A reverse total shoulder replacement is a surgical procedure used to treat severe shoulder problems, particularly in cases where the rotator cuff muscles are damaged or non-functional. It involves removing the damaged parts of the shoulder joint (ball and socket) and replacing them with an artificial joint. The main difference from a standard shoulder replacement is that the positions of the ball and socket are reversed or switched. The artificial ball is attached to the socket side (glenoid), and the artificial socket is placed on the arm bone (humerus) where the natural ball used to be.

When Is It Recommended?

A reverse total shoulder replacement may be recommended in the following cases:

• Massive or irreparable rotator cuff tears
• Cuff tear arthropathy (combination of rotator cuff tear and arthritis)
• Failed previous shoulder replacement surgery
• Complex shoulder fractures
• Chronic shoulder dislocation
• Tumors of the shoulder joint

How Does It Work?

By reversing the ball and socket positions, the surgery allows different muscles like the deltoid to power the arm movement instead of relying on the damaged rotator cuff muscles.

This changes the biomechanics of the shoulder joint, improving stability and range of motion even with a non-functional rotator cuff.

Surgical Procedure

The damaged bone is removed, and the artificial components (metal ball and plastic socket) are positioned to restore shoulder function. The surgery typically takes 2-3 hours under anesthesia.

Recovery & Rehabilitation

While a reverse total shoulder replacement can provide significant improvement in pain and function for specific shoulder conditions, it is a complex procedure with potential risks like any major surgery. Careful evaluation by an orthopedic surgeon is essential to determine if it is the appropriate treatment option.

• Immediate post-op protocol involves wearing a sling for 4 weeks.
• Physical therapy is crucial to regain strength and range of motion.
• Most patients can lift their arm to shoulder height or above after rehabilitation.

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