FDA-approved procedure eliminates pain and vastly improves range of motion
The constant pain in Helen Richardson’s right shoulder from arthritis and damaged tendons forced her to give up many of the activities she loved. “I could hang my arm out to the side, but I couldn’t raise it and had very limited forward motion. I love to swim, but I couldn’t do the backstroke any more. I couldn’t play golf any more. I couldn’t even hang my clothes on the line to dry,” recalls Mrs. Richardson, 86, of Rosemont, Md.
But thanks to a new type of shoulder replacement surgery offered by the University of Maryland Department of Orthopaedics, Mrs. Richardson is able to do many of the things that were once out of her reach. “There’s no more pain. I have a lot more freedom. This operation has really given me my life back,” she says. Mrs. Richardson, who also has had several knee replacement surgeries, teaches deepwater exercise three times a week, swims, plays golf with her husband and gives piano lessons.
Anand M. Murthi, M.D., an orthopaedic surgeon at the University of Maryland Medical Center, specializing in shoulder and elbow injuries, and an assistant professor of orthopaedics at the University of Maryland School of Medicine, rebuilt Mrs. Richardson’s shoulder joint through a procedure called a “reverse” shoulder replacement.
“Patients often see a drastic difference in their range of motion and ability to perform daily activities such as eating or combing their hair. It’s a miraculous change of lifestyle,” says Dr. Murthi, who has performed 20 of these surgeries since the U.S. Food and Drug Administration approved the operation last year. “We finally have a way to help patients with arthritis and serious rotator cuff tears who are often not good candidates for standard shoulder replacement surgery.”
The shoulder is a ball-and-socket joint, with the top of the arm bone, or humerus, shaped like a ball that fits into a socket in the shoulder blade, or scapula. The rotator cuff is made up of four muscles and tendons that help to lift and rotate the arm. Injury to the muscles and tendons can create severe arthritis within the joint, causing the bones to rub together.
In standard replacement surgery, the ball on the humerus is removed and replaced with a metal implant that fits into a new plastic socket in the scapula. In the reverse shoulder replacement, the surgeon rebuilds the joint with the ball and socket reversed – the ball is attached to the shoulder blade and the socket is on the upper end of the arm bone. The patient is able to move the joint with the help of the deltoid muscle, the large triangular muscle that forms the rounded contour of the shoulder, rather than the muscles in the damaged rotator cuff.
The new procedure is most commonly used to treat older patients with longstanding, chronic rotator cuff injuries and degenerative arthritis, including some who have had unsuccessful surgery to replace the joint or repair a fractured shoulder, Dr. Murthi says. Some patients have what is known as a pseudoparalytic shoulder, a condition that severely reduces movement within the joint and is caused by a massive rotator cuff tear that cannot be repaired.
Dr. Murthi notes that the technique can be used to treat younger patients, but they may face additional surgery as the new joint wears out.
“This procedure is a new option for patients with significant pain and weakness in the shoulder who have exhausted all other means of repair,” Dr. Murthi says. He performs many of the procedures at Kernan Hospital, an orthopaedic and rehabilitation hospital in Woodlawn that is part of the University of Maryland Medical System.
Patients who have the surgery remain in the hospital for two days and then receive outpatient physical therapy for about three months.
An estimated 15,000 total shoulder replacement surgeries are performed in the United States each year. The Department of Orthopaedics at the University of Maryland Medical Center offers the full range of treatments for shoulder disorders as well as injuries of the elbow, spine, knee, hip, ankle, wrist and hand. Teams of specialists, including orthopaedic surgeons, rehabilitation physicians, neurologists, occupational therapists, physical therapists and athletic trainers, provide cutting-edge care for patients of all ages.
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