The Reverse Total Shoulder Prosthesis: Pearls and Pitfalls

Abstract

Reverse total shoulder arthroplasty is a unique surgical solution for patients with pain and dysfunction from advanced glenohumeral joint arthritis associated with severe rotator cuff deficiency. In the normal shoulder, the rotator cuff and deltoid muscles work together to elevate the arm. However, with massive rotator cuff tears and advanced degenerative joint disease, the normal mechanics of the shoulder are disrupted, making arm elevation difficult if not impossible. The reverse shoulder prosthesis corrects this by providing a fixed fulcrum for the shoulder joint that allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm. Reverse total shoulder arthroplasty is still in its infancy, and a number of issues have yet to be resolved with this procedure; however, with thorough patient evaluation and careful patient selection, complications can be minimized, and satisfactory pain relief and increased range of motion can be achieved in most patients.

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