Understanding Your Total Shoulder Replacement Options

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Understanding Your Total Shoulder Replacement Options

There are many issues that can lead to shoulder pain including osteoarthritis, rheumatoid arthritis, and injury from an accident or fall. While in minor cases, pain can be treated at home with a combination of rest, ice and over-the-counter medication, more severe shoulder injuries and persistent conditions are best treated by an orthopedist who can provide proper diagnosis and treatment.

According to shoulder expert Dr. Neema Pourtaheri of Santa Rosa Orthopaedics there are actually two major types of shoulder replacement: standard and reverse. These terms can sometimes be a little confusing. “The major difference between a standard shoulder replacement and a reverse procedure is that in a reverse shoulder replacement (RTSR) the ball and socket parts of the shoulder joint switch locations,” explains Dr. Pourtaheri “With reverse total shoulder replacement, we essentially change the structure of the joint and the socket and metal ball are switched.”

In other words, with traditional total shoulder replacement, the ball and socket of the joint are simply replaced. The reverse total shoulder replacement procedure swaps the position of the ball and socket because of irreparable rotator cuff damage. “By reversing the ball and socket, we can mechanically repair the shoulder allowing for improved function and pain control.”

When a reverse prosthesis is better than standard shoulder replacement

With a standard total shoulder replacement procedure muscles and tendons around the shoulder joint are still healthy and can support a new joint. In this situation, muscles attach to the shoulder blade as they should, and are supported by tendons which connect to the shoulder. This configuration of muscles and tendons makes it possible to move the shoulder normally.

“In some patients, these tendons become damaged and torn to the point that they no longer support the bone structure of the shoulder, causing pain and significant loss of motion. Where a standard shoulder replacement procedure works great for patients where the supporting muscles and tendons of the rotator cuff are functional, a reverse total joint procedure is the better choice where it is torn or damaged.”

How rotator cuff becomes damaged

Due to the constant use and normally wide range of motion of the shoulder, the rotator cuff is susceptible to injury and tearing.  This type of wear and tear causes strain on the tendon which can develop painful tears over time, eventually resulting in chronic pain and disability. This type of slow deterioration can result in significant and irreversible degeneration.

Who qualifies for Reverse Total Shoulder surgery?

In most cases, rotator cuff degeneration makes it impossible for patients to qualify for traditional total shoulder replacement surgery and that is where reverse total shoulder replacement becomes a better option.

Reverse total shoulder replacement is often recommended for patients who have:

  • An irreparable torn rotator cuff
  • Cuff tear arthropathy
  • Experienced shoulder replacement previously that failed
  • Severe shoulder pain and difficulty lifting the arm normally
  • A complex fracture of the shoulder joint
  • A chronic shoulder dislocation
  • A tumor of the shoulder joint

Reverse total shoulder replacement is also recommended for patients who have repeatedly tried other treatments, such as rest, medications, cortisone injections, and physical therapy with little or no benefit.

Bottom line on RTSR

“An important part of maintaining an active, healthy lifestyle is having flexibility and mobility in the shoulder,” explains Dr. Pourtaheri. “Nagging symptoms such as chronic pain and arthritis that limit mobility can limit a person’s ability to participate fully in life.  For these patients, either traditional shoulder replacement or reverse total shoulder replacement can make a huge difference in the level of enjoyment they can get out of life.” Orthopaedic surgeons like Dr. Pourtaheri offer a variety of non-surgical and surgical treatment options aimed at helping patients resume the activities that make life meaningful.

About Dr. Pourtaheri and SRO

Dr. Neema Pourtaheri is a board certified and fellowship trained orthopaedic surgeon who brings invaluable medical expertise to the SRO team. He has trained alongside some of the world’s finest orthopaedic surgeons and in highly versed in the latest advancements in shoulder and elbow care. In addition, he practices general orthopaedics including arthroscopy, fracture care, joint replacement, reverse total shoulder replacement and total shoulder & elbow replacement with a focus on minimally invasive procedures. Dr. Pourtaheri also performs Platelet Rich Plasma (PRP) injections to advance healing and pain relief when standard treatments are not as effective.

SRO offers patients in-house diagnostic imaging, rehabilitation, sports injury prevention, as well as advanced surgical treatments in joint replacement, sports medicine, trauma care, hand, foot and ankle, shoulder and elbow and general orthopedic surgery.


We are open for patients needing all orthopaedic surgeries with IN-PERSON or ONLINE appointments. In accordance with our own high standards and following the Centers for Disease Control and Prevention guidelines, our priority continues to be protecting staff and patients. Elective and urgent care surgeries are available and we are also open for patients seeking appointments covering all orthopaedic needs. To learn more and to make an appointment with Dr. Pourtaheri call 707-546-1922.


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