The Shoulder Solution

Shoulder Pain? Nathan Richardson, MD, explains an advanced treatment that may be right for you

Reverse shoulder replacement surgery is somewhat of a newbie, having been performed for just 12 years in the United States. But it’s quickly becoming the popular option for a variety of shoulder problems. The shoulder is the third most often replaced joint, and Dr. Nathan Richardson, an orthopedic surgeon with Bingham Memorial’s Orthopedic Institute, highlights some common signs he looks for to determine if a patient would be a candidate for a reverse shoulder replacement.


As an orthopedic surgeon who is fellowship trained in shoulder and elbow surgery, I see patients with a variety of different joint problems. When evaluating a patient suffering from shoulder pain I look for three specific mechanical conditions that may be causing the pain.

  1. Stiffness: Often caused by a frozen shoulder or arthritis.
  2. Weakness: Commonly the result of torn tendons of the rotator cuff, or, more rarely, an injury to the nerves that control the rotator cuff.
  3. Instability: The wear and tear of ligaments or a dislocated ball and socket joint.


If a patient suffers from all three of the above conditions, it’s likely the rotator cuff has been torn for quite some time. With a torn rotator cuff, the deltoid—the large muscle on the outside of the shoulder—will pull the ball out of socket every time a patient tries to raise their arm above the shoulders or head. As the ball continues to dislocate, it wears down the cartilage on the ball and socket, eventually causing arthritis. As the arthritis progresses, the shoulder will become extremely stiff, accompanied by poor and painful shoulder function. This results in the condition commonly referred to as rotator cuff arthropathy.

Rotator cuff arthropathy is most often seen in patients who are 65 years or older who have had a rotator cuff tear that’s been present for more than five years. This condition is also prevalent in patients who have had a rotator cuff repair. If their tendons tear again after a rotator cuff repair, a larger tear can occur. When this happens, it is often unknown or ignored by patients.


When all of the above conditions are present, joint replacement through reverse shoulder surgery is typically recommended. This leading-edge surgery restores the function of the shoulder and alleviates pain. Reverse shoulder replacement is often misunderstood. They imagine that after the surgery they will have an arm placed on backwards, or they will have to walk on their hands. The term “reverse” in this case means that instead of replacing the ball and socket of the shoulder back to the original positions, they’re switched.

Normally the ball is on the long arm bone that runs from the shoulder to the elbow—the humerus—and thesocket is on the shoulder blades. In the past, when surgeons performed shoulder surgery using a metal ball and plastic socket in the same place, the replacement failed within a year. Later, it was discovered that by reversing the positions of the ball and socket, a stable shoulder was created and the deltoid no longer dislocated the joint. The deltoid becomes a powerful muscle once again and most of the function that had been lost are restored.

If you are experiencing pain, weakness, severe stiffness and are unable to use your shoulder for daily activity, it’s important that you find a surgeon who has been well trained in reverse shoulder replacement surgery. Patients often assume that this type of shoulder surgery cannot be done locally. However, with my specialty training in shoulder surgery, patients in eastern Idaho can now stay close to home and have cutting edge treatment. If you are experiencing shoulder pain, I would be happy to help you find a solution for the pain. Please call my office to set up a consultation, and let me help you restore your shoulder function and give you relief from your pain.

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