Reverse Shoulder Arthroplasty – Case file

She was a 65 year old retired school teacher. The Left shoulder pain started after lifting a heave object 6 years back. She took some pain medications and progressively the pain settled down. Although there was some weakness on lifting the right arm over head or lifting a heavy object, she could manage almost all her activities of daily living. She consulted a local orthopedic surgeon, who did an X-ray which did not show any significant bony changes.

There was on-and-off pain radiating to the left side of the neck and back of the shoulder with activity. Another area which hurt was the outer aspect of the arm.

She was getting along with this problem, when suddenly the pain increased 4 months earlier she could not lift up the arm without support. Traditional treatment was sought for, with some oils and massages, which relieved the significant pain, but the inability to do above the shoulder lifting continued. She could not keep her hand at the level of her head to comb or tie her hair, as outward rotation was significantly affected.

On presentation to the OP, the lifting power of the shoulder was significantly affected on strength testing (emply can test indicating supraspinatus tendon tear) and outward rotation was very weak (indicating Infraspinatus tendon tear). Xray and MRI images attached below.

There was significant fatty infiltration of the rotator cuff muscles along with osteoarthritis of the shoulder joint. Treatment options were discussed. Reverse shoulder arthroplasty is the modern treatment for this type of pathology, which can restore muscle function by orienting the shoulder centre of rotation in such a way that the Deltoid muscle can help in elevating the limb from neutral position (Read more about Reverse shoulder replacement >>).