I viewed a reverse shoulder replacement surgery.

The patient was 80 years old and a right handed female. She had a multiple year history of severe shoulder pain and loss of function. Her diagnosis was pseudoparalysis of the shoulder, in which she was unable to lift the arm to the shoulder level because of pain and significant weakness of the rotator cuff.

The type of surgery was the open surgery, which was specifically for the reverse shoulder replacement. In the reverse shoulder replacement surgery, the ball is placed on the glenoid fossa of the scapula and the socket is placed on the head of the humerus. Because I had never heard and seen about this surgery, I was really surprised that the surgery provided the patient a different anatomical structure than the human normally has!!!

According to the physician, the reverse shoulder replacement surgery prevents the bones between the head of the humerus and the acromion from colliding because of the lack of the rotator cuff muscles when the patient elevates the shoulder after the surgery. This is because the socket on the head of the humerus is stuck on the ball on the glenoid fossa at around 120 degrees elevation of the shoulder. As a result of those, the reverse shoulder surgery minimizes pain from the bone collision after the surgery, but limits the ROM (range of motion) within around 120 degrees, which is sufficient ROM for daily activity. I thought it did make sense. If I have two choices one being less pain and sufficient ROM, or another involving more pain and close to normal ROM at ages of over 70 years old, which is around the average age the physician performs, I will choose less pain and sufficient ROM ^^!

The physician conducted the surgery with the delto-pectoral approach, which reaches to the head of the humerus and glenoid of the scapula between the deltoid and pectoral major muscles.

I thought it was good way to decrease the tissue damage. The surgery began with cutting off the arthritis of the humerus head and shaving it to the hemisphere to be able to sit for the socket. I wondered how the physician decided how much bone to actually cut off because it seemed he did not care about the size or the length of the humerus he cut off. After that, the physician made a canal to fix the socket on the humerus head. Before the physician actually fixed the socket, he put the base plate on the glenoid fossa, and then put the ball on the base plate and fixed it with a back up screw. The physician came back to the humerus side, and poured the cement with antibiotic into the canal of the humerus that he had made. Then, he set up the socket on the humerus head and connected the subscapularis muscle to the humerus. I thought that the operation room and the tools were sterile so I did not think about infection. However, I learned that infection of the surgery site after the surgery is a major issue for a second surgery. The final outcome of the surgery was that the patient could abduct and flex the involved shoulder to around 120 degrees, and rotate internally and externally as usual while the patient was anesthetized and there was no collision of the bones and no interference of the muscles when the physician performed each ROM of the shoulder. Those indicators meant that the operation was a success.

The general anatomy I needed for understanding this surgery was about function of the rotator cuff muscles in the glenohumeral joint. The rotator cuff is a group of muscles: the supraspinatus, infraspinatus, teres minor and subscaplaris muscles. The function of the supraspinatus muscle is to abduct the arm. The fuction of the infraspinatus and teres minor muscles is to externally rotate the arm, and the function of the subscapularis muscle is to internally rotate the arm. Those muscles, however, work more as a group. The rotator cuff maintains the humeral head center on the glenoid with shoulder elevation and allows the deltoid muscle to elevate the humerus, so the balance of the rotator cuff is really important for shoulder elevation. If the rotator cuff muscle loses the balance, there is no muscle to counteract the deltoid muscle and upward shifting of the humeral head happens when the humerus is elevated. Long-term effect of upward shifting in the motion provides damage to the humerus head and causes the arthritis. As a result, the rotator cuff imbalance finally causes the loss of ability to elevate the arm.

Regarding tissue damage, from the superficial layers to the deep layers, the epidermis, dermis, subcutis, fascia, muscles, and bones were damaged. Also, to expose the head of the humerus and the glenoid fossa, the labrum and some muscles and ligaments were completely removed. However, a patient who needs the reverse shoulder replacement surgery generally has already many ligaments, tendons, muscles and bones damaged.

I thought the bone healing was a major component for the healing process after the surgery. The humerus head was cut off and the humerus and glenoid was drilled to fix the ball and socket. Also, the physician used a hammer and a screw so there were many hefty works. Based on the tissue damage, the patient is generally required to immobilize the shoulder for 6 weeks to maximize the connective tissue healing process and bone healing process. The physician said that those patients also start the ultrasound treatment and really mild ROM exercises after 10 days of the surgery. After 6 weeks, the patient starts stretching and ROM exercises to regain the ROM, and strength exercises, especially for the deltoid muscle for the next 3 to 6 months. I think that this is because the patient's supraspinatus and the tendon of the biceps brachii long head are no longer existent in the shoulder. Thus, the deltoid has a major role in the shoulder elevation after the surgery. I also think that a patient's age must be considered. The average age of a patient for this surgery is around 70, according to the physician. I think that healing process is relatively slower and the osteoporosis might exist, so I need to be careful about it and communicate well with the patient. Therefore the patient and the athletic trainer should be really careful to progress the rehabilitation process because of the large amount of the tissue damage and the patient's age.

My interest was about a patient's outcome and satisfaction. As I mentioned earlier, the reverse shoulder surgery creates abnormal anatomical structure in the shoulder joint and limits shoulder elevation to around 120 degree because of the design of the surgery. However, because patient feels less pain and more stability of the shoulder after the surgery according to the physician's experience, the reverse shoulder replacement gives a good satisfaction to the patient. I think the patient's age is an important factor about it. The patient's hope is to decrease pain and to be able to move the arm with no inconvenience in normal daily activity. Regaining full ROM of the shoulder is not considered for the patient's priority. Thus, considering the surgery, defining what is the final outcome of the reverse shoulder replacement to the patient is important.





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まっとめBLOG速報 : 2012/10/26 (金)


手術見学してきました^^専門用語を日本語に訳す時間がないため、今回は英語で感想書きます^-なかなか見れ … >>この記事を読む

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中嶋 康博

Author:中嶋 康博



体育学部健康科 卒業 

第一種衛生管理者 取得

食肉ヨーロッパ研修 パリ•ミュンヘン 参加

食肉流通業務実践コース 修了

University of California, San Diego Athletic Training Room
Internship for Athletic Training 2009/8~2011/4 

Core Power Yoga
Yogi Training Course 修了

University of North Carolina, Greensboro
Kinesiology, Master of Science Athletic Training
Class of 2013 



A mouse groupie(A star?)
-Ma vie-