Shifting into Reverse

Reverse shoulder replacement corrects severe shoulder damage.

Sally Van Dyke, 66, and her husband, Steve, consider themselves “hard-core” sailing enthusiasts. A quick glance through their ship’s log explains precisely what they mean by hard-core. In addition to sailing locally on the Gulf of Mexico, Sally and Steve have sailed their 45-foot Gulfstar from New York to Bermuda and from New York to their Florida home in Punta Gorda.

Photo by Jordan Pysz.

Sally Van Dyke is back on the water now that her shoulder has been repaired.

It was while they were preparing for another long excursion – a 2017 summer trip from Florida back to New York – that Sally injured her left shoulder while raising the mainsail.
“We were going out sailing one day, and I just got a little overzealous with it,” Sally explains. “At first, I didn’t want to say anything to my husband about it because we were planning on sailing back to New York the following week, and I didn’t want anything to mess up our trip.
“And really, it wasn’t like the pain was all that unbearable. I thought it was just a muscle, but then it got to the point where I couldn’t move my arm at all. Sleeping became impossible because I couldn’t turn over and lie on my side. I couldn’t even lift a coffee cup off the table with my left hand.”
Sally’s symptoms were not foreign to her. She went through a similar experience in 2009 when she tore the rotator cuff in her right shoulder. A doctor in New York repaired that injury, but she tore the rotator cuff again in 2015. That’s when she met Robert P. Stchur, MD, at Advanced Orthopedic Center.
“I had been referred to Advanced Orthopedic Center by a friend when I was having some trouble with my knees,” Sally informs. “So when I hurt my right shoulder again, I went back and spoke to the doctor who had done my knees. He said to me, Well, Dr. Stchur [pronounced Sure] is our shoulder man, so you should see him.
After an MRI revealed that too much damage had been done to repair Sally’s right rotator cuff, Dr. Stchur recommended doing a reverse total shoulder replacement. The results were so favorable that Sally opted for the same procedure after Dr. Stchur’s examination of her left shoulder injury revealed the same problem.

Transfer of Power

Originally designed in Europe in the 1980s, the reverse total shoulder replacement procedure was approved by the Food and Drug Administration for use in the United States in 2003. It is considered a better option for patients such as Sally who have suffered a complete tear of a rotator cuff or someone experiencing severe shoulder pain, having difficulty moving their arm away from their body or lifting it above their head. The result of the reverse total shoulder replacement procedure is that the shoulder uses different muscles than it normally does to lift the arm.
In a healthy shoulder, the muscles and tendons in the rotator cuff work together to keep the ball of the upper arm bone, which is the humerus, in the shoulder socket. They also work to power the process of raising and rotating the arm. The reverse total replacement procedure transfers the task of powering the arm to the deltoid muscle through the use of a device that places a metallic ball where the socket was and the socket where the ball was.
“You’re basically just flipping the joint around,” says Dr. Stchur. “Especially with older patients, it’s the best way to go, because the failure rates are much higher in big tears and poor quality tissue.
“And I’ve seen it happen where someone has gone through a big repair and months of rehabilitation and then they tear it again, and they have to go in and do the reverse anyway. That’s why we’re favoring the reverse more and more.”
The reverse total shoulder replacement is not just for people with severe rotator cuff damage. People who have suffered complex fractures in the shoulder joint, suffer from chronic dislocations of the shoulder or previously had conventional shoulder replacement surgery that was unsuccessful are good candidates for the procedure as well.

Photo by Jordan Pysz.

Sally is back to working as first mate to her husband, Steve.

“There’s a fairly large population of people that kind of slowly over time get these degenerative, irreparable rotator cuff tears,’’ Dr. Stchur explains. “Most people will just adapt to it and that works for them for a while, but at some point, the rotator cuff just doesn’t work any more because it doesn’t ride correctly in the socket and so it starts getting arthritis or it starts to wear down. A lot of people don’t know they have it or don’t really have any symptoms until it gets to that point where it’s worn down enough so that they start to have pain. That’s when we recommend the reverse procedure.’’
For those procedures, Dr. Stchur uses the DELTA XTEND system, which he describes as a better physical design of the shoulder joint.
“In the normal shoulder, there’s a big ball in a very small socket,’’ Dr. Stchur educates. “It’s a lot like a golf ball on a tee. It’s just very unstable and it’s a weak rotator on its own because there’s no good fulcrum there. But by flipping the construction around, you’re constraining it to a certain extent so that you have a fulcrum that, when the deltoid fires, allows the arm to just pivot right up.”

Speedy Recovery

Another advantage of the reverse total shoulder replacement procedure is the recovery time. Though it is more invasive than some other treatment options, the time needed to recover is “shockingly fast because we’re not really repairing anything,” Dr. Stchur explains.
“We’re not really replacing anything. We’re just going in there and placing metal and plastic components that stick to your bones immediately, and so we encourage you to begin using the shoulder right away.”
Sally was among those who returned to normal almost immediately. A shooting enthusiast as well, she says she was able to return to the gun range and was back working as the first mate to her husband, the captain on their sailboat, shortly after the reverse total replacement procedure was completed.
“They get you moving right away in the hospital and so I had good movement with my arm within a couple of days after the surgery,” she reports. “And the pain I felt in my shoulder while recovering from the surgery was less than the pain I had in my shoulder before the surgery was done. They were just excellent.
“And I have to admit that, coming from New York, I was a little concerned about the medical situation here in Florida. But the entire experience I had with Advanced Orthopedic could rival anything that I had done up in New York City. They were very caring, and thanks to them, I’m back to being myself again.”

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    • Advanced Orthopedic Center

      Whether you are a professional or collegiate athlete, an active retiree, a "weekend warrior," a high school football star or a hard-working employee anxious to make a difference, the Advanced Orthopedic Center is here to help you feel better a... Read More

    • Robert P. Stchur, MD

      Robert P. Stchur, MD, is a Board-Certified Orthopedic Surgeon. He joined The Advanced Orthopedic Center in 2004. He completed a Sports Medicine fellowship at the Lake Tahoe Sports Medicine Program. He is originally from Michigan and received h... Read More