Reverse shoulder replacement

[fredtoast]

My father is in amazing physical condition for a man 86 years old. He still raises cattle on his farm and cuts enough firewood every year to heat his home for the whole winter. He even split the wood with an ax or maul until he was into his 70's. He has a woodsplitter now, but he still falls the trees, cuts them up, hauls and stacks all of the wood.

This year his shoulder finally gave out on him. he can't lift his arm above shoulder level. They did an MRI and the doctor told him that his rotator cuff (a group of tendons that stabilize the shoulder joint) was completely torn. The doctor also said that the tendons were so worn out that they could not be repaired. If they were sown back together they would just tear again. So instead he ordered some physical therapy and told my dad he may need a shoulder joint replacement.

My dad does not think that physical therapy will help, and he also did not understand how replacing the the bones in the shoulder joint would help with his rotator cuff problem. He asked me to do some research and I found some fascinating information about a "reverse shoulder replacement".

Everyone knows that there is a ball on the end of the arm bone that fits into a socket in the shoulder. With a reverse shoulder replacement they attach a ball on the shoulder and the socket is on the end of the arm bone. Then somehow the way they reattach the muscles allows the shoulder to work without the rotator cuff tendons. I am sure it will not work as well as a normal shoulder joint, but it is supposed to function a lot better than a shoulder with no rotator cuff tendons.

I still don't know exactly how it works, but it is fascinating that they even thought of something like this. Anyone have any experience with this procedure? The doctor said it would heal faster and have less pain than repairing the rotator cuff tendons.

Anyone else ever heard of this?

[JustWinBaby]

Interesting topic, and I'm anxious to know the outcome.  But surgery is far too serious to seek recs from a message board, especially for someone in their 80's.  Seek a second, and possibly third, medical opinion. My guess is the physical therapy is designed to learn to function with the injury rather than real physical improvement (as you've described the injury). If that works and pain is limited, that's probably the best bet - even routine surgeries at that age (when you're put under) are to be avoided unless necessary.

My only question is I know they sometimes use cadaver ligaments/tendons in knee surgery, and I wonder if they don't do it for shoulders, as well.  But, again, given his age that's likely not an option.

Maybe search google for grafts.  I have no idea if it's a better first option, but it seems to me sewing the injured tendon and strengthening with a graft would be better than a joint replacement.  But I have no idea.

He's not looking to return to sports or even chopping wood, so whatever provides some strength and mostly complete ROM without pain would be a great outcome.

[fredtoast]

I am not really asking for advice. I just thought this was something that most people had not even heard of. I know I have not.

Plus I am sure the doctor will talk to him a lot more and answer all of his questions before they decide on surgery. Dad has to go back after a month of physical therapy.

A lot of people my fathers age might not even risk surgery as long as they can still use their arm at all. My mom has some heart problems and I know she would not risk going under anesthetics if she could avoid it at all.

Even though my dad will have to cut back on his activities he will still be very active. He told me that he can still use a chain saw as longs as he doesn't have to lift it very high. I told him he was crazy.

[StLucieBengal]

Your dad has probably had a lifetime of repeated shoulder subluxations... Based on his activity level and types you described that's probably why his tendons can't be repaired. That would explain what you described.

Hope he feels better.

[oncemoreuntothejimbreech]

If the rotator cuff is torn to the point it can't be repaired it is doubtful the physical therapy will give your dad complete pain relief. But, you don't know until you try and it won't hurt anything to give it a try. The physical therapy can help speed his recovery after surgery by improving the shoulder's conditioning beforehand if that is what they choose to do. I wish your dad well.