A standard total shoulder replacement depends upon muscles and tendons around the shoulder joint to be intact. These muscles and their tendons function to move the shoulder and are together called the rotator cuff. When these tendons become extensively torn so that they do not attach to the bone any longer, the shoulder often does not function normally. The loss of the rotator cuff can produce pain and also loss of motion. A normal shoulder replacement is designed to work only if those tendons are intact.
Reverse Shoulder Replacement (Arthroplasty) has emerged as a very attractive alternative for patients with cuff-tear arthropathy, selected proximal humerus fractures and nonunions. Its indications continue to expand, especially for revision surgery.
Without an intact rotator cuff, the ball can ride high in the socket and wear abnormally, creating abnormal contact forces across the joint. Over time this leads to 'cuff-tear arthropathy.' In the later stages of a cuff tear, the patient develops arthritis in the shoulder and the result is constant pain, weakness and lack of function. The pain is so severe that patients suffering from cuff-tear can't sleep at night; they can't do their activities of daily living. They get depressed about their shoulder and it's affecting everything about what they do and who they are.
