janitor that caught up with her after she retired. She had severe arthritis in both of her shoulders. Moore had both of her shoulders replaced over a two-year period of time. The "reverse shoulder replacement" technique is designed to eliminate pain and restore function in people with severe shoulder arthritis who also have a tear in the rotator cuff. The rotator cuff is essentially a cushion that prevents cartilage from rubbing on bone while at the same time providing an attachment for four muscles that are necessary for raising the arm. Basically, the rotator cuff kept things moving easily and intact. When that becomes damaged, it causes pain and loss of mobility.
People with severe shoulder arthritis combined with damage to the rotator cuff are generally not good candidates for standard total shoulder replacement because traditional shoulder replacement will not restore function and will relieve only part of the pain.
The conventional replacement joint uses a metal ball on the top of the arm bone, and a plastic socket on the shoulder blade; thus the ball-and-socket joints are replaced. The reverse shoulder replacement uses a ball-and-socket joint as well, but the ball is placed on the shoulder blade and the socket is placed on top of the arm bone; opposite of the normal anatomy which explains why it is known as "reverse" shoulder replacement. By reversing the socket and metal ball, the center of rotation is maintained. This shifts the strength needed to move the arm away from the damaged rotator cuff muscles and is instead shifted to the healthier deltoid muscle, solving the problem of what to do with the problematic rotator cuff. Before reverse shoulder replacement, we could relieve pain but normal motion was not restored to satisfactory levels. With a reverse procedure, we're able to relieve pain and restore motion. Patients report a big improvement and are able to return to normal activities and enjoy life again.