Clinician-to-Clinician Update Clinician-to-Clinician Update

Patient Regains Range of Motion after Reverse Total Shoulder Arthroplasty

March 2017

Contributed by Alicia K. Harrison, MD

Cartilage and bone loss in the shoulder due to chronic osteoarthritis can lead to degradation of the tendons that support the rotator cuff muscle and ultimately rotator cuff tearing.1 Standard total shoulder arthroplasty in patients with an irreparable rotator cuff tear results in poor range of motion and a higher rate of artificial joint component failure. Reverse total shoulder arthroplasty, approved by the FDA in 2004, allows the deltoid muscle to raise the shoulder joint and offers improved shoulder range of motion and reduction in pain.2

Patient

A 72-year-old male patient was referred to the University of Minnesota Health Orthopaedic Clinic with shoulder pain and limited range of motion. Chronic osteoarthritis had contributed to the degeneration of tendons in his shoulder joint. He was unable to perform simple daily tasks or to receive hugs from his grandchildren without severe pain.

March-2017-Adult-Spec-Ortho-Case-Study-Figure-1
— Figure 1. Pre-operative X-ray

Management

X-ray images revealed a complete loss of space in the glenohumeral joint and marked migration of the humerus superior to the glenohumeral joint as a result of irreparable rotator cuff tear due to chronic osteoarthritis. (See Figure 1.) The patient was diagnosed with cuff tear arthropathy. Due to severe deterioration in the rotator cuff and in the tendons supporting the joint, standard total shoulder arthroplasty was not indicated. The patient was prescribed reverse total shoulder arthroplasty. Evaluation by a team including the primary care physician, cardiologists, and anesthesiologists revealed no increased risk of complications. The patient agreed to undergo the procedure.

March-2017-Adult-Spec-Ortho-Case-Study-Feature-and-Figure-2
— Figure 2. Postoperative X-ray

The procedure was performed without complications by an experienced orthopaedic surgeon specializing in shoulder disorders. The patient received physical therapy and was monitored in routine clinic visits and with X-rays. (See Figure 2.) The patient experienced a marked reduction in pain and is now able to raise his arm above his head and perform basic daily tasks. Perhaps most important to the patient, he can hug his grandchildren again.

Discussion

The need for total shoulder arthroplasty is rising most rapidly in adults over the age of 55. Commonly in this age group, osteoarthritis leads to irreparable damage to the rotator cuff.2 Close attention to the condition of soft tissue and bone within the arthritic shoulder joint guides an experienced shoulder specialist in determining treatment.1 In this instance, reverse total shoulder arthroplasty was appropriate and provided the best outcomes for the patient.

References

  1. Millett PJ, Gobezie R, Boykin RE. Shoulder osteoarthritis: diagnosis and management. Am Fam Physician. 2008;78(5):605-611.
  2. Westermann RW, Pugely AJ, Martin CT, et al. Reverse shoulder arthroplasty in the United States: a comparison of national volume, patient demographics, complications, and surgical indications. Iowa Orthop J. 2015;35:1-7.
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