What's a Reverse Total Shoulder?

In the past 15 years, there has been a remarkable advance in the world of shoulder surgery in the form of a new type of shoulder replacement called a "reverse" total shoulder.  In surgery, it is rare that something truly new comes along.  The reverse shoulder replacement represents a real improvement in a surgeon's ability to treat severe shoulder problems.

A Diagram of a Reverse Shoulder Replacement

What's new about it?  Unlike a standard shoulder replacement, the ball and socket are completely reversed.  In a normal shoulder replacement I remove the ball and socket and replace them with a new metal ball and plastic socket.  In a reverse total shoulder,  the metal ball actually goes on the socket side of the shoulder and the plastic socket is placed on what used to be the ball side.  Because the ball and socket are now opposite from their normal position, they are "reversed"--thus the term "reverse shoulder replacement."

Why is it needed?  What's so great about it?   Before the reverse total shoulder, there was no good way to treat the combination of shoulder arthritis and severe rotator cuff tendon tear.  We could treat shoulder arthritis with a regular shoulder replacement.  We could treat a tendon tear with a tendon repair.  But the patient with both of these problems at once could not be effectively treated.  There was literally no good answer for someone with that combination of problems.  The reverse total shoulder replacement was developed to provide a solution to that problem, and so far it has proved enormously successful.

Reverse shoulder replacement is only appropriate for a small number of patients with a very specific set of problems.  In my shoulder practice, I perform about 30-40 reverse shoulder replacements a year. Like any surgery, there is a risk of complications, and any decision to proceed with a replacement should only be undertaken after a careful evaluation and discussion with your surgeon.

To read more about reverse shoulder replacement, the American Academy of Orthopedic Surgery has a nice summary for patients at http://orthoinfo.aaos.org/topic.cfm?topic=A00504

New Shoulder Study: An Alternative to Cortisone Injection

A May, a new study was published in the Journal of Shoulder and Elbow Surgery which suggests an alternative to cortisone injection for people with shoulder pain.  For years, cortisone injections were given to patients with longstanding shoulder pain, because it works effectively to decrease inflammation.  This new study looked at a different medication, called toradol, to decrease inflammation in shoulder pain.  The researchers compared an injection of toradol with an injection of cortisone for people with pain in their shoulder. 

The result:  both medications worked to decrease pain and improve function.  However, the patients who received the toradol injection had better improvement in function and pain at the four-week mark compared with those who received cortisone. 

This information is quite useful, showing that there is an alternative to cortisone for patients with shoulder pain.  In my practice, I usually use toradol injections for patients who have not had benefit from cortisone.  This study may change my practice, and I may be more likely to recommend toradol instead of cortisone.  However, it is possible that the type of cortisone injection matters:  I use a long-acting cortisone medication, while this study did not.  Also, cortisone injections may give quicker pain relief, important for someone with significant pain.

Overall, though, this study is good news for those with shoulder pain, expanding the options for treatment.  To read more, here's the link to the study:

http://www.jshoulderelbow.org/article/S1058-2746(12)00372-2/abstract

For more on cortisone injections, here's a previous blog post:

http://blog.doctorfrisella.com/2013/01/are-cortisone-injections-bad-for-you.html