What Is Reverse Shoulder Replacement?
Your shoulder is a ball-and-socket joint. The ball is the upper end of the arm bone (humeral head) and the shallow socket is part of the shoulder blade (glenoid). In a normal shoulder, the rotator cuff, a group of four muscles and their tendons, keeps the ball centered in the socket and helps you lift and rotate your arm.
In a reverse shoulder replacement, the surgeon attaches a new ball to the shoulder blade and a new socket on a stem to the upper arm bone. This is the reverse of your natural anatomy, which is where the name comes from. The new arrangement lets the large deltoid muscle over the outside of your shoulder do the work of lifting the arm, so the joint can function even when the rotator cuff no longer can.
This is different from a standard (anatomic) total shoulder replacement, which keeps the ball and socket in their natural positions and depends on a working rotator cuff. Your surgeon will explain which design fits your shoulder.
Performed at a hospital or surgery center where our surgeons operate, with evaluation, imaging, follow-up visits and physical and occupational therapy here in our Boynton Beach office.
Who Is a Candidate?
You may be a candidate if you have one of these problems and it causes pain or weakness that limits daily life:
- A large rotator cuff tear that cannot be repaired, especially if you cannot lift your arm well above shoulder height.
- Cuff tear arthropathy, a type of shoulder arthritis that develops after a long-standing rotator cuff tear.
- Arthritis of the shoulder together with a weak or torn rotator cuff.
- A complex fracture of the upper arm bone near the shoulder (proximal humerus fracture), often in older adults, when the pieces cannot be reliably fixed.
- A previous shoulder replacement that is no longer working well, in selected cases.
When it is reasonable, our surgeons start with non-surgical care such as physical therapy, activity changes, medication when safe for you and injections. Surgery becomes a choice when those no longer give enough relief or when a fracture needs it. Your health, bone quality and goals all shape the recommendation.
What to Expect
Your evaluation includes an exam and X-rays in our Boynton Beach office, and sometimes an MRI to look at the rotator cuff. Your surgeon reviews the images with you, explains why a reverse design fits your shoulder and talks through the plan. Our on-site therapists can show you how to use the sling and set up your home before surgery.
Surgery usually takes about two hours. Most patients receive general anesthesia, often with a nerve block that numbs the shoulder and arm for pain relief. Depending on your health and the facility, you may go home the same day or stay in the hospital for a night or two. You will leave in a sling.
Risks and Side Effects
Reverse shoulder replacement is an established operation, but it carries risks. These include infection, blood clots, dislocation or instability of the new joint, nerve injury, fracture of the bone around the implant, loosening or wear of the implant over time, and risks from anesthesia or the nerve block. Some patients develop scapular notching, which is wear on the edge of the shoulder blade where the implant meets the bone; it is often seen only on X-ray, and your surgeon will watch for it at follow-up visits.
Reverse shoulder replacement is designed to restore lifting, but rotating the arm behind your back or outward may remain limited. Your surgeon will talk with you about realistic goals and the steps used to lower your risks.
Recovery
Recovery varies. Most patients wear a sling for several weeks, often around four to six. Therapy is staged: gentle motion first, then active motion as the shoulder heals, and strengthening later, often starting around two to three months. Many people return to everyday tasks such as dressing and light household work within a few months, with gradual improvement for six months to a year.
Your physical and occupational therapists work in our office and share your chart with your surgeon, so each stage of therapy matches how your shoulder is healing. Your surgeon will give you guidelines on lifting, reaching and pushing up from a chair, and these protect the joint while it heals.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Reverse shoulder replacement is usually covered by Medicare and most commercial PPO plans when it is medically necessary, often with prior authorization. HMO and managed-care plans require a referral from your primary care physician before your visit. Co-pays, co-insurance and deductibles apply. Call our office and our team will verify your benefits.
When to Talk to a Specialist
Schedule an evaluation if shoulder pain keeps you up at night, you cannot lift your arm well, or weakness from a rotator cuff tear is getting worse. Go to the emergency room or call 911 if your shoulder looks deformed after a fall. After surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision, or if your shoulder suddenly looks out of place or you cannot move it after a pop or fall, which can be a sign of dislocation. For other questions after hours, call our main office number to reach the answering service. Call 911 for sudden shortness of breath or chest pain.
