Reverse shoulder operation

Not sure what you mean by reverse shoulder operation. Can you explain?

I had shoulder surgery Oct 30 last year, but mine was to reattach 3 tendons torn off the bone.

Wish there were some replies. My surgeon suggests that procedure for both of mine. Ive done 2 knee replacements, but im concerned about this too.

Reverse shoulder replacement is for those with large, irreparable rotator cuff tears that have consistently demonstrated poor outcomes from “traditional” shoulder replacement due to loss of the stability provided by these muscles.

In the normal shoulder joint, the “ball” is at the top of the arm bone, and the “socket” is in the shoulder. After reverse shoulder replacement, the ball and socket are reversed, which results in a more stable joint. You MUST have an intact and functional deltoid muscle for a reverse shoulder replacement to work, though.

Also, the term “socket” should not be taken literally, as it does not surround the “ball” as you would see in the mechanical world. It’s actually a very shallow cup, and the stability of the joint is totally reliant on the many muscles surrounding it being intact.

Reverse Shoulder Replacement

I know more than I want to know about this procedure due to having multiple irreparable rotator cuff injuries (total separation) in both shoulders, and having torn the deltoid in my right shoulder about 4 years ago. Fortunately, the deltoid was surgically repaired, and I have almost full range of motion in both shoulders, although not totally pain free. Ive been told that if I should ever need shoulder replacement surgery, the only type that would work for me is a reverse.

:):)

A good friend had this procedure about five years ago and was very pleased with the results. He also had the conventional surgery on the other shoulder. The only setback with the non-conventional method was that when he was in rehab, the therapist over extended the shoulder muscle and tore some of the tissue which resulted in a second surgery to repair. OUCH!

Kevin explained the procedure very well. I had rotator cup surgery in 2003 with 4 Titanium moly bolts reattaching the top part of the cuff. Since then 3 ligaments were completely torn and retracted. In addition my bicep tendon is partially torn and pulled out of position. I asked about putting a spacer in for the retracted tendons and the Dr said it is possible but if the tissue is too soft it will only tear out again. They use thick skin from a cadaver for this spacer. So he was suggesting a reverse shoulder as a safer alternative. I guess it is a fairly new procedure within the last 10 years.

After reading the info here, I see my situation does not apply to your query.

I went off a ladder a few years ago, (Dec 2015) put my arm out to stop the fall and I severely damaged my rotator cuff. According to the doctors there are 4 main tendons holding things together in there. I tore 3 of them, 2 completely off and a 3rd halfway through, plus one for my bicep that was not found until the surgery.

I didn't go to the doctor right away, being a typical male thinking it was just a minor sprain and it will heal itself... I was very wrong.

It never healed, only got worse to the point I could not do daily living functions with my right arm without a lot of pain. I finally went to the doctor in early 2018, seeking some relief from all the pain. It got so bad I couldn't even feed myself with my right arm, had to use my left. I had major trouble sleeping too from the constant heavy aching.

Mine was a work related injury, but WCB threw me under the bus and used every excuse to deny my claim, so I was on my own. Still had to work and make a living, that was tough.

I wound up at the Sports Medicine Center at the University of Calgary, and saw a totally amazing specialist there. He works on a lot of pro athletes so he really knows his stuff. Long wait for surgery, but I had it on Oct 30, 2019. Doc told me it was one of the worst damaged shoulders he has ever seen. He said it was a real mess and that he couldn't promise a successful repair, but would do his best. And do his best he did! He told me after that it was a complete success.

Fast forward to now, 10 1/2 months later, it is doing very well. I cannot lift my arm over my head yet, but it is coming along well, getting better all the time. Range of motion is still limited, but the pain is gone. I can function quite well again, just cannot lift anything over my head. My strength is returning, I can do things with my arm down lower, such as cranking my TT off the hitch.

I cannot say enough good about the surgeon at the U of C. He was amazing.

Glad you are on the mend Bob. Do you know what he actually did to make the repair? I did not realize I torn mine completely off over a year ago that is why they shrunk. Apparently other muscles get stronger and compensate somewhat so I was still able to do pullups and any kind of pulling exercises. I just could not push anything over head or any other pushing exercises. Then about a month age I fell off my bike in soft sand and that tore the bicep tendon and pulled it out of joint when I put my arm down to break the fall. I have an appointment next wed to review options. The reverse shoulder seems very extreme that is why I asked here hoping there may be another option.

Gary, I understand how you feel about the reverse shoulder surgery. It sounds extreme to me as well, which is why I haven’t gone that route yet. My doc also feels I should hold off as long as possible, because there’s the possibility that if it’s done too soon you could actually wear out the new parts and need a second replacement 15 or so years down the road.

There are four rotator cuff muscles, and it’s not uncommon at all for someone (males especially) to tear or totally separate the two smallest ones by the time you’re in your mid-forties. That’s what I did in both shoulders, and just thought it was normal “getting old” aches and pains. Then moving some heavy equipment I started tearing my right deltoid away from its attachment point at the shoulder. That didn’t hurt too much until the muscle started ripping down the middle, and I lost use of my upper arm.

During surgery to fix the tear, the doc also found that the bicep long-head tendon was damaged to the point where it had to be cut loose and not reattached (bicep tenotomy vs. tenodesis where it’s reattached to the upper arm bone), so my right bicep looks funny now. My upper arm was immobile long enough that all the arm and shoulder muscles associated with it atrophied. Getting them working again took several months, and the 24x7 pain didn’t stop for almost two years.

Today like I said, I have 90-95% range of motion, maybe only about half of the upper arm and shoulder strength, and similarly diminished endurance with that arm. Working above shoulder height is difficult, but I can do it if it’s for a short duration. It’s not pain free, but it’s manageable without Rx drugs, and thank goodness it’s no longer 24x7.

So, you CAN live without some of your rotator cuff muscles, half your bicep disconnected, and a repaired deltoid. But I would never advise anyone which way to go on this. The wisest thing to do would probably be to get a second and maybe even a third opinion. Your age will likely play a big part in what you decide.

:):)

NRALIFR wrote:
Gary, I understand how you feel about the reverse shoulder surgery. It sounds extreme to me as well, which is why I haven’t gone that route yet. My doc also feels I should hold off as long as possible, because there’s the possibility that if it’s done too soon you could actually wear out the new parts and need a second replacement 15 or so years down the road.

There are four rotator cuff muscles, and it’s not uncommon at all for someone (males especially) to tear or totally separate the two smallest ones by the time you’re in your mid-forties. That’s what I did in both shoulders, and just thought it was normal “getting old” aches and pains. Then moving some heavy equipment I started tearing my right deltoid away from its attachment point at the shoulder. That didn’t hurt too much until the muscle started ripping down the middle, and I lost use of my upper arm.

During surgery to fix the tear, the doc also found that the bicep long-head tendon was damaged to the point where it had to be cut loose and not reattached (bicep tenotomy vs. tenodesis where it’s reattached to the upper arm bone), so my right bicep looks funny now. My upper arm was immobile long enough that all the arm and shoulder muscles associated with it atrophied. Getting them working again took several months, and the 24x7 pain didn’t stop for almost two years.

Today like I said, I have 90-95% range of motion, maybe only about half of the upper arm and shoulder strength, and similarly diminished endurance with that arm. Working above shoulder height is difficult, but I can do it if it’s for a short duration. It’s not pain free, but it’s manageable without Rx drugs, and thank goodness it’s no longer 24x7.

So, you CAN live without some of your rotator cuff muscles, half your bicep disconnected, and a repaired deltoid. But I would never advise anyone which way to go on this. The wisest thing to do would probably be to get a second and maybe even a third opinion. Your age will likely play a big part in what you decide.

:):)

Thanks for sharing your experience Kevin. I am 73 but fairly active. I can live with the pain I have had knee arthritis since 52 and was very painful at first, and now no longer notice it except from getting off of a chair. I guess you get used to the pain. What I worry about is further tearing out my bicep mussel or doing some other damage. I know what you mean about rehab it took me 1&1/2 years to rehab each rotator cuff repair.

Gjac wrote:
Glad you are on the mend Bob. Do you know what he actually did to make the repair? I did not realize I torn mine completely off over a year ago that is why they shrunk. Apparently other muscles get stronger and compensate somewhat so I was still able to do pullups and any kind of pulling exercises. I just could not push anything over head or any other pushing exercises. Then about a month age I fell off my bike in soft sand and that tore the bicep tendon and pulled it out of joint when I put my arm down to break the fall. I have an appointment next wed to review options. The reverse shoulder seems very extreme that is why I asked here hoping there may be another option.

Thanks, yes I am on the mend for sure. I likely could have been further along, but I got lazy with my at home physio and exercise. I was actually very paranoid about re-tearing the muscles off again, so I was extremely careful not to overdo it.

Doctor told me that he used something to basically "rivet" them back onto the bone. Not an actual rivet, but something similar in concept. He told me that with the attachment to the bone, it would bond itself naturally over time, which it has done.
I was in a sling for 6 weeks with no use whatsoever of my shoulder. I could use my hand a bit at my side but no more.

It sounds like your injury is similar to mine, so perhaps the extreme "reverse shoulder" procedure may not be needed. Obviously, I am not a doctor and I am only guessing at that. We are all different. But it sounds like yours was done in a similar fashion. If it is just a case of muscles/tendons being torn off the bone, then the arthroscopic procedure used on me may suit you. Arthroscopic is a small incision where they insert the tools to perform the repair, rather than cutting things wide open. It heals faster too. I have 3 small scars where he went in.

My other muscles did indeed compensate, and I was still able to do a lot prior to surgery. I couldn't lift my arm over my head, but I could grab it with my left and drag it up there. Once above my head I could put a drill in my hand and use it, albeit with a lot of pain. Strange thing...

I was still working out at the gym after the injury. I refused to accept I was hurt I guess. I was ok pushing / pulling down low, as long as I didn't try extending my arm. With the injury I could still dead lift 245 with a straight bar, 265 with a trap bar. Not bad considering I was 65 when I had things fixed.

My muscles were badly atrophied before surgery, as they were torn right off and resting in the contracted position. But the doc was still able to stretch them out enough to reattach to the bone. I was nearly 4 years from the injury date to surgery, so they had lots of time to just sit there doing nothing.

I agree with the things Kevin is saying here too, sounds like he is educated in this problem too.

You are only a few years older than I am, you said you are active, so am I. I would try for the reattachment process before getting radical about it.

Recovery? Well, I have to admit, after surgery I had a dickens of a time. There was no comfort to be found in bed. As soon as I laid down, the aching set in. And it was miserable. Lots of pillows, sleep upright, try a recliner chair, I did it all. I took the meds they gave me once, only once. Opioids, and they put me into a stoned stupor. I did use Advil for the first couple weeks, then decided to tough it out. Drug free body, and I like it that way. Yes I suffered a lot at first. However, after a couple months passed I was able to sleep again with less discomfort. It's a process, you gotta go through some ugly times for the first while. But it does pass.

I am now pain free. My shoulder no longer sounds like a bowl of rice crispies when I move it. I am now glad I had it done, wasn't sure at first. The lack of living in pain makes it all worthwhile. I imagine I will be another while before I'm back to normal. I could exercise more..