Concerns after Reverse Total Shoulder Replacement

Posted by fredaardvarks @fredaardvarks, Mar 3, 2024

Hello, I'm new to this forum.

I'm 55 yo, and I'm just over 6 weeks post Reverse total shoulder replacement. I am concerned. I have not contacted my surgeons office yet because I don't want to complain without more facts.

My rotator cuff and all associated movement/external rotation etc was perfect before the surgery, and now it seems it's destroyed. (please read on).

I've been dealing with bone on bone shoulder arthritis for years, (heavy weight lifter off/on over the years) and finally decided to get it done and over with ( also, now is a good time because of other life situations).

Every assessment of my rotator cuff per-surgery was that it was good. I've never had any issues with rotator cuff, very strong. So I went into the surgery, and was literally in pre-op with the understanding I was going to have a standard anatomic total shoulder replacement, with a possible need for a custom made augmented socket insert (to compensate for some socket wear). I never had an MRI pre surgery, because the surgeon said once he's in the shoulder during surgery, he'll be able to much better assess the condition of my rotator cuff.
In the recovery room after surgery, is when I hear they had to do a reverse total shoulder, because apparently my socket was so worn down . That upsets me, because why didn't the CT scan show them before the surgery that the socket was so worn? And that I was expected to have a Reverse Total Shoulder Replacement? And then, what the ramifications of that will be e.g., big loss of use of dominate arm. The facility touts they use "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, why didn't they know ahead of time that I needed a Reverse Total Shoulder.

The point is, my rotator cuff and all associated movement/external rotation etc was perfect before the surgery, and now it seems it's destroyed. Even though I'm only barely over six weeks post op, I have no external rotation with "positive elbow flexion". In other words, I can't hold my elbow straight out in from of me, with arm bent at 90 degrees. Elbow will push outward, I can't keep in near my body.(SEE PICTURE BELOW).
Even sitting straight upright, at a table, with elbows very slightly in front of me (like now at a keyboard), I have to external rotation. The surgery was performed on my left shoulder and I'm left-handed. I have to hold my dominant arm so that I can brush my teeth, shave, even eat. If that doesn't get any better, it'll be a disaster. I'm already wishing I had my arthritis back. 🙁

I will be angry if they knew ahead of surgery that I needed a Reverse total shoulder replacement, while also having a perfectly good rotator cuff, and didn't tell me that I will lose a lot of use of my dominate arm.

Again, I'm sure people will read this and say ....."hey you're not even two months post surgery, give it time to heal", ......but other aspects of my recovery (Active range of motion) are going very well and this external rotation thing is not at all. If it was going to improve, I would think it would have started improving by now.

I'm hoping that somebody here who has had a reverse shoulder replacement can address external rotation ability. Again from my perspective, my rotator cuff was perfect. I had no limitations whatsoever, and now I'm afraid the use of my dominant arm will be much worse than before the surgery. I am making very quick recovery in all other aspects.

attached is picture of left arm. Can't move it outward. It's not because it's sore, it's just there is nothing there to move the arm.
Seems doubtful it will improve but looking for feedback.

Thanks all

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@fredaardvarks

Hello,
Yes, I can move my arm easily if assisted (passive motion). Nothing keeping it from externally rotating if I push on it, but Active (unassisted) motion stops at the same place.
If I assist my surgery arm, so that forearm is perpendicular to the floor, and then let go, it pops right back to the same spot. As hard as I try, all my might, there is just nothing there. I would think there would be some progress, some ability if it were going to get better.
all other movements of my arm are rather good already. ...elevating my arm forwards, sideways, internal rotation.
It's uncomfortable constantly fighting the elbow moving outward when I'm trying to reach for something. Deltoid is sore.

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I'm trying to think of what muscle group would be used in rotating your arm up. Maybe the deltoid? Don't know for sure.

It just seems like a muscle issue. You have no strength to rotate that forearm up, but you can easily push it up with your other arm.

Finally, did your Dr. tell you a RSR was possible? That seems like a big decision to make if you didn't know it could be coming.

I have arthritis in both shoulders, one of them produces pain and cortisone shots help a lot. I may get it replaced in the future, and as my rotator cuff is intact, I expect that would be an anatomically-correct TSR, not an RSR. I'm not sure I'd have an RSR, but I certainly would like to know if that might be necessary.

Again, this looks like total loss of the muscle responsible for rotating your arm up.

I'm sorry for what you're going through and hope you can get some answers. All the best to you young man.

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I have the same problem. Did you find out what was causing this?

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@heyjoe415

I'm trying to think of what muscle group would be used in rotating your arm up. Maybe the deltoid? Don't know for sure.

It just seems like a muscle issue. You have no strength to rotate that forearm up, but you can easily push it up with your other arm.

Finally, did your Dr. tell you a RSR was possible? That seems like a big decision to make if you didn't know it could be coming.

I have arthritis in both shoulders, one of them produces pain and cortisone shots help a lot. I may get it replaced in the future, and as my rotator cuff is intact, I expect that would be an anatomically-correct TSR, not an RSR. I'm not sure I'd have an RSR, but I certainly would like to know if that might be necessary.

Again, this looks like total loss of the muscle responsible for rotating your arm up.

I'm sorry for what you're going through and hope you can get some answers. All the best to you young man.

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Yes it is the deltoids that help to raise your arm,especially if rotator cuff is not good. I am 12 months postoperative after trust and still cannot touch the middle of the back of my head and am not driving. My surgery was done because of fractures and surgeon said outcome is not always as good as it would be for arthritis. I had a nerve test done to make sure that was not the issue,but it was not. I will keep exercising and now am doing light weights ,for deltoids,which was not suggested at the 2 pt places I went to.
I am hoping Fredhas made more progress and never give up .

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@nonnahelen

Yes it is the deltoids that help to raise your arm,especially if rotator cuff is not good. I am 12 months postoperative after trust and still cannot touch the middle of the back of my head and am not driving. My surgery was done because of fractures and surgeon said outcome is not always as good as it would be for arthritis. I had a nerve test done to make sure that was not the issue,but it was not. I will keep exercising and now am doing light weights ,for deltoids,which was not suggested at the 2 pt places I went to.
I am hoping Fredhas made more progress and never give up .

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Thanks very much. Keep up the good work. It's hard I'm sure but you are determined.

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@ddsack

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.

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It’s interesting that you say he was too young. I am 35 and just discussed have a reverse shoulder replacement with my surgeon at Mayo yesterday. So age isn’t necessarily a factor but it is hard at any age to go through this.

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