Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

Okay by everyone else's standards, I am considered "elderly" but even at 88, I feel energetic and ready to take on the next 20 years. The problem is I have a severely torn rotator cuff and the pain and loss of motion are very limiting. My children and grandchildren are just sure "Granny" (that's what they call me) won't make it. What are the odds here?

Answer:

You may be pleased to know that many "seniors" are taking aging by the horns and redefining it. Perhaps you've heard the expression "60 is the new 40" (referring to age in years). Well, if that's true then 80 is the new 60 and so on. The Baby Boomers (adults born between 1946 and 1964) have also voted to eliminate the word "elderly" from our vocabulary and substitute "older adult" instead. Whatever we choose to call today's modern grandparents, it is clear that they are outliving many of their body parts, including and especially joints. Hip, knee, and shoulder joint replacements are on the rise in this age group. And many older adults are outliving their joint replacements! In the case of massive rotator cuff tears leading to severe degenerative changes of the shoulder joint, orthopedic surgeons have teamed up with other researchers, engineers, and component parts manufacturers to rethink the mechanics of the shoulder joint and design an artificial shoulder that works in such cases. The solution was to reverse the socket and the ball, placing the ball portion of the shoulder where the socket used to be and the socket where the ball or humeral head used to be. This new design led to a much more stable shoulder joint that could function without a rotator cuff. The artificial joint itself provided more stability by creating a deeper socket that prevented the ball from sliding up and down as the shoulder was raised. The large deltoid muscle that covers the shoulder could be used to more effectively lift the arm, providing better function of the shoulder. The final goal is to have a shoulder that functions better, is less painful, and can last for years without loosening. As with all major operations, complications (including death) are possible. Some studies report that patients receiving reverse shoulder group have higher rates of complications (e.g., dislocations, infections, ongoing pain, loosening of the socket) compared with total shoulder replacement or hemiarthroplasty (only replacing half the joint). Rsearch results support the use of reverse shoulder arthroplasty primarily for older patients with a degenerative shoulder joint and humeral head collapse from a massive rotator cuff tear. In fact, it has been suggested that the "use of the reverse shoulder arthroplasty should continue to be restricted to elderly patients." Regardless of what you call yourself or how you refer to your age group, an orthopedic evaluation is the place to start. There may be simpler nonoperative measures that can be taken to assist you. Or you may be a good candidate for some type of shoulder replacement. For sure, there is no reason for you to suffer debilitating pain and loss of function for the next 20 years! Simon W. Young, FRACS, et al. Comparison of Functional Outcomes of Reverse Shoulder Arthroplasty with Those of Hemiarthroplasty in the Treatment of Cuff-Tear Arthropathy. In The Journal of Bone and Joint Surgery. May 15, 2013. Vol. 95A. No. 10. Pp. 910-915.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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