This surgery repairs a tear of the rotator cuff in your shoulder. The rotator cuff is group of muscles and tendons. It holds the head of the humerus in the shoulder socket.

This outpatient procedure is a minimally-invasive surgical technique commonly used to identify problems in the shoulder joint. It is performed with the aid of a specialized camera called an arthroscope.

Shoulder replacement removes damaged areas of bone and replaces them with parts made of metal and plastic implants. This surgery is called shoulder arthroplasty.

The shoulder is a ball-and-socket joint. The round ball of the upper arm bone fits into a shallow socket in the shoulder. Damage to the joint can cause pain, weakness, and stiffness.

Shoulder implants are available in a few different shapes and a range of sizes. Replacement options include partial and total using either anatomic or reverse implants.

Why it's done

Shoulder replacement surgery is done to relieve pain and other symptoms that result from damage to the shoulder joint.

Conditions that can damage the joint include:

• Osteoarthritis. Known as wear-and-tear arthritis, osteoarthritis damages the cartilage that covers the ends of bones and helps joints move smoothly.
• Rotator cuff injuries. The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Rotator cuff injuries sometimes can result in damage to cartilage and bone in the shoulder joint.
• Fractures. Fractures of the upper end of the humerus may require replacement, either as a result of the injury or when the prior surgery for fracture fixation has failed.
• Rheumatoid arthritis and other inflammatory disorders. Caused by an overactive immune system, the inflammation associated with rheumatoid arthritis can damage the cartilage and occasionally the underlying bone in the joint.
• Osteonecrosis. Some types of shoulder conditions can affect blood flow to the humerus. When a bone is starved of blood, it can collapse.

A reverse total shoulder replacement is a special type of shoulder surgery. During the surgery, your surgeon removes the damaged parts of the shoulder and replaces them with artificial parts.

The shoulder joint is made up of the upper arm bone (humerus) and the shoulder blade (scapula). The rounded end of the upper arm bone moves inside a shallow socket in the shoulder blade. Because of this, your shoulder normally has a very wide range of motion. Cartilage, tendon, and ligaments around the joint also provide support and help the joint move smoothly.

In a reverse total shoulder replacement, a surgeon removes the rounded head of the upper arm bone. Using screws and special tools, he or she attaches a plastic socket to the remaining bone. The surgeon also removes part of the socket of the shoulder blade. This is then replaced with a metal ball. The metal ball can then move around inside the socket that attaches to the upper arm bone.

This is different from a standard total shoulder replacement. In a standard surgery, the metal ball attaches to the upper part of the humerus. The new socket attaches to the shoulder blade. This more closely follows a person’s real anatomy.

Healthcare providers advise reverse total shoulder replacements for certain types of shoulder injuries. The most common type is arthritis with a large rotator cuff tear.

Why might I need a reverse total shoulder replacement?

Surgery may be an option for you if you have severe pain that gets in the way of everyday activities. Surgery may also be advised if you have weakness in your shoulder and are not able to move it fully. It may also be advised if your symptoms don’t get better with other treatments. These may include medicines, shots (injections), and physical therapy.

Most people get a standard total shoulder replacement. However, reverse total shoulder replacement works better for people with certain injuries, including some rotator cuff injuries. If you have this type of injury, a standard shoulder replacement still might leave you with some pain and limited movement. A reverse total shoulder replacement usually improves these problems. After surgery, instead of using the rotator cuff to lift up your arm, you can use your deltoid muscle. This is a muscle that helps lift the arm up and away from the body.

Healthcare providers also may advise the surgery to people who have already had a standard shoulder replacement for osteoarthritis or other reasons. These people may still have symptoms that a reverse total shoulder replacement can fix.

What are the risks of a reverse total shoulder replacement?

Every surgery has risks. Risks for this surgery include:

• Infection
• Excess blood loss
• Damage to the surrounding nerves (which might impair arm movement)
• Break (fracture) of one of the shoulder bones
• Dislocation of the artificial joint
• Complications from anesthesia

Some of these risks may be higher in people having a repeat surgery. Your own risks may vary depending on the anatomy of your shoulder problem and your general health. Ask your provider about the risks that most apply to you.

How do I get ready for a reverse total shoulder replacement?

Talk with your provider about how to prepare for your surgery.

• Tell your provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements.
• Ask if you need to stop taking some medicines before the surgery, such as blood thinners.
• Don’t eat or drink after midnight the night before your surgery.
• Follow any other instructions from your healthcare provider.

Before your surgery, you may need imaging tests. These will give your provider more information about your shoulder. These might include:

• X-ray
• CT scan to see the bones in more detail
• MRI to see the soft tissue around the bones in more detail

What happens during a reverse total shoulder replacement?

Your healthcare provider can explain the details of your surgery. An orthopedic surgeon will do the surgery aided by a team of specialized healthcare providers. The procedure will take several hours. In general, you can expect the following:

1. You will likely have general anesthesia. This will make you sleep through the surgery.
2. You might also get an injection that blocks the nerves in your shoulder and arm. Some people have this instead of general anesthesia.
3. A healthcare provider will carefully check your vital signs during the procedure.
4. Your surgeon will make a cut through the skin near the top of your shoulder. He or she will also need to cut through the layer of muscle beneath.
5. Your surgeon will remove the damaged section of the humerus and the scapula. Using special screws, he or she will attach the metal ball to your scapula and the plastic socket to the top of the upper arm bone.
6. Your surgeon may place a tube to drain extra fluid in the joint. This tube will be taken out later.
7. After the new joint is in place, your surgeon will close the muscles and skin with stitches or staples.

What happens after a reverse total shoulder replacement?

Ask your provider about what you should expect after your surgery. In general, after your operation:

• Your operated arm may be numb from the anesthesia. You also may not be able to move your hands or fingers. This will last for several hours.
• You may have some pain, but pain medicines may help as needed.
• You might use a device to keep ice on your shoulder.
• You’ll probably need follow-up X-rays to make sure your surgery was successful.
• Your arm will probably be in a sling after the surgery for several weeks.
• You will probably begin physical therapy exercises while you are still in the hospital.
• You should be able to have a normal diet as soon as you can handle it.
• You will probably need to stay in the hospital for 2 to 3 days.

You’ll have some pain as you heal after the surgery. But your original shoulder pain should be improved.

Follow all your provider’s instructions about caring for your shoulder and wound. This might include continued icing of your shoulder and physical therapy. A little bit of drainage from the wound is normal. But let your provider know if it continues to swell and bleed, or if you have a fever or chills.

Your provider can let you know when you will be able to use your hand and arm more fully. You will probably be able to use your wrist and hand soon after your surgery. You won’t be able to use your arm for several weeks, though. Most people can return to light work within a few weeks.

Make sure to keep all your follow-up appointments with your provider. Keeping in close touch with your provider can help you have the best possible outcome. Most joints will last several years before they will need to be replaced.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure

Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken collarbone (clavicle).

The clavicle is a long thin bone located between your ribcage and the shoulder blade. Different kinds of injury can damage this bone, causing it to fracture into two or more pieces. Most often, this happens along the middle of the bone. Occasionally, the bone breaks near where it attaches to the ribcage, or near where it attaches to the shoulder blade.

In certain types of clavicle fractures, your clavicle has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone fragments out of alignment.

If you fracture your clavicle, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces surgically back into their proper alignment. In a closed reduction, a doctor physically moves the bones back into place without surgically exposing the bone.

Internal fixation refers to the method of physically reconnecting the bones. This method uses special screws, plates, wires, or nails to position the bones correctly. This prevents the bones from healing abnormally. The entire operation usually takes place while you are asleep under general anesthesia.

Why might I need a clavicle fracture open reduction and internal fixation?

Certain medical conditions may make fracturing your clavicle more likely. For example, osteoporosis increases the risk of clavicle fracture in many older adults.

You may fracture your clavicle from a direct blow to the shoulder, such as while playing a sport or if you're in a car wreck. Falling on an outstretched arm may also fracture a clavicle. In some cases, a newborn baby will fracture the clavicle during the birth process.

Not everyone with a fractured clavicle needs ORIF. In fact, most people don’t. If possible, your doctor will treat your clavicle fracture with more conservative treatments, like pain medicines, splints, and slings.

You probably won’t need ORIF unless there is some reason your fracture might not heal normally with these conservative treatments. You may need ORIF if:

• The pieces of your clavicle are significantly out of alignment
• Your clavicle broke through the skin
• Your clavicle broke into several pieces

In these cases, ORIF can position your bones back into their proper configuration. This significantly increases the chance that your bone will heal properly. In some cases, you might opt not to have ORIF even if your clavicle is significantly out of alignment, because the bone often heals correctly on its own. Your doctor can talk to you about the risks and benefits of ORIF or discuss other, more conservative treatments for your situation.

What are the risks for clavicle fracture open reduction and internal fixation?

Most people do very well with ORIF for their clavicle fracture. However, some rare complications do sometimes occur. Possible complications include:

• Broken screws or plates

• Infection
• Damage to an artery or vein
• Nerve damage
• Bone misalignment
• Injury to the lung
• Complications from anesthesia

There is also a risk that the fracture won’t heal properly, and you’ll need repeat surgery.

Your own risk of complications may vary according to your age, the anatomy of your clavicle fracture, and your other medical conditions. For example, people with low bone mass or diabetes may be at higher risk of complications. Being a smoker may also increase your risk. Ask your doctor about the risks that most apply to you.

How do I prepare for a clavicle fracture open reduction and internal fixation?

ORIF often takes place as an emergency or urgent procedure. Before your procedure, a healthcare professional will take your medical history and do a physical exam. You’ll need an X-ray of your clavicle. Tell your doctor about all the medicines you take, including over-the-counter medicines like aspirin. Also, let your doctor know the last time you ate.

In some cases, your doctors might perform your ORIF as a planned procedure. If this is the case, talk to your doctor about how to prepare for the procedure. Ask whether you should stop taking any medicines ahead of time, like blood thinners. You’ll need to avoid food and drink after midnight the night before your procedure.

What happens during a clavicle fracture open reduction and internal fixation?

Your doctor can help explain the details of your particular surgery. The details of your surgery will depend on the location and severity of your injury. An orthopedic surgeon and a team of specialized healthcare professionals will do the procedure. The whole operation may take a couple of hours. In general, you can expect the following:

• You will receive general anesthesia to make you sleep through the operation so that you won’t feel any pain or discomfort. (Or, you may receive local anesthesia and a medicine to help you relax.)
• A healthcare professional will carefully monitor your vital signs, such as your heart rate and blood pressure, during the operation. You may have a breathing tube placed down your throat during the operation to help you breathe.
• After cleaning the affected area, your surgeon will make an incision through the skin and muscle near your clavicle.
• Your surgeon will bring the pieces of your clavicle back into alignment (reduction).
• Next, your surgeon will secure the pieces of clavicle to each other (fixation). To do this, he or she may use screws, metal plates, wires, and pins. (Ask what the surgeon will use in your case.)
• Your doctor may make other necessary repairs.
• After the team has secured the bone, your surgeon will surgically close the layers of skin and muscle around your clavicle.

What happens after a clavicle fracture open reduction and internal fixation?

Talk to your doctor about what you can expect after your surgery. You may have some pain after your procedure, but pain medicine may help to reduce the pain. You should be able to resume a normal diet fairly quickly. You will probably need an imaging procedure, like an X-ray, to make sure that your surgery was successful. Depending on the extent of your injury and your other medical conditions, you may be able to go home the same day.

For a while after your surgery, you’ll need to keep your arm immobile. Often, this means that you will need to wear your arm in a sling for several weeks. You’ll receive instructions about how you can move your arm.

Your doctor might give you other instructions about caring for your clavicle, like applying ice. Follow all your doctor’s instructions carefully. Your doctor might not want you to take certain over-the-counter medicine for pain, because some of these can interfere with bone healing. Your doctor may advise you to eat a diet high in calcium and vitamin D as your bone heals.

You might have some draining of fluid from your incision. This is normal. Let your doctor know right away if:

• You see an increase in redness, swelling, or draining from your incision
• You have a high fever or chills
• You have severe pain
• You have loss of feeling anywhere in your body

Make sure to keep all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.

At some point, you may need physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your chances of a full recovery. Most people are able to return to all their normal activities within a few months.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure