March 2010

Reverse Shoulder Replacement New Option for Rotator Cuff Injury

C. Benjamin Ma, M.D.
Chief of Sports Medicine
UCSF Orthopaedic Institute

Rotator cuff arthropathy is severe arthritis following a long-standing rotator cuff injury, typically caused by a direct fall onto the shoulder or chronic inflammation. It is most common in patients between the ages of 40 to 70. Rotator cuff tears also can be attributed to the normal aging process with symptomatic age-related degeneration. The condition does not respond well to standard shoulder replacement.

An advanced shoulder prosthesis available at select medical centers, called reverse shoulder replacement, effectively relieves pain and restores shoulder function.

Reverse Shoulder Replacement

The ball-and-socket joint of the shoulder is formed by the articulation of the humeral head "ball" with the glenoid "socket." This procedure differs from conventional shoulder replacement surgery in that the position of the "ball" or humeral head and "socket" or glenoid are reversed.

Conventional total shoulder replacement requires the rotator cuff function to be present to move the replaced shoulder joint. Without functional rotator cuff muscles, the replaced shoulder will not move well and can continue to be painful.

Reverse shoulder replacement takes advantage of the functioning deltoid muscle to enable movement of the replaced shoulder. The reverse shoulder design changes the mechanics of the shoulder so that it can still be functional despite the loss of rotator cuff tendons.

The Procedure

The procedure is performed as an inpatient procedure.

  • Patients typically stay in the hospital for two days post-operatively.

  • Post-operative recovery involves sling immobilization of the operative arm for six weeks and physical therapy that focuses on elbow, wrist and digital range of motion exercises.

  • After six weeks, formal physical therapy will start with range of motion and strengthening.

  • Recovery from the procedure typically takes four to six months.

Patients with active infection or a non-functional deltoid muscle are not eligible for reverse total shoulder replacement.

UCSF Orthopaedic Institute

The UCSF Orthopaedic Institute is the most comprehensive center of its kind in Northern California. The "one-stop shop" — from evaluation to treatment to follow-up — offers the latest technology and procedures.

Other Resources

For more information, contact the Physician Referral Service at UCSF Medical Center:

Phone (888) 689-UCSF or (888) 689-8273