Reverse Total Shoulder Arthroplasty as Treatment for Rotator Cuff-Tear Arthropathy and Shoulder Dislocations in an Elderly Male with Parkinson’s Disease

Abstract

We report the case of a 70-year-old male with Parkinson's disease (PD) and recurrent traumatic left shoulder dislocations. This case is rare because (1) he had a massive irreparable rotator cuff tear and end-stage arthritis (i.e., rotator cuff-tear arthropathy) of the same shoulder and (2) his shoulder was ultimately reconstructed with a reverse total shoulder arthroplasty (RTSA). His first dislocation occurred after a fall. Recurrent shoulder dislocations occurred despite successful closed reduction and physical therapy. Initial surgical treatment included an open capsular-labral reconstruction; RTSA was not an ideal option because of the presumed risk of failure from PD-related dyskinesias. However, the capsular-labral reconstruction failed after he lost balance and stumbled but did not fall. A RTSA was then done which restored the patient's shoulder stability and greatly improved his pain. At final follow-up two years later, he reported pain relief and improved function. This was partially attributed to the fact that he had moved to an assisted living center. He also began using an electric wheelchair one year after the RTSA. We report this case because of the unusual set of conditions and circumstances, namely, the implantation of a RTSA in a patient with PD and shoulder instability.

Manual wheelchair use leads to a series of failed shoulder replacements: A case report and literature review

“…In contrast to our current protocol and the high MW‐to‐electric wheelchair postoperative transition reported by Chiche et al, 29 we located only one other mention of a MWU that transitioned to a power wheelchair after a RTSA 28 . Additionally, we did not locate any report stating that this is a preoperative recommendation for some patients.…”

“…Studies that have explored reasons for the reluctance of some MWUs to transition to power wheelchairs can help healthcare providers identify potential physical, psychosocial, and financial barriers that might be at play 26,27 . In the perspective of these reports and our own experience, 28 we will not revise shoulder prostheses in MWUs until they establish the preoperative use of an electric or power‐assisted wheelchair. This approach can also be beneficial for some MWUs who are undergoing an index shoulder arthroplasty 29 .…”

“…While this might be a desirable choice for some wheelchair users, RTSAs are more appropriate for patients (including selected wheelchair users) with glenohumeral arthritis and significant rotator cuff dysfunction and/or shoulder instability. This is because RTSAs do not rely on the rotator cuff muscles for overhead arm elevation (the deltoid muscle performs this function) and the ball‐in‐socket design provides a high degree of intrinsic stability 28,34,35 . In 2015, when we performed our patient's RTSA there was limited data that supported this application, including one unpublished study 36 and one case report 37 .…”

“…This is because RTSAs do not rely on the rotator cuff muscles for overhead arm elevation (the deltoid muscle performs this function) and the ball-insocket design provides a high degree of intrinsic stability. 28,34,35 In 2015, when we performed our patient's RTSA there was limited data that supported this application, including one unpublished study 36 and one case report. 37 Following the RTSA in our patient, several studies have been published that further support using this procedure in MWUs (Table 1).…”

A Proximal Humerus Fracture Dislocation in a Patient with Stiff Person Syndrome

“…Therefore, the risk of dislocation and need for revision surgery was particularly worrisome. We considered the possibility of revising to an RTSA, which has been shown to be an option in patients at a higher risk of dislocating such as spastic paraplegics and patients with Parkinson's [10,11]. While RTSA can relieve pain and provide glenohumeral stability, these patients generally have high complication rates and less predictable improvements in range of motion [11,12].…”