Dr. Miller: At 73, Wilton resident E.S. still missed his sport, skeet and trap shooting. He had been a serious competitor in skeet and trap shooting tournaments until twelve years earlier when he noticed his left shoulder “catching” as he followed his target. It didn’t sweep in the smooth arc that he was accustomed to. Before long, the problem became painful and also began affecting other activities including putting on shoes and even driving a car.
After consulting an orthopaedic surgeon, he learned that years of wear and tear had resulted in a torn rotator cuff. A year later, after losing much of his arm’s mobility and living with increasing pain, he underwent surgery to repair the tear. The result was only modestly successful and over the next nine years, he underwent two more surgeries. His condition continued to deteriorate, eventually forcing him to retire from his work as a plumbing contractor.
After the failure of his third surgery, E.S. was referred to Dr. Seth Miller, who was successfully using a brand new procedure known as a reverse shoulder replacement. Approved by the FDA in 2004, reverse shoulder replacement has been performed in Europe for nearly 20 years. The surgery uses a metal and plastic implant that works the opposite of a normal shoulder by placing the ball onto the shoulder blade and the socket onto the top of the upper arm bone. The reversed position of the ball and socket alters the mechanics of the shoulder, changing the center of the shoulder’s rotation. The strength needed to move the arm is shifted away from the damaged rotator cuff muscles, allowing the deltoid muscle to take over.
A reverse shoulder replacement is a breakthrough for patients with a rotator cuff that has degenerated to the point it no longer functions and cannot be repaired. “Many of these patients are unable to raise their arm more than a few inches and a traditional shoulder replacement is not an option because the tendons aren’t healthy enough to hold the shoulder ball into the socket,” explains Dr. Miller. “Until the reverse shoulder replacement was invented, there was no solution for a patient with such a badly damaged shoulder.”
Dr. Miller performed the surgery and E.S. remained in the hospital for three days. Soon after, he began a home exercise program to strengthen and train the deltoid muscle for its new job. In only a few weeks, he began to regain the ability to lift his arm and within two months, he was able to raise his arm well over his head, something he hadn’t been able to do for years. (ES)