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Reverse Shoulder Replacement: Pre-Surgery Questions

Posted by Greg Corio @gregcorio, Dec 8, 2023

Hi All! I’m scheduled for Left shoulder RSA in January 2023 and have some questions re the surgery. I’m 77, active, a golfer. Due to my age, a previous open shoulder surgery, severe arthritis and significant rotator cuff damage, my HSS surgeon says RSA is the only option. I know now, that with RSA, the deltoid muscle provides shoulder movement after the surgery. What’s unclear to me, is what happens to the 4 rotator cuff tendons and muscles during the surgery. Are they left still attached (i.e. in their current damaged condition), but still provide some assistance in moving the shoulder? Or are they completely removed from the shoulder joint and just left in the body, providing no function at all? In my brief appointment with the surgeon, when I asked if he’d be repairing the rotator cuff during the RSA surgery, he responded that “I won’t need them anymore. That the deltoid muscle would provide the movement for the shoulder. I wasn’t prepared for this and then the appointment was over. He said I could call him if I had further questions. Long story short, he’s been unresponsive for weeks. So that’s why I’m looking for answers here…. Thanks in advance for your help!

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dmk | @dmk | Dec 9, 2023

RTS ( reverse total shoulder)
After a failed rotator cuff surgery many years ago and then osteoarthritis set in I had my RTS in 2019. Indeed I have a life again. The pain post op was nothing compared to pain preop. No your tendons and rotator cuff muscles will be gone and the deltoid will learn to do all the work. There are u tube videos of surgery if you want to watch. I hope you are in therapy now to strengthen your muscles before surgery. I wish I had done that as my surgeon has suggested but I didn’t find therapist in time. I did do therapy prior to my Total knee replacement in 2021 and I rehabbed much quicker. Having said that this is major surgery and is not a sprint but a marathon. I was in therapy for a year. I still do dry needling and taping every month and do daily exercises to keep shoulder going but I have quality of life now. This surgery requires a great surgeon, a great doctor of physical therapy ( I hit jackpot on both) and hard work on our part. I am only allowed to lift 5 lbs for rest of life with that shoulder even though I forget sometimes

Here is my experience
Had my RTS 2019
 Motorized cryocuff machine for pain management, an awesome ice machine,
 Rebound wear shirts have oodles zippers easy access for therapists, Velcro tops and pjs or night shirts. 
Carry pillows in car for arm you will feel every bump
. Constipation can be huge issue with narcotics so stool softener, etc I found narcotics didn’t really help pain only took one at night for about 4 or 5 days
Finding a great therapist prior to surgery is a must just as important as a great surgeon. Preferably a place that you have a DPT where you will have the same therapist every visit.
You will need help as I was not allowed to use arm at all to lift anything for 2 weeks. Even after took a while
Lots pillows
Recliner for sleeping
Dry shampoo as I was not allowed to shower for a week, was miserable!
Eventually get set of theraband pulleys for home but wait til therapist has you doing it. As long as surgeon has done their part tell therapist any issues you are having they know when to send you back to the surgeon, if need be
It’s not a sprint but a marathon
Positive attitude goes a long way, it’s a long recovery
. My therapist gave me a lifetime exercise regimen for my shoulder which I still do today! Eventually a heating pad can come into play but not for a long time.
 Lot of work on our part but well worth it!
 For some reason I had a lot of nausea and vomiting for a while post op so I carried my anti nausea meds with me, but haven’t heard that happening to anyone else.
 Good luck

REPLY
1 reply
jprust | @jprust | Dec 9, 2023

I had a total reverse shoulder replacement in September of 2023. They do not connect the rotator cuff. The surgeon did reattach the biceps somewhere. The deltoid takes over the power. They remove your ball and socket and put in implants-with the ball on the top and socket on the bottom. I did physical therapy before surgery for several weeks to strengthen everything in my shoulder.

I was in a sling for six weeks, which could be removed for showers and getting dressed. No lifting anything heavier than a pen for 6 weeks, then no heavier than a coffee cup for 4 more weeks. Now during therapy I am doing strengthening rehab with no more than 2-3 pounds. But lifetime limit of 20-25 pounds.
I am 74 years old and have excellent range of motion. No pain meds needed after 5 days except over the counter when needed. Had a icing machine that I used all the time for the first month.
I was cleared to drive after I was off pain meds, but did not use my surgical arm for driving, just my left arm.
We had to buy a recliner with a remote because the lever for recliners is on the right side and I could not use the lever.
At 10 weeks post-op I have zero shoulder pain. I have been doing all my daily activities of living since week two with modifications.
I had previously had the same shoulder repaired with rotator cuff repair. That surgery was more difficult to recover from with a immobilizer sling that had a pillow in front.
The one drawback I can think of is that due to the mechanics of the reversed ball and socket you may not be able to move your hand behind you past your back pocket.
I attached a picture of my X-ray at 10 weeks post-op. I saw the doc after surgery at 2 weeks, 6 weeks and 10 weeks. Now in one year. I started physical therapy with only passive range of motion exercises after two weeks.
The doctor told me I would be able to return to my activities like swimming, kayaking, tai chi after I was done with the strength training.
I hope this information helps relieve some pre-op worries.

REPLY
basslakebabe19 | @basslakebabe19 | Dec 15, 2023

I had the reverse shoulder surgery decades ago and have been very pleased with the outcome. Dr. Sperling knows what he’s doing. I am 81 and can do 20 wall pushups every morning. I am also a swing dancer which includes many turns from the lead. I can do all of that. He saved my shoulder and my social life.

REPLY
Greg Corio | @gregcorio | Dec 20, 2023
In reply to @dmk "RTS ( reverse total shoulder) After a failed rotator cuff surgery many years ago and then..." + (show)
@dmk

RTS ( reverse total shoulder)
After a failed rotator cuff surgery many years ago and then osteoarthritis set in I had my RTS in 2019. Indeed I have a life again. The pain post op was nothing compared to pain preop. No your tendons and rotator cuff muscles will be gone and the deltoid will learn to do all the work. There are u tube videos of surgery if you want to watch. I hope you are in therapy now to strengthen your muscles before surgery. I wish I had done that as my surgeon has suggested but I didn’t find therapist in time. I did do therapy prior to my Total knee replacement in 2021 and I rehabbed much quicker. Having said that this is major surgery and is not a sprint but a marathon. I was in therapy for a year. I still do dry needling and taping every month and do daily exercises to keep shoulder going but I have quality of life now. This surgery requires a great surgeon, a great doctor of physical therapy ( I hit jackpot on both) and hard work on our part. I am only allowed to lift 5 lbs for rest of life with that shoulder even though I forget sometimes

Here is my experience
Had my RTS 2019
 Motorized cryocuff machine for pain management, an awesome ice machine,
 Rebound wear shirts have oodles zippers easy access for therapists, Velcro tops and pjs or night shirts. 
Carry pillows in car for arm you will feel every bump
. Constipation can be huge issue with narcotics so stool softener, etc I found narcotics didn’t really help pain only took one at night for about 4 or 5 days
Finding a great therapist prior to surgery is a must just as important as a great surgeon. Preferably a place that you have a DPT where you will have the same therapist every visit.
You will need help as I was not allowed to use arm at all to lift anything for 2 weeks. Even after took a while
Lots pillows
Recliner for sleeping
Dry shampoo as I was not allowed to shower for a week, was miserable!
Eventually get set of theraband pulleys for home but wait til therapist has you doing it. As long as surgeon has done their part tell therapist any issues you are having they know when to send you back to the surgeon, if need be
It’s not a sprint but a marathon
Positive attitude goes a long way, it’s a long recovery
. My therapist gave me a lifetime exercise regimen for my shoulder which I still do today! Eventually a heating pad can come into play but not for a long time.
 Lot of work on our part but well worth it!
 For some reason I had a lot of nausea and vomiting for a while post op so I carried my anti nausea meds with me, but haven’t heard that happening to anyone else.
 Good luck

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Thank you very much for your detailed response!

REPLY
Greg Corio | @gregcorio | Dec 20, 2023

Has anyone on this forum been able to return successfully to golf after left shoulder (I'm a right handed golfer) RSA? I'm 77 and had to stop playing several months ago due to pain and reduced range of motion. Unfortunately, my surgeon says that an anatomical TSA is not an option due to arthritis, severe rotator cuff damage and a previous open surgery on my left shoulder. I'm concerned that the strength loss due to removal of the 4 rotator cuff muscles and reduced range of motion associated with RSA (as compared to TSA), will impact my golf came so much it won't be worth it. I'd appreciate hearing your experiences about returning to golf from anyone who's had RSA. Especially if you're in my age group. Thanks Much!

REPLY
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