Reverse Shoulder Replacement (Delta joint replacement) for arthritis: Surgery with a reverse prosthesis can lessen shoulder pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Friday, June 20, 2008
Review of the conditionWhat are some general characteristics of reverse shoulder? What are its usual manifestations? Rotator cuff tear arthropathy (or shoulder arthritis with a large
rotator cuff tear) is a severe and complex form of shoulder arthritis
in which the shoulder has lost not only the cartilage that normally
covers its joint surface, but also the tendons of the rotator cuff tear
which help position and power the joint. [Figure 9]
Normally, the tendons of the rotator cuff (large arrows) allow
smooth motion of the upper end of the arm bone (humerus) beneath the
overlying bones, ligaments, tendons and muscles. [Figure 10]
When the rotator cuff is degenerated, chronically torn or otherwise
deficient, the normally smooth upper surface of the upper end of the
arm bone (humeral head) is unprotected from rubbing with the
undersurface of the bone and ligaments above as shown by the large
arrow. [Figure 11]
In cuff tear arthropathy, the upper surface of the ball of the upper
arm bone (humeral head) becomes roughened as it rubs against the
overlying bone (the acromion) as shown by the arrow. [Figure 12] This
condition results in shoulder pain, weakness, stiffness and grinding on
movement. What are the different types of reverse shoulder? Rotator cuff tear arthropathy appears to be a condition with a
succession of stages, depending on the stability of the humeral head
(ball of the shoulder joint) in respect to the glenoid (socket of the
shoulder joint). These stages have been described at the beginning of this article.What else might be confused with or similar to reverse shoulder? How can these be distinguished from the condition? Shoulder arthritis with a massive cuff defect must be distinguished
from arthritis without substantial rotator cuff involvement, from
isolated rotator cuff disease, from frozen shoulder, and from neck
arthritis, each of which may produce somewhat similar symptoms.
Arthritis usually gives rise to stiffness without weakness. Rotator
cuff tears usually cause pain and weakness, but stiffness is less
common. Frozen shoulder is characterized by shoulder stiffness, but the
X-rays are usually normal. Neck arthritis may cause shoulder pain and
weakness that is worse when the head is held in certain positions.How common is reverse shoulder (statistics, demographics, risk factors)? Rotator cuff tear arthropathy (or shoulder arthritis with a large
rotator cuff tear) most commonly occurs in individuals over the age of
65 and is more common in women than men.
How is reverse shoulder diagnosed? What tests or exams may be used? Rotator cuff tear arthropathy (or shoulder arthritis with a large
rotator cuff tear) is diagnosed by a history of progressive loss of
shoulder function, usually without an injury, along with a physical
examination showing weakness and grinding on movement and a typical
appearance on X-ray. In these films the humeral head can be seen
contacting the undersurface of the coracoacromial arch (indicated by
the arrows). [Figure 13] The most important test for cuff tear
arthropathy is the x-ray, characteristically showing rounding off of
the humeral head as it contacts with the undersurface of the
coracoacromial arch.
[Figure 14]
Rotator cuff tear arthropathy (arthritis of the shoulder associated
with a massive cuff tear) is best diagnosed by an orthopaedic surgeon
with experience in shoulder disorders. Certain surgeons specialize in
rotator cuff tear arthropathy (arthritis of the shoulder associated
with a massive cuff tear). Such individuals may be found in the
shoulder services of major schools of medicine. Can medications help reverse shoulder? Mild analgesic medications may relieve some of the symptoms of cuff tear arthropathy.Can exercises help reverse shoulder? If the symptoms of rotator cuff tear arthropathy (shoulder arthritis
with a massive rotator cuff tear) are mild, the condition may be
treated with gentle motion exercises and exercises to strengthen the deltoid and other muscles around the shoulder that remain intact. Specifically, how is reverse shoulder improved by reverse shoulder? When exercises are not successful, most cases of cuff tear arthropathy are considered possible candidates for shoulder joint replacement arthroplasty with a cuff tear arthropathy
(CTA) head prosthesis that allows arthritic shoulders to regain some of
their lost comfort and function. However, when the shoulder is no
longer stabilized with the ball in the socket, consideration can be
given to a reversed (reverse Delta) prosthesis.
Joint replacement surgery can improve the mechanics of the shoulder,
but cannot make the joint as good as it was before the onset of rotator
cuff tear arthropathy. The effectiveness of the procedure depends on
the health and motivation of the individual, the condition of the
shoulder, and the expertise of the surgeon. When performed by an
experienced surgeon, shoulder replacement arthroplasty with reversed
(reverse Delta) prosthesis can provide improved stability along with
improved shoulder comfort and function. The greatest improvements are
in the ability of the individual to sleep and to perform some of the
simple activities of daily living. In that the tendons of the rotator
cuff are not repairable in this condition, normal strength and function
of the shoulder cannot be regained.
Surgery for Reverse Shoulder at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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