Indications for reverse total shoulder arthroplasty in rotator cuff disease.
BACKGROUND
Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear.


OBJECTIVE
We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.


METHODS
We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.


RESULTS
Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short- and medium-term followup studies.


CONCLUSIONS
In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA.


CONCLUSIONS
For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction.


METHODS
Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Drake
Gregory N
GN
Core Orthopedics and Sports Medicine, 555 Biesterfield Road, Elk Grove Village, IL 60007, USA. gregdrake@aol.com
O'Connor
Daniel P
DP
Edwards
T Bradley
TB
D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D000075202:Contraindications; D006801:Humans; D017060:Patient Satisfaction; D018579:Patient Selection; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000517:prevention & control; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome