Concerns after Reverse Total Shoulder Replacement

I am really sorry to read this, you are too young to have had this kind of bad result. From the picture, it looks like your arm is almost frozen in a sling position? Do I have that right? Were you referred to Physical Therapy after the surgery, and if so have you discussed with your PT person what might be causing this lack of motion? If they are properly licensed, they should have as much knowledge about the workings of bones and muscles as doctors.
I had a reverse TSR at about 74, and my new shoulder was working perfectly by about four months. My TSR has the same range of motion now as my non-surgical arm in every direction. My only limitation is trying to reach behind my back from butt level on up, I can only reach about to my waist, no further up. Over the shoulder and back, same on both sides. From what I understand, only the frontal part of my rotator cuff was removed, and you can see the slight depression there, compared to my normal shoulder.
Prior to surgery, I had x-rays to determine the condition of the bone and cartilage, those verified I was a candidate for a TSR. Next I had an MRI and a CT scan both in one appointment to determine the condition and health of surrounding tissues. After viewing these results, my surgeon said my rotator cuff was somewhat frayed and right on the borderline for a regular TSR and he could not guarantee good long term results. He gave me the choice, and I opted for a reverse, because I did not want to go through a possible 2nd surgery in a few years. I then went back for one more special MRI which was to take measurements for a custom made prosthesis for me from the manufacturing company.
Surgery went fine, very little pain afterwards. I wore an immobilizer instead of a traditional shoulder sling during recovery, which let me unhook the wrist band from the waist velcro at times and use the lower arm freely while keeping the elbow locked to the waist. I was able to use a keyboard on a desk right after getting home from the overnight hospital stay. I have not had the outward swing problem you describe.
It does seem very odd that you would be changed from a traditional to a reverse TSR during the surgery, and I think you deserve a more detailed explanation why he chose to do that. The ball and the socket are replaced in both surgeries, so just saying the socket was worn down makes no sense. I would also try to work closely with a good PT specialist to determine why the lack of range and what can be done about it. So sorry for your bad experience.

Thank you so much for your response! My arm is not frozen. The picture I posted is showing the extent to which I can externally rotate my left arm when my elbows are straight out. You should be able to watch a quick video clip with link below. If my elbow is straight down, next to my body, with hands at 90 degrees facing forward, I have external rotation, but the moment I start moving my elbows forward, and upward, I can't rotate my forearm outward.

SEE VIDEO CLIP HERE:
ezgif.com/video-to-gif/ezgif-1-814135dce8.mp4

My surgeon had mentioned, during my pre surgery consultation with him, that in the X-ray, it appeared that my socket was worn. He mentioned they can put in an augmented custom made piece to compensate for that.
I specifically asked if I would be getting an MRI, he said I really don't need one, because he will be better able to assess the rotator cuff while he's actually in the shoulder. Since I had no rotator cuff issues at the time, and his quick test in the office for rotator cuff strength showed it was good, I assumed there would be a standard anatomic shoulder replacement. In retrospect I should have insisted on and MRI, but he's the expert so I went with his suggestion.

turns out (from what I heard) that my socket was too badly worn, for that custom made socket piece to work properly. It only compensates for about 8 degrees of wear and mine was worse than that, so that's why they needed to do a reverse apparently.

What angers me, is why didn't the detailed CT Scan reveal this beforehand? I received literature advertising "Blueprint 3d Planning + PSI" that "creates an anatomic 3D model of your shoulder and virtually perform your shoulder replacement surgery".

If that's the case, someone certainly must have known my socket was too badly worn for a standard Anatomic Shoulder Replacement.

But I'm wondering if, and why, my reverse shoulder replacement will result in worse results with a good rotator cuff (pre surgery) than someone who had a damaged rotator cuff.
Again, I'm only 6+ weeks post surgery, but it seems I should be able to move my arm much better than I can at this point. Other aspects of my recovery are very good. I feel I could do push ups. Internal rotation seems like it was pre surgery.
I requested the "Operative Report" from the surgery (which my therapist recommended). He said he will interpret, if he can, any documented problems that arose during the surgery. I don't have an appointment with my surgeon until four months after the surgery. I think I will call and make a sooner appointment.
I'm hoping it will just take a bunch of time and hard work to get most of my motion back, but I'm really doubting it at this point. This is my dominant arm, so the prospect of having to support my dominant arm to brush my teeth as a result of the surgery is really gonna **** me off.

Thanks again for your reply!!

Does arm motion stop at the same place in therapy, or can the therapist push it further passively? It would be nice if it was a matter of just stretching and loosening a muscle. You are still pretty early at 6 weeks, so some hope there. I thought I would have to learn to use my left (rightie here) hand to brush teeth while healing, but I found propping my right elbow on the counter and bending over the sink did a better job than awkward brushing with the left. You are probably taller than I am, so that may not be comfortable for you. It did take longer to get certain rotational motion back with the TSR arm, such as soaping up your body in the shower. I could get the range of motion, but my circular movements were very slow for the first couple of months, so I tended to use the off hand. A few years prior to surgery, I developed a frozen shoulder, there was no pain, but I could not lift my hand above ear level, could not comb or shampoo my hair or pick up heavy objects one handed. Then had PT which gave me about 80% of my range back. But then the next year I started to develop constant arthritis pains and again lost my range of motion, but this time it was with pain, x-rays showed bone on bone, so time for the TSR.
I hope your PT person can be of help in figuring out what they did in surgery and coming up with a plan to increase your range of movement. The PT guy I have seen for both my knees and my shoulder regularly sits in to view ortho surgeries a few times a year, it was interesting to hear him describe the operations from different view point.

Thank you so much for your response! My arm is not frozen. The picture I posted is showing the extent to which I can externally rotate my left arm when my elbows are straight out. You should be able to watch a quick video clip with link below. If my elbow is straight down, next to my body, with hands at 90 degrees facing forward, I have external rotation, but the moment I start moving my elbows forward, and upward, I can't rotate my forearm outward.

SEE VIDEO CLIP HERE:
ezgif.com/video-to-gif/ezgif-1-814135dce8.mp4

My surgeon had mentioned, during my pre surgery consultation with him, that in the X-ray, it appeared that my socket was worn. He mentioned they can put in an augmented custom made piece to compensate for that.
I specifically asked if I would be getting an MRI, he said I really don't need one, because he will be better able to assess the rotator cuff while he's actually in the shoulder. Since I had no rotator cuff issues at the time, and his quick test in the office for rotator cuff strength showed it was good, I assumed there would be a standard anatomic shoulder replacement. In retrospect I should have insisted on and MRI, but he's the expert so I went with his suggestion.

turns out (from what I heard) that my socket was too badly worn, for that custom made socket piece to work properly. It only compensates for about 8 degrees of wear and mine was worse than that, so that's why they needed to do a reverse apparently.

What angers me, is why didn't the detailed CT Scan reveal this beforehand? I received literature advertising "Blueprint 3d Planning + PSI" that "creates an anatomic 3D model of your shoulder and virtually perform your shoulder replacement surgery".

If that's the case, someone certainly must have known my socket was too badly worn for a standard Anatomic Shoulder Replacement.

But I'm wondering if, and why, my reverse shoulder replacement will result in worse results with a good rotator cuff (pre surgery) than someone who had a damaged rotator cuff.
Again, I'm only 6+ weeks post surgery, but it seems I should be able to move my arm much better than I can at this point. Other aspects of my recovery are very good. I feel I could do push ups. Internal rotation seems like it was pre surgery.
I requested the "Operative Report" from the surgery (which my therapist recommended). He said he will interpret, if he can, any documented problems that arose during the surgery. I don't have an appointment with my surgeon until four months after the surgery. I think I will call and make a sooner appointment.
I'm hoping it will just take a bunch of time and hard work to get most of my motion back, but I'm really doubting it at this point. This is my dominant arm, so the prospect of having to support my dominant arm to brush my teeth as a result of the surgery is really gonna **** me off.

Thanks again for your reply!!

Good evening @fredaardvarks and @ddsack ......my goodness you have almost written a book. I have read through your responses twice and hope I can remember which one of you had which issues. As you may know, reverse shoulder replacement surgery has only been available in the US for somewhere around 18 years. It was developed in France and then brought to the Univ of Washington. My cognitive abilities are aging as I just turned 82 yesterday. I will try to share some of my experiences accurately and hope they are helpful.

When I had my reverse TSR at 70 years of age. there was no "Blueprint" 3D planning. Therefore, I was warned that the replacement might not fit perfectly. Post-surgery PT was not yet developed. My surgeon and local PT got together and worked out the program before introducing it to me post-surgery. My injury was the result of a tragic fall during which I severely dislocated my right shoulder and suffered three breaks in my right elbow. I too wore the minimizer.

It might be helpful for you to know that I had two Pre-surgeries. The first was an attempt at traditional rotator cuff repair. My surgeon told me that when he got in there it was like the "Grand Canyon" of holes. Then...because my insurance company was not very willing to cover the "reverse" my surgeon attempted a cadaver replacement. That was also a failure. One day I was in his office and watched as he slid down the wall onto the floor while talking to the insurance company. They thought I was too young and would require additional repair work as I aged.

He did win the battle and as I was wheeled into the surgical room, I noticed that there appeared to be an audience, including one of the manufacturer's engineers. My surgeon chose to stay in or near my room the first night. Even the anesthesist dropped in to make sure everything was o.k.

My post-surgery recovery was not excruciating.....just cumbersome. Because my dominant arm was the site of the injury, I had to train my left arm to do many life activities including handwriting. I probably qualified as ambidextrous. It was always hard to zip my clothes and use my keyboard.

Just now, I tried the movements that you have described and pictured. I have no problems and have a full range of motion. So somewhere along the way in the last few years, my shoulder has learned to perform exactly what it was designed to do. I recall that eating an ice cream cone was always a bit unbalanced with the elbow locked up higher than necessary.

So.....when did I regain full use of my shoulder? I think it was in the last few years. There was no recognition of the moment. I just know that when I eat an ice cream cone, my elbow stays against my body like it should and when the sheets come out of the dryer, I can fold them without giving in to total frustration. Be patient......you cannot change what has occurred. You can look forward to significant improvement.

May you both be safe, protected, and free of inner and outer harm.
Chris

Link in above comment "expired". Here is a very quick video clip of me trying to externally rotate forearm. Just nothing there.

Link in above comment "expired". Here is a very quick video clip of me trying to externally rotate forearm. Just nothing there.