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Orthopedic Innovation: A Solution for Pearl Ahmad’s Shoulder Woes

Reverse Total Shoulder Replacement: A Game-Changer for Pain Relief

JORDAN PYSZ / iFoundMyDoctor.com
Pearl had shoulder arthritis, then suffered a torn rotator cuff while cleaning her garage. It was a miserably painful combination of ailments that made her a candidate for a reverse total shoulder replacement.

Most cruise ships spend an average of eight hours in each port of call. For most passengers, that’s plenty. For an explorer such as Pearl Ahmad, however, it is nowhere near enough time to do all that she wants to do at each stop. “I want to get out and meet the people, talk to them, really get to know them,” Pearl says. “I want to learn as much as I can about each of the places I visit, and the last cruise I went on didn’t allow me to do that, so I wasn’t all that pleased with it.” That cruise took Pearl to the Bahamas and the Turks and Caicos Islands, and while she was disappointed with the brief stays, it didn’t sour her completely on cruising. Indeed, there is at least one more cruise in this 89-year-old traveler. “I want to take a river cruise through Europe somewhere,” Pearl states. “That’s my last wish, and with the war going on in Ukraine I’ve had to put it off, so we’ll have to see on that. But I would really like to take one of those river cruises.” Pearl sailed away on her last ocean cruise in February. That trip was taken in part to celebrate the one-year anniversary of her recovery from a disabling right shoulder injury sustained while cleaning her garage. “I was getting a bunch of things together to donate to the Red Cross, and I had a moment where I thought I was stronger than I am and I pulled something in my shoulder,” Pearl explains. “I found out later that what I did was pull my shoulder out of the socket. “I didn’t know that when it happened. All I knew was that it hurt. It wasn’t excruciating pain, but it hurt, and I could barely lift my arm. I had very limited range of motion and couldn’t lift anything or do much of anything with my right arm.” Pearl’s injury left her with just enough strength to feed herself, but she struggled to hold a cup of tea and soon found it nearly impossible to use her right arm to bathe and dress herself. Those issues sent her in search of medical help. “I first went to my primary care physician, who recommended physical therapy,” Pearl remembers. “I did that three times a week for a month, but then the physical therapist said, Something else is wrong here because what we’re doing isn’t making you better.

JORDAN PYSZ / iFoundMyDoctor.com
Pearl Ahmad

Double Trouble

The physical therapist’s inability to resolve Pearl’s problem prompted another trip to the primary care physician. This time, the doctor recommended that Pearl visit Advanced Orthopedic Center, where she was placed in the care of Sean A. Spence, MD. Dr. Spence began his care for Pearl by conducting a thorough examination that included taking imaging tests, which showed there was indeed more wrong with Pearl’s shoulder than initially thought. “The imaging showed us that she had a terrible case of degenerative arthritis in that shoulder as well as a torn rotator cuff, which is the muscle that attaches to the top of the shoulder and allows us to move our shoulder in space,” Dr. Spence reports. “This is a common degenerative condition that often develops from wear and tear, overuse or some type of injury, and over time, as the shoulder mechanics are not working properly, the joint breaks down. That’s what causes the pain, loss of motion and weakness.”  In treating these cases, Dr. Spence typically starts by prescribing topical and anti-inflammatory medications. If those don’t alleviate the pain, he recommends physical therapy and often offers steroid injections. By the time Pearl visited Advanced Orthopedic Center, she had already been through those stages of treatment. Because her shoulder damage was twofold, Dr. Spence took a few steps up the treatment ladder and recommended a surgical procedure called reverse total shoulder replacement. “I recommended the reverse total shoulder replacement procedure because if I had only addressed one problem, such as fixing the torn rotator cuff, then Pearl still would have had pain and difficulty with range of motion,” Dr. Spence explains. “And if I had only fixed the joint problem through a standard shoulder replacement, Pearl’s rotator cuff would still not be strong enough to power the joint replacement. The reverse total shoulder arthroplasty addresses both problems.” 

How It Works

Approved in the US in 2003, a reverse total shoulder replacement procedure is considered the best option for patients with damage so great that the arm cannot move away from the body or be raised above the head. Mechanics is the reason. In a healthy shoulder, the muscles and tendons in the rotator cuff work together to help raise and rotate the arm. Through the reverse replacement procedure, those tasks are transferred to the deltoid muscle through a unique device. That device includes a metallic ball attached to the socket of the scapula and a plastic socket (humeral cap) attached to the humerus. By flipping the construction of the ball-and socket joint, a better fulcrum is created that allows the arm to pivot up when the deltoid fires. Because of its construction, the reverse total shoulder replacement is often recommended for anyone who has severe rotator cuff damage, chronic shoulder dislocations, a complex fracture of the joint or a failed conventional replacement surgery. The construction of the joint used in a reverse total shoulder replacement also allows for speedier recovery times than standard repair options. That’s because the new joint is made of components that stick to the bones, which allows for almost immediate use of the shoulder.

No Pain Whatsoever

Dr. Spence urges anyone who is experiencing shoulder pain or weakness, or considering shoulder surgery, to be evaluated by a specialist who treats a variety of shoulder conditions. “There are a lot of options to treat shoulder problems, and specialists are going to have a lot of operations in their armamentarium that will allow them to recommend the right option no matter the condition they’re dealing with,” says Dr. Spence, an orthopedist who is fellowship-trained in hand and upper-extremity surgery. After considering Dr. Spence’s detailed explanations and medical experience, Pearl accepted the recommendation and had the reverse total shoulder replacement about a year and a half ago. Today, she says her shoulder feels “as if nothing ever happened.” “I have no pain at all, none whatsoever in that shoulder,” Pearl enthuses. “I can do all the things I was having trouble with before I had the surgery. I can bathe myself, dress myself, brush my teeth and I can drive again. “I can do all of that now without any pain or discomfort, and that’s all thanks to Dr. Spence, who is a wonderful doctor. He’s very patient, and he explained everything to me and answered all my questions. He even showed me diagrams of everything. “He’s a really great doctor and I would absolutely recommend him in a heartbeat.”

Sean A. Spence, MD

Orthopedic Surgery
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