Vol. XIX, No. 4, Fall 2011
Rotator cuff problems? That’s a story for the sports pages. Baseball pitchers, tennis players. Even swimmers...among others. Surgery. Extended rehab. Often a career ender.
Rotator cuff problems among elders never make the papers, but it’s a very real problem. One estimate maintains that 25 percent of all rotator cuff problems involve patients over 60 as shoulder muscles and tendons simply wear out. The arthritis of aging makes it worse.
Until recently, elderly patients with rotator cuff problems were told to take a strong analgesic and “live with it.”
Old vaudeville joke:
Patient, lifting right arm: “Doc, it hurts when I go like this.”
Doctor, demonstrating: “Sooo, don’t go like this.”
Fortunately, new surgical techniques developed in 2004 have come to the rescue of many of these elderly sufferers.
And fortunately for the many elders populating this region, there’s one surgeon on Cape Cod who performs that technique known as Reverse Shoulder Surgery: Dr. Donald E. O’Malley, board certified in orthopedics, practicing at Cape Cod Sports Medicine in Falmouth and affiliated with Falmouth Hospital.
One of his recent examples involves Alba Tontini, an 83-year-old Sagamore resident who had been living with pain in her right shoulder for many years.
The arthritis had progressed to the point that the normal cartilage cushion between bones was gone and the rubbing of bone on bone was excruciating. In addition, her rotator cuff–the group of muscles and tendons that stabilize the shoulder–was chronically torn, resulting in limited range of motion and preventing her from taking part in many of the normal acts of daily living.
Fortunately, Dr. O’Malley and relief were available.
In a normal shoulder, the rounded end of the upper arm bone (humerus) fits into and moves against a dish-like socket (glenoid) in the shoulder blade (scapula). The joint is normally covered in smooth cartilage and the shoulder is able to be rotated through a wide range of motion.
Traditional shoulder replacement surgery involves replacing the shoulder joint with a metal ball and a plastic socket. The Reverse Shoulder Surgery also uses a ball-and-socket joint, but the normal anatomy is “reversed.” The ball is placed on the glenoid and the socket is placed on the head of the humerus.
This configuration is designed for people who do not have a functioning rotator cuff, Dr. O’Malley explained. The reverse anatomy makes it easier for the deltoid muscle–the large muscle on the outside and top of the shoulder – to compensate for the lack of a rotator cuff. By reversing the ball and socket, the deltoid is able to move the arm in all directions more efficiently.
“It makes the shoulder more stable,” Dr. O’Malley said. “We’re taking the muscle that’s good and giving it a better lever. We’re using physics to solve the problem.”
On the morning of her surgery, Mrs. Tontini was brought into a FH operating room and the surgical team placed her in what’s called a “beach chair” position, which provides the best angle for operating on her shoulder.
The Reverse Shoulder Prosthesis is made by DJO Surgical. A manufacturer’s representative is present in the operating room for each procedure to provide the right size implant, as determined by the surgeon, who cemented it into the implant canal in the humerus.
A similar procedure was used to place the ball portion of the implant into the scapula, and with that, the Reverse Shoulder Surgery was completed.
As the surgical team readied Mrs. Tontini for the recovery room, Dr. O’Malley prepared for his next surgery–another Reverse Shoulder.
Mrs. Tontini spent four days at Falmouth Hospital following the surgery. Several weeks later, she reported she was still in some pain from the surgery itself, but her physical therapist and VNA of Cape Cod nurse were pleased with her progress and expected that she would regain pain-free movement in her shoulder.
The operation didn’t make the sports pages.