Timothy J. Treible, M.D. on Reverse Total Shoulder Replacement (Part 1)

The treatment of patients suffering from chronic shoulder pain and disability as a consequence of rotator cuff tears has evolved dramatically. Prior to the introduction of reverse total shoulder replacements, treatment of patients with rotator cuff tears and subsequent severe arthritis caused by the abnormal mechanics of the shoulder resulting in so-called cuff arthropathy has been fraught with difficulty. Now, a type of shoulder replacement called a reverse total shoulder is available to treat these very challenging problems.

Patients oftentimes present with longstanding shoulder pain which has been treated with a number of nonoperative modalities including analgesics, physical therapy, and observation for years prior to being evaluated by an orthopedic surgeon. Unfortunately, rotator cuff tears are a very common shoulder problem and without early intervention, rotator cuff tears spontaneously progress and lead to a condition known as cuff arthropathy, in which the articular cartilage of the shoulder is lost, leaving the patient with a painful and very weak shoulder. Oftentimes, this progresses to the point where the patient is unable to lift their arm. They may not even be able to reach to touch the top of their head, and in some situations are unable to use that hand even to feed themselves.

The deterioration that occurs inside a shoulder as a consequence of a neglected rotator cuff tear is a complicated cascade. Since two of the tendons of the rotator cuff, the supraspinatus and infraspinatus, are important in initiating shoulder motion in a flexion and abduction type of arc, if those two tendons no longer are functioning other muscles attempt to compensate.

Unfortunately, when some of these other muscles, specifically the deltoid, take over the function of the rotator cuff with shoulder abduction and flexion, this may result in the humeral head subluxing out of the socket superiorly. This can cause the top of the humerus to scrape on the undersurface of the shoulder blade resulting in the development of arthritis.

Once the cartilage has been lost from the ball portion of the shoulder (the humeral head) there are no good techniques available that can regrow that lost cartilage. Making things worse, when the rotator cuff tendons initially tear if they are not promptly repaired oftentimes the tendons simply absorb, retract, and scar into position and become irreparably misshapen and shortened and can no longer be reconstructed appropriately.

More information on Timothy Treible, MD and the services he offers at East Portland Orthopedic and Fracture Clinic can be found at www.orthopdx.com.