Overview
Shoulder arthritis, particularly in the context of rotator cuff deficiency, often necessitates reverse shoulder arthroplasty (RSA) to restore function and alleviate pain. RSA involves reversing the normal ball-and-socket mechanics to enhance stability and compensate for deficient rotator cuff muscles.Diagnosis
Clinical Presentation: Pain, weakness, and limited range of motion in the shoulder 125.
Imaging: X-rays to assess joint space narrowing, osteophyte formation, and acromial abnormalities; MRI or MRI arthrography to evaluate rotator cuff integrity 12.
Grading: Use of Constant-Murley Score for functional assessment 145.Management
Primary Treatment: Reverse shoulder arthroplasty for severe rotator cuff arthropathy, irreparable cuff tears, and complex fractures 1245.
Surgical Techniques:
- Subscapularis sparing approach vs. tenotomy; higher internal rotational strength observed with sparing approach 1.
- Consideration of humeral lengthening effects on postoperative pain and clinical outcomes using 3D measurements 3.
Postoperative Care: Regular follow-up with clinical assessments (Constant Score, ASES, Quick-DASH, ROM) and radiographic evaluations to monitor implant stability and functional outcomes 12345.Special Populations
Elderly Patients: Common indication for RSA with successful functional improvement but higher complication rates noted 145.
Os Acromiale: Functional outcomes comparable to those without os acromiale, though careful monitoring for complications is advised 2.Key Recommendations
Use of Subscapularis Sparing Approach: Consider sparing the subscapularis tendon in RSA to potentially enhance internal rotational strength without compromising external rotation (Evidence: Moderate 1).
Long-term Follow-up: Implement rigorous long-term follow-up protocols to assess survivorship, functional scores, and radiographic signs of loosening, with significant survivorship drops observed around 2-9 years post-surgery (Evidence: Moderate 4).
Evaluation of Humeral Lengthening: Utilize advanced 3D imaging techniques to evaluate the impact of humeral lengthening on postoperative clinical outcomes, given its potential influence on pain and implant stability (Evidence: Weak 3).
Monitoring for Complications: Regularly screen for complications such as scapular notching, radiolucent lines, and mechanical issues like dislocations, especially in revision cases (Evidence: Moderate 5).References
1 Ellwein A, Torke G, Pastor MF, Horstmann H, Karkosch R, Smith T. Subscapularis sparing approach vs. tenotomy of the subscapularis tendon in reverse shoulder arthroplasty: a prospective, randomized, double-blinded clinical trial. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2025. link
2 Lopiz Y, Herzog R, Arvinius C, Garcia C, Anhui E, Marco F. Functional outcomes and complications of classic grammont-style reverse shoulder arthroplasty in patients with os acromiale: a retrospective case-control study. International orthopaedics 2025. link
3 Nakazawa K, Manaka T, Minoda Y, Hirakawa Y, Ito Y, Shimizu H et al.. Effect of humeral lengthening on post-operative pain scores by three-dimensional measurements in patients undergoing reverse shoulder arthroplasty. Archives of orthopaedic and trauma surgery 2025. link
4 Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time?. Clinical orthopaedics and related research 2011. link
5 Stechel A, Fuhrmann U, Irlenbusch L, Rott O, Irlenbusch U. Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty. Acta orthopaedica 2010. link