Orthopaedic Services – Specialized Shoulder Care

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Frequently Asked Questions

Why see a shoulder specialist?

We live in a world of increasing specialization. As more and more new information is discovered in a particular field it becomes more and more difficult to maintain a level of expertise without specializing. The field of orthopaedics is no exception. Although orthopaedics in itself is a specialized field, many orthopaedists choose to complete additional training to sub-specialize after their general training. Specialization has been shown to be beneficial because there is value in repetition for surgeons who perform a particular procedure. Studies have shown that patients are better served by a surgeon who sees a large volume of shoulder surgery cases, because the number of times a surgical procedure is performed may have a bearing on how well it is done.

What makes someone a shoulder specialist?

Most orthopaedic surgeons who specialize in shoulder and elbow surgery are fellowship trained, meaning that they have completed an additional year of training to focus on surgery of the shoulder and elbow. There are a limited number of shoulder and elbow fellowship positions that are recognized by the American Shoulder and Elbow Surgeons. In 2009, there were only 23 recognized fellowship positions in the entire United States. These programs tend to place an emphasis on arthroscopic surgery as well as joint replacement and reconstructive surgery. In addition, involvement in clinical and scientific research is an important aspect of training that is highly recommended. Dr. Choi at Guthrie Orthopaedic Services is the only American Shoulder & Elbow Surgeons fellowship-trained shoulder specialist in the Twin Tiers.

What kinds of injuries or conditions can be helped by seeing a shoulder specialist?

Patients with rotator cuff arthropathy – a complex shoulder problem that occurs when there is a large tear of the rotator cuff tendons that causes arthritis in the shoulder joint – will need to see a shoulder specialist. Patients suffering from certain fractures of the shoulder that are complex and involve the part of the bone where the rotator cuff tendon inserts are also good candidates for a shoulder specialist. And, any patient who has failure of a prior surgery which results in loss of rotator cuff tendon function may also need to seek help from a shoulder specialist.

Is there a particular procedure that only a shoulder specialist can perform?

The reverse shoulder replacement is a highly specialized procedure that is performed by shoulder specialists. The reverse shoulder replacement was specifically designed for people who do not have a functioning rotator cuff, and therefore do not have normal shoulder function. In a traditional shoulder replacement surgery, the ball of the top of the arm bone is replaced with a metal ball. The socket of the shoulder blade is replaced with a plastic socket. People who have total shoulder replacement and also have a torn rotator cuff run a high risk of having the implant come loose. The reverse shoulder replacement uses a ball-and-socket joint as well, but the ball is placed on the shoulder blade and the socket is placed on the top of the arm. This is the reverse of our normal anatomy, thus the name reverse shoulder replacement. The reverse shoulder replacement is designed to make the deltoid, the large shoulder muscle, more efficient by being able to life the arm up overhead and compensate for the torn rotator cuff.

Who is a good patient for a reverse shoulder replacement?

Patients with severe shoulder arthritis and/or a chronic rotator cuff tear are good candidates for the reverse shoulder replacement procedure. Other factors that can influence the decision to perform a reverse shoulder replacement include the function of the deltoid muscle (that must be working well), the age of the patients, and the functional demands of the patients. In general, reverse shoulder replacements are designed for patients with limited activity demands.