Shoulder & Elbows

• TCJR Now Offering "Reverse Total Shoulder" Replacements
• The Shoulder: A Vulnerable Joint
• New Shoulder Treatments
• Rotator Cuff Injuries
• Elbow or Shoulder Replacements

TCJR Now Offering "Reverse Total Shoulder" Replacements

By Richard Reitman MD
Texas Center for Joint Replacement is now offering a solution to a debilitating problem with shoulder arthritis — the "Reverse" total shoulder replacement. While the name brings up images of odd anatomical changes, it is really a way to utilize other muscles outside the rotator cuff group to do the job of the rotator cuff and allow surgeons to effectively treat arthritic shoulders.  Shoulder arthritis is often accompanied by torn or degenerated muscle and tendons of the so-called "rotator cuff".  Because an intact rotator cuff is critical to the long-term success of total joint replacement in the shoulder, people with this condition often had limited solutions to their pain and discomfort.

Arthritis is a condition that occurs in various joints in the body. The pain can vary from mild to very severe, depending upon many factors, including the severity of the disease, the type of arthritis (most of the time degenerative arthritis-caused by wear and tear, but sometimes rheumatoid arthritis), and the activity level of the patient.

The treatment of shoulder arthritis depends on how disabling and painful the disease is. Physical therapy, particularly water therapy, is very soothing, and helps maintain or regain range of motion of the joint, and strengthens the surrounding muscles. If the arthritis is advanced, then your doctor may consider an operation. Some early arthritis can be treated with arthroscopic (microsurgical) techniques. With this operation, the doctor will trim out the inflamed synovial lining tissue and remove debris. It is not a cure, but can relieve many of the symptoms. In severe cases, the only treatment is total shoulder replacement. For people with intact rotator cuffs, this operation is very successful. But for people whose rotator cuff has been torn beyond repair, and who often cant even lift their arm, this operation is not indicated.

The rotator cuff is comprised of a very important group of muscles beneath the deltoid muscle. It forms a "cuff" of muscle and tendon around the humeral head and helps keep the shoulder joint stable. In the past, candidates with severe rotator cuff deficiency were not candidates for total shoulder replacement. And the same wear and tear that can bring about arthritis of the joint is often responsible for degeneration of the muscle tissue around the joint as well.

Reverse Total Shoulder Replacement is a key development in the field of shoulder surgery. It makes better use of the large deltoid muscle covering the shoulder joint. The deltoid is responsible for shoulder motion to the side, from and back. The Reverse Total Shoulder Replacement uses a reverse ball and socket, which is specifically designed for use in patients with non-functional rotator cuffs, but who have good functioning deltoid muscles. In a normal total shoulder replacement, there is a plastic cup that fits into the shoulder joint itself and a metal ball that fits in the top of the humerus (arm bone). In a reverse total shoulder, the liner and ball change positions, which allows the deltoid to function more like the rotator cuff and restore motion to the shoulder.

Reverse total shoulder replacement components