Reverse shoulder replacement compared to rotator cuff repair arthropl

Good afternoon @jprust. Well, you caught me. I think I fit your criteria. After a fall down a mountain, I went through three surgeries on my dominant shoulder. #1...Rotator cuff repair. The surgeon told me it was the Grand Canyon of holes. #2...Attempt at a cadaver rotator cuff repair. #3....Reverse shoulder replacement.

Briefly, here is how the attempts compared. And I can see why that didn't make a lot of sense to you when the more major surgery had the best recovery according to your surgeon.

The rotator cuff repair was the most painful recovery. After my fall, I was in the hospital for a couple of days and was treated with pain pills and given a sling. to wear. Eventually, I was able to get dressed and go to work by myself but the pain never receded as you might expect. My surgeon was not happy with the outcome and wanted to give it another chance to become functional. So....he suggested #2 but the donated rotator cuff just did not match up with my body. So, I went back home post surgery again.

At the time, the Reverse Shoulder Replacement was new in the US. It was developed in France and the Univ. of Washington handled the initial patients. My surgeon spent the time to become competent......and even brought back a video to share with me. Then came the big challenge. My insurance turned me down for the RSR because I was too young at 68. Evidently, they preferred the patients to be older for various reasons,

Once again, my surgeon won the battle and the surgery was scheduled. When they wheeled me into the operatng room it sounded like a party. The engineer who designed the replacement was there along with other professionals. I slept through the party......woke up with my surgeon sitting in my room. He wanted to make sure I was well taken care of and he wanted to personally experience any issues that arose. Even the anesthetist dropped by to see how the drugs had worked.

Within 3 days I was going out to dinner with friends. The pain was very moderate. I even argued with my surgeon about bedtime sleep aids but followed his directions.

So now you can have the replacement mechanism designed for you which might help with the ROM and other agillity issues. For the couple of years that I couldn't rely on my shoulder, I was forced to learn to use my non-dominant arm even for writing. So of course I now use both arms for just living.

Good luck to you. And I will be here for you next week and thereafter.

Chris

Thank you so much for your reply. Your experience helped me a lot. Right now, with surgery scheduled 4 days away, I am having second thoughts. The MRI listed many things wrong, including complete tear, and changes due to the prior repair. Then the surgeon had CT scans of the shoulder done on Thursday. That report was visible today and most things said unremarkable. It said it was mild to moderate arthritis . The clinic visit report showed good range of motion and strength. But I just completed 2 months of physical therapy.
Three surgeons have recommended a reverse shoulder replacement on that side. My pain is only at a 2, and only at a 3 or 4 if I do some more strenuous activities. Today I shoveled dirt from pots, swept the garage, and I had some pain and instability.
So now I am worried that I am making a big mistake and will never be able to do all the things I do now. The surgeon said I should be able to swim, kayak, do tai chi, vacuum, with little to no pain.
Maybe I am just starting to panic a little because it seems like a huge decision. I have had a total hip replacement and then a revision of that due to metallosis and that didn’t seem as scary as this. But I could hardly walk. I can still use my shoulder.
Now I am babbling. I will read your comment over before surgery to remind me that I will still have a shoulder when done.

You do have a significant set of challenges. I am 73 with both shoulders replaced conventionally, one 5 and one 7 years ago. For me, the most recent of these shoulder replacements is a continuous messy recovery but the original pain is gone. The pain now is from efforts to operate the shoulder in its proper position instead of up and forward as it prefers. Range of motion is returning as the uncomfortable exercises slowly do their magic. PT, acupuncture, Tai Chi, daily yoga, relearning swimming: all have returned me to a much younger energy level of 20 years ago. It is not a comfortable process but I wanted to avoid the necessity of re-opening the shoulder for a reverse replacement as perhaps should have been done initially. For you to do both simultaneously would be a huge shock to your body and life energy. You are a trooper if that is your chosen route. I understand the benefits of reverse shoulder replacements but have not directly experienced them. Be confident that your surgeon will guide you on the right track. That said, they are focused on their version of the cure.

In my case they did repair some rotator cuff tears while doing the replacement. The shoulder is essentially immobilized after surgery anyway, thus protecting the cuff repairs. The joy of the reverse joint, from what I understand, is a more rapid return to functionality, avoiding some of the joint stability and range of motion problems I have experienced, now mostly solved (85%) after a long drawn out process.

As an aside, what I personally have found is that the habit of indexing or registering one’s scapula before and during shoulder movements is an important way of avoiding further shoulder problems and rebuilding mobility. Consciously thinking about moving the shoulder blade down and back ( pinching them together if both available) is often overlooked when discussing arm movements. It may not be appropriate for some rotator cuff injuries, but eventually I hope it will be a habit worth remembering as your recovery proceeds.
And I must add that having to use the non dominant side was a refreshing skill to learn, leading to a more general feeling of well being
Once again, be confident that your surgeon will guide you on the right track
My struggle continues, as I slowly reap the benefits
I wish you a speedy recovery.

Mike

Thank you for your reply. I am only having one shoulder surgery now. Then the other when I have recovered.
I am doing a lot of yard work now to get things ready for our long Minnesota winter. If I had doubts that my shoulders needed surgery, the work this weekend removed them.
The things we go through to maintain or get back function amazes me. I can see how it would be easy to just let nature take its course. It is tiresome.

It will be two years since I had a reverse TSR on my right shoulder. I hope your surgery and recovery go as well as mine did. Although I never had prior rotator cuff surgery, my surgeon gave me a choice and said my rotator cuff was borderline, not in good shape, frayed, and if they did a regular TSR, they might have to re-do it to a reverse anyway in a few years if the cuff continued to deteriorate. The healing is faster on a reverse, since some of the rotator cuff muscles are removed, you have no long waiting time for missing muscles to heal, so can start rehab a few weeks sooner than with a regular TSR.
I am so pleased with my shoulder results, I have no more constant arthritic ache, and my range of motion and strength is such that I don't even think about my shoulder being artificial, and sometimes have to stop myself from dragging or lifting something way too heavy. I can reach that top shelf again. My left shoulder is still fine, so I have to remind myself to let it take more of the weight when needed. Kayaking -- no problem!

Wow! Thanks for taking the time to comment to the conversation. After the rotator cuff repair I was all healed and doing everything 2 months after the sling came off.
Some things you read on orthopedic sites talk about taking a year to be back to normal.
I like what you said about stopping and being aware of your shoulder when lifting.
My primary care doctor told me she has patients that had the reverse replacement and did fine. Then she said, “But you have to be very very patient.”

Hi Chris, I had the reverse shoulder replacement Wednesday Sept 27. They kept me overnight, but never said why.
The nerve block kept me happy until the third day, then got very uncomfortable.
I am taking a few hydrocodone 5 mg a day and doing the passive exercises given to me.
My problem is I hurt all over-like I fell down several flights of stairs. I have a bad headache all the time and run hot and cold and clammy.
Did you feel like that? If so, how long did it last? I don’t think it is severe enough to call the doctor, but I do want to scream a little.

@jprust - if you are still feeling that bad overall today, I would call the doctor immediately. Do you have a fever? You don't want to come down with a sepsis infection from the surgery. Hard to say why they kept you overnight, could have been your reaction to anesthesia, or any number of other things, don't be shy about asking. It's your health, you deserve answers, but sometimes you have to push for them.