Pain or Stiffness After Reverse Replacement

Reverse shoulder replacement generally produces good long-term functional outcomes. However, a small subset of patients could have prolonged unexplained pain and limited range of motion, or stiffness, following surgery.

Where the pain comes from

Stiffness is one cause of pain, which could be from buildup of scar tissue, especially if you have had several prior surgeries.

Another cause of pain is impingement, or contact between the implant and the coracoid — a part of the shoulder blade that extends towards the front of the shoulder. The latter is exacerbated when moving the arm across the chest and behind the back.

How arthroscopy can help

Although arthroscopy after replacement is most often employed for diagnostic purposes, we believe it can be used to treat front shoulder pain and stiffness.

This arthroscopic technique, developed at Oregon Shoulder Institute, eliminates scar tissue and widens the space between the implant and coracoid, which allows for more contact-free motion, resulting in decreased pain. Despite limited studies on this technique, we have successfully decreased pain levels and improved range of motion in our patients.

Arthroscopic images of the space above the rotator cuff before and after clearing scar tissue — Figure 1. Arthroscopic images showing the space above the rotator cuff in a patient with stiffness and front shoulder pain. Image A shows dense white scar tissue covering the rotator cuff. Image B shows the superior surface of the rotator cuff after clearing the scar tissue.

Read the published technique.

Patrick J. Denard, MD

Dr. Denard is a shoulder surgeon at Oregon Shoulder Institute in Medford, Oregon. He is ranked #2 in North America for rotator cuff repair and #17 globally for shoulder replacement, has authored over 300 peer-reviewed publications, and performs over 400 shoulder surgeries annually.

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