Dr. Matthew Levy, orthopedic surgeon, writes a monthly column for the Cleveland Jewish News focusing on orthopedic issues, concerns and topics. This column was originally published in Cleveland Jewish News on July 8, 2021. 

It wasn’t that long ago when patients who did not find relief through conventional treatments for shoulder pain were forced to resign themselves to a life with pain and limited mobility. Particularly for those with rotator cuff tears and advanced arthritis, options were limited.

Fortunately, recent advancements in implants and surgical techniques provide hope for life beyond pain and restored function. In fact, shoulder replacement is now the fastest growing joint replacement surgery in the country, with nearly 70,000 performed each year.

In shoulder replacement surgery, a metal ball is placed on the top of the arm bone and a plastic socket is positioned on the shoulder blade, mimicking the structure of how the shoulder is designed. The tendons and the muscles that make up the rotator cuff keep the ball and socket together and functioning.

For those living with chronic pain from osteoarthritis, shoulder replacement is an effective option when nonsurgical treatments have failed.

However, because the procedure relies on the integrity of the rotator cuff muscles to allow the arm to function, it is oftentimes not beneficial to those with large rotator cuff tears combined with advanced shoulder arthritis, a condition named rotator cuff tear arthropathy. A traditional replacement could actually lead to even higher levels of pain and functional limitations.

A reverse shoulder replacement may be the answer to help these individuals because it relies on different muscles to move the arm.

In a reverse shoulder replacement, the surgery reverses the patient’s normal anatomy by placing the ball on the socket and the socket on top of the arm bone. In doing so, our patients are able to utilize the deltoid muscle – the large muscle in the shoulder – to compensate for the damaged rotator cuff muscles and tendons to power the arm through range of motion.

This ultimately allows patients to regain their ability to raise their arm over their head and restore function. Reverse shoulder replacement may also be an option for those with a previous unsuccessful shoulder replacement, with a complex fracture of the shoulder joint, or a tumor of the shoulder joint.

As a more recent approach to addressing these complex conditions, many patients are unaware there is an effective treatment option. It is rewarding to see their hope return when they learn there is a solution.

Dr. Matthew Levy writes about orthopedics for the Cleveland Jewish News. He is an orthopedic surgeon at St. Vincent Charity Medical Center and practices in Solon, Independence and downtown Cleveland.