New Procedure Provides Relief for Shoulder Pain
Reverse Shoulder Replacement enables patients with complex shoulder problems to regain a fuller range of motion
Ora Martin of Phoenix spent eight years living with the pain of arthritis in her right shoulder. The discomfort, dysfunction and damage to the shoulder had grown so severe that she no longer was a candidate for traditional shoulder replacement, because although there may have been some pain relief with that surgery, elevation of her arm still would have been impossible. Until 2004, when a new procedure was approved by the U.S. Food and Drug Administration, she had no choice but to endure the effects of the arthritis.
But recently, Ora underwent the newer procedure at John C. Lincoln Deer Valley Hospital. The procedure, called a Reverse Shoulder Replacement (arthroplasty), was performed by Bryan Wall, MD, a physician with the Center for Orthopedic Research and Education (CORE) Institute and a specialist in arthroscopic and reconstructive surgery of the shoulder.
In the Reverse Shoulder Replacement procedure, the anatomy, or structure, of the healthy shoulder is reversed. Instead of the upper arm bone ending in a ball shape like it does in a healthy shoulder and fitting into a socket formed by the shoulder blade, an implant is designed so that the ball portion is attached directly to the shoulder blade and the socket is placed at the upper end of the arm bone.
"Older people who have significant pain and little to no movement in their shoulder are the best candidates," says Dr. Wall. "It is ideal for patients with chronic, longstanding rotator cuff tears with arthritis."
Ora, 76, is delighted with the results of her procedure. "I’m thrilled that now I can move my shoulder and raise my arm as high as I want to. Dr. Wall literally saved me from lifelong pain and misery."
Dr. Wall recently was awarded "The Mel Post Award for Excellence in Clinical Research" by the American Shoulder and Elbow Surgeons (ASES). Dr. Wall’s paper, "Scapular Notching in Reverse Shoulder Arthroplasty" will be presented and recognized at the 6th Biennial American Academy of Orthopedic Surgeons (AAOS)/ASES Meeting to be held April 3-6 in Orlando, Florida.
Dr. Wall learned the internationally recognized reverse shoulder replacement (arthroplasty) procedure while participating in a highly coveted fellowship program in shoulder surgery at the renowned Clinique St. Anne Lumiere in Lyon, France with Gilles Walch, MD, and the co-inventors of the procedure.
Dr. Wall now is conducting clinical outcome studies and biomechanical studies regarding reverse shoulder replacement with Dr. Walch. He has presented numerous papers and published several recent book chapters and articles on the subject while serving as a teaching figure to instruct other surgeons on how to perform the procedure.
"Reverse shoulder arthroplasty is usually reserved for individuals who possess complex problems of the shoulder and are rotator cuff deficient," Dr. Wall explains. "It represents an improvement over traditional treatment options because it allows for better function and motion. The procedure has also allowed treatment for a larger segment of patients who until recently did not have any good surgical options."
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| Bryan Wall, MD |
He says the procedure "is not recommended for people who have infections, deficiencies in the shoulder blade, or for patients without functioning deltoid muscles. It is also not recommended for younger patients, except in limited cases, because of the increased functional demands of a younger person’s shoulder."
He says patients "see a drastic difference in their range of mobility, and their ability to perform daily activities, such as eating, drinking and combing their hair."
Patients who have had the procedure often go from suffering from severe shoulder dysfunction to having nearly full elevation of the arm, Dr. Wall adds.
Although the procedure has been performed in the U.S. for only four years, "the long-term outlook for patients with this implant is positive," Dr. Wall says. "Very good preliminary studies with initially a small amount of data are very encouraging.
We are continually working to improve and refine the surgical technique to make the implant last longer and function even better."