Science Video

Painless Shoulder
FDA Approves Surgical Procedure to Alleviate Shoulder Pain

January 1, 2006 — Patients who suffer from debilitating shoulder pain due to arthritis or to a torn rotator cuff may benefit from new kind of prosthesis. The procedure, which has been performed successfully in use in France and Germany for 15 years, was recently approved for U.S. patients by the Food and Drug Administration.

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ATLANTA--Millions of people are living with a pain so debilitating they can't even lift their arms. Until now, treatment for a torn rotator cuff or shoulder arthritis was limited. A new invention may give patients the relief they're looking for.

Ann Remite, an arthritis patient, says, "It's like a drill, a sharp, shooting pain and the pain goes up into your neck." Ann's arthritis took away her ability to do just about everything, including crochet. "It just wasn't worth it, so I gave it up."

Her doctor suggested RSP or reverse shoulder prosthesis to relieve her pain. Spero Karas, M.D., an orthopedic surgeon at Emory University in Atlanta, says, "With the reverse shoulder prosthesis, the classic ball-and-socket shape of the joint is basically reversed."

The shoulder is made up of a ball and socket joint and a rotator cuff. The ball connects to the arm; the socket connects to the shoulder blade. The rotator cuff is muscle that surrounds the joint and helps lift and rotate the arm. In patients suffering from a torn rotator cuff or arthritis, however, this protection is gone, and bone painfully scrapes against bone.

With the new procedure, Dr. Karas says, "Instead of the ball being on the arm side, now we see a socket on the arm side, and the ball is actually on the shoulder side, or the socket side."

"What the reverse prosthesis does -- is allows us to stabilize the shoulder, normalize the center of rotation, thus improving function and relieving pain," Dr. Karas says.

The surgery takes 90 minutes. Ann had a full recovery in four months. "I can wash windows. I can crochet. I can do everything I did before my arm went bad, and I have no pain." No pain and she's back to doing what she loves.

Surgeons in Europe have been performing reverse shoulder arthroplasty for 15 years with excellent results. After several years of clinical trials, the FDA recently approved the procedure for patients in the United States. Physicians in America have seen excellent success rates for up to seven years with the device.

BACKGROUND: A new shoulder prosthesis can provide relief to those who suffer from pain and limited movement of their shoulders. The FDA has just approved the device, which has been used successfully in Europe for more than 10 years. Emory University in Atlanta, Georgia, is one of the few locations performing the procedure.

ABOUT THE SHOULDER JOINT: Your shoulder consists of a ball and socket joint that fit together much like a baseball in a glove. The ball is at the head of the upper arm, and the socket is an indented area in the shoulder blade. Then there is the rotator cuff: a small group of muscles and tendons surrounding the joint. The rotator cuff helps lift and rotate the arm, as well as stabilize the ball of the shoulder in the socket. When the rotator cuff tears loose from the bone, it can severely limit the join's stability and range of motion and cause considerable pain.

HOW IT WORKS: The reverse shoulder surgery helps the artificial joint to function when there is significant bone loss, or if the rotator cuff no longer works. The prosthetic reverses the positions of the ball and socket. The normal socket is replaced with a prosthetic ball, and the upper arm is replaced with an implant that has a socket in which the ball rests. Reversing the positions prevents the prosthetic joint from dislocating and improves the function of the surrounding muscles.

WHO CAN BENEFIT: Anyone who experiences pain or limited function of the shoulder from arthritis, a rotator cuff injury, or a previous shoulder replacement. Patients who had the surgery reported significant decreases in pain and noticed marked improvements in functional arm movement. The surgery requires an overnight hospital stay, followed by six weeks with their arm in a sling, and then six weeks of physical therapy.

Note: This story and accompanying video were originally produced for the American Institute of Physics series Discoveries and Breakthroughs in Science by Ivanhoe Broadcast News and are protected by copyright law. All rights reserved.