Concerns after Reverse Total Shoulder Replacement

Posted by fredaardvarks @fredaardvarks, Mar 3 8:59am

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 .

Jump to this post

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

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