Latest techniques and feedback in shoulder replacement surgery

[Mirdad]

I know that there are a few threads on tennis after shoulder replacement surgery but most of them are outdated. They have made more advancements in both regular and reverse shoulder replacement surgeries so that is why I'm creating a new thread. For example, doctors can now create a 3D diagram of the shoulder from a MRI that will greatly minimize the errors that can happen in fitting of the implants. It's also my understanding that there are better components they use. The surgery also takes only one hour and its now considered out patient surgery. In the past, a shoulder replacement was at the top of the most difficult and painful surgeries to recover from but now knee replacement, followed by hip replacement are more problematic than shoulder replacement.

I'm curious if there are any tennis players out there that in the past few years had shoulder replacement surgery? If so, I'd like to hear your feedback. My main objective is to comeback and at least be able to hit powerful groundstrokes.....the kind of force that a 5.0 player would hit with. It would be icing on the cake if I could return to hitting booming serves and overheads, but my thinking is that the serve probably causes the most trauma to the joint. I'd be willing to give up serving or at least give up hitting booming serves in order to preserve the life of the new joint and components.

Any feedback is much appreciated.

P.S. I'm meeting with my surgeon in mid-July and I'll be asking him these questions, but I'd also greatly value real life experience from fellow players. I only know of one person who knows another player who had a replacement surgery and his return to tennis performance was better than ever......and he is a 5.0 player. So, I'm cautiously optimistic about at least returning to the game hitting stronger groundstrokes and giving up serving if that makes sense.

 

[Injured Again]

"Shoulder replacement" is a very broad category and can range from relatively easy to recover from, to life altering. I've known players at our club in both camps, and depending on surgery they've come back to a range from limited functioning to much better than before surgery. So exactly what is worn out and what would your surgery exactly entail?

 

[yossarian]

If it’s an anatomical replacement it is doable depending upon your recovery and previous activity level.

If it’s a reverse, no way

 

[Mirdad]

"Shoulder replacement" is a very broad category and can range from relatively easy to recover from, to life altering. I've known players at our club in both camps, and depending on surgery they've come back to a range from limited functioning to much better than before surgery. So exactly what is worn out and what would your surgery exactly entail?

Thanks for your reply.

Here are the findings from my MRI. I don't know exactly what the surgeon is going to do.....yet. I will find out during my next appointment in mid-July. He said he wasn't sure if he was going to do a regular or reverse, but that this MRI would help him finalize his decision. I can tell you that the main pain I'm receiving which has stopped me from hitting ground strokes is the bone spur that is infringing on quadrilateral space (see the last sentence of the findings.) Also, as you can see, this latest MRI was back in October. I had made a decision to take off tennis for five months to see if my shoulder would feel better. The good news it felt so much better that I was able to hit groundstrokes again but after about six times out, the pain got more severe so I had to stop. Keep in mind, I have not hit an overhead or serve in about 10 years.

IMPRESSION: 1. Atrophic rotator cuff tendinopathy with moderate grade partial tear of the insertional subscapularis. No full-thickness cuff tear, myotendinous retraction, or muscle atrophy. 2. Severe end-stage right shoulder arthritis. release

Narrative​

EXAMINATION: MRI SHOULDER RIGHT WITHOUT CONTRAST DATE/TIME: 10/28/2023 2:18 PM HISTORY: RT SHOULDER PAIN; RULE OUT ROTATOR CUFF TEAR COMPARISON: 4/26/2023 TECHNIQUE: MR images of the right shoulder were obtained without contrast.

FINDINGS: Coracoacromial arch: There is a type 2 acromion. There is an anterior directed acromial enthesophyte.There is moderate acromioclavicular joint osteoarthritis. The coracoacromial ligament is normal. There is mild subacromial-subdeltoid bursitis. Rotator cuff: The rotator cuff muscle bulk and signal are normal. Atrophic rotator cuff tendinopathy is noted. There is partial tearing of the deep subscapularis near its lesser tuberosity attachment (7/9, 3/11). There is no full-thickness tear or myotendinous retraction. Biceps labral complex: The long head biceps tendon is thickened at the rotator interval but intact. The glenoid labrum is macerated. Misc: There is severe end-stage glenohumeral osteoarthritis with biconcave remodeling of the glenoid. A large inferiorly directed humeral head osteophyte encroaches on the quadrilateral space.

 

[Mirdad]

If it’s an anatomical replacement it is doable depending upon your recovery and previous activity level.

If it’s a reverse, no way

Yeah, I've read that in most cases a reverse doesn't work well for tennis. However, the surgeon and his PA said that even with a reverse he'd have me back out hitting groundstrokes within 4 to 6 months. Of course, I'm skeptical and have not confronted him with this information that I've read on the internet regarding statistical cases that show a low probability of returning to tennis after having a reverse replacement. I won't name the surgeon for privacy purposes, but I can tell you he's the most highly regarded shoulder surgeon in San Diego and has been the go to guy for most of the professional sports teams in the area. If he says I need a reverse then he will have to really convince me that I can return to tennis. As of right now, my pain is much better having not hit a ball for the past two months and am able to start doing some stretching and rehab exercises. I'm fairly confident I can put off the surgery for several years if the doctor says I need to have a reverse. So, basically, if he says I need a reverse that will probably be the end of my tennis. I won't have the surgery until later or never depending if and how well my shoulder heals from physical therapy.

Lastly, I've had about five other opinions over the years and they all say I need a replacement. I've been doing physical therapy on my shoulder for many years and that has definitely helped keep me pain free but just while hitting ground strokes. I did have a rotator cuff surgery to clean up some bone spurs about 26 years ago. I'm 68 and in decent shape despite my shoulder.

 

[dkmura]

Not sure if I should be chiming in here, but I'm 69 and had ORIF shoulder surgery back in 1986 after a motorcycle accident. Still carry a plate and screws in my left shoulder, but at least the clavicle, scapula and seven fractured ribs healed well. I've also had an ACL rupture and repair on my left knee (skiing) and other assorted injuries over the years. Having said all that, I wish all the latest surgical techniques and technology in the world could restore "normal" function in either my shoulder, knee or hip (car accident), but that's not what modern surgery can accomplish. It can take you so far, but after that, it's your grit, determination and adaptive qualities that make the difference.

Despite the difficult nature of rehabbing from shoulder surgery, I did make it back to playing competitive tennis. Earned USTA rankings in NTRP and age groups and considered it a point of pride that my serve was always a strong suite. As I get older, my left shoulder gets stiff and sore at times, but it's pliable and functional when it comes to tennis. I understand that you're looking for the best path through to a favorable outcome. That's smart. Listen to your surgeon and his recommendations, but always remember that YOU and your determination will ultimately make the difference. Good luck!

 

[yossarian]

Yeah, I've read that in most cases a reverse doesn't work well for tennis. However, the surgeon and his PA said that even with a reverse he'd have me back out hitting groundstrokes within 4 to 6 months. Of course, I'm skeptical and have not confronted him with this information that I've read on the internet regarding statistical cases that show a low probability of returning to tennis after having a reverse replacement. I won't name the surgeon for privacy purposes, but I can tell you he's the most highly regarded shoulder surgeon in San Diego and has been the go to guy for most of the professional sports teams in the area. If he says I need a reverse then he will have to really convince me that I can return to tennis. As of right now, my pain is much better having not hit a ball for the past two months and am able to start doing some stretching and rehab exercises. I'm fairly confident I can put off the surgery for several years if the doctor says I need to have a reverse. So, basically, if he says I need a reverse that will probably be the end of my tennis. I won't have the surgery until later or never depending if and how well my shoulder heals from physical therapy.

Lastly, I've had about five other opinions over the years and they all say I need a replacement. I've been doing physical therapy on my shoulder for many years and that has definitely helped keep me pain free but just while hitting ground strokes. I did have a rotator cuff surgery to clean up some bone spurs about 26 years ago. I'm 68 and in decent shape despite my shoulder.

Since your cuff is intact I’d be very surprised if they’d recommend a reverse

 

[Mirdad]

Not sure if I should be chiming in here, but I'm 69 and had ORIF shoulder surgery back in 1986 after a motorcycle accident. Still carry a plate and screws in my left shoulder, but at least the clavicle, scapula and seven fractured ribs healed well. I've also had an ACL rupture and repair on my left knee (skiing) and other assorted injuries over the years. Having said all that, I wish all the latest surgical techniques and technology in the world could restore "normal" function in either my shoulder, knee or hip (car accident), but that's not what modern surgery can accomplish. It can take you so far, but after that, it's your grit, determination and adaptive qualities that make the difference.

Despite the difficult nature of rehabbing from shoulder surgery, I did make it back to playing competitive tennis. Earned USTA rankings in NTRP and age groups and considered it a point of pride that my serve was always a strong suite. As I get older, my left shoulder gets stiff and sore at times, but it's pliable and functional when it comes to tennis. I understand that you're looking for the best path through to a favorable outcome. That's smart. Listen to your surgeon and his recommendations, but always remember that YOU and your determination will ultimately make the difference. Good luck!

Thanks for sharing your experience and encouraging words. I too have had many surgeries over the years and have also learned that a successful recovery is based upon not only a good surgeon but for the patient to do the physical therapy with zeal and keep up that therapy for the rest of your life. For example, about seven years ago, I had surgery on my knee and my surgeon was surprised that I was able to keep playing singles. Today I have zero pain in my knee as I keep doing the exercises that I had learned during rehab.

 

[Mirdad]

Since your cuff is intact I’d be very surprised if they’d recommend a reverse

I'm keeping my fingers crossed that he will avoid doing a reverse as that could be a show stopper for me.

 

[Mirdad]

If it’s an anatomical replacement it is doable depending upon your recovery and previous activity level.

If it’s a reverse, no way

Just visited with my shoulder surgeon today and unfortunately after viewing the MRI he said it was not conclusive enough to determine whether to do an anatomical or reverse until he actually cuts me open. There is some thinning out of the rotator cuff tendons so there is some concern that an anatomic shoulder replacement may not help with sustainability of symptoms based on the quality of my rotator cuff tendons. He also said they have been doing a lot more reverse replacements than anatomical and have been having good results for racquet sports. However, he said the biggest drawback for a reverse is that it won't supply enough overhead flexibility. Therefore, most people won't be able to hit serves, maybe just easy overheads. I can live without ever serving again but want to be able to hit out with great force on my groundstrokes. The doctor didn't see why I would not able to hit groundstrokes with no problem. I'm right handed and have a two handed backhand.

Therefore, I'm searching the internet to find out if anyone has had a reverse replacement and have been able to hit strong groundstrokes.

P.S........I'm very confidant in this surgeon as he does about 5 of these per week and is the most highly regarded shoulder surgeon in the San Diego area.

 

[mctennis]

I am interested in this thread. I am a candidate for shoulder replacement surgery. I am putting it off until it is absolutely necessary. Everyone I have talked to say it is a rough one and takes a long time to recover.

 

[LuckyR]

Just visited with my shoulder surgeon today and unfortunately after viewing the MRI he said it was not conclusive enough to determine whether to do an anatomical or reverse until he actually cuts me open. There is some thinning out of the rotator cuff tendons so there is some concern that an anatomic shoulder replacement may not help with sustainability of symptoms based on the quality of my rotator cuff tendons. He also said they have been doing a lot more reverse replacements than anatomical and have been having good results for racquet sports. However, he said the biggest drawback for a reverse is that it won't supply enough overhead flexibility. Therefore, most people won't be able to hit serves, maybe just easy overheads. I can live without ever serving again but want to be able to hit out with great force on my groundstrokes. The doctor didn't see why I would not able to hit groundstrokes with no problem. I'm right handed and have a two handed backhand.

Therefore, I'm searching the internet to find out if anyone has had a reverse replacement and have been able to hit strong groundstrokes.

P.S........I'm very confidant in this surgeon as he does about 5 of these per week and is the most highly regarded shoulder surgeon in the San Diego area.

So, what happened?

I'm 2 weeks out from a total joint replacement.

 

[Injured Again]

@LuckyR - Best of luck!

 

[LuckyR]

@LuckyR - Best of luck!

Hey thanks, appreciate it.

 

[Mirdad]

So, what happened?

I'm 2 weeks out from a total joint replacement.

I haven't yet made the decision to have the shoulder replacement surgery.

The main reason is I have recently experienced pain in my knee. About 8 years ago I had a micro fracture surgery on my knee. I don't know if it's a meniscus problem or if the tissue formed from the micro fracture surgery has worn out? Getting old sucks......

Please keep in touch and let me know how your recovery goes.

Good luck to you..........

 

[glenda]

I know that there are a few threads on tennis after shoulder replacement surgery but most of them are outdated. They have made more advancements in both regular and reverse shoulder replacement surgeries so that is why I'm creating a new thread. For example, doctors can now create a 3D diagram of the shoulder from a MRI that will greatly minimize the errors that can happen in fitting of the implants. It's also my understanding that there are better components they use. The surgery also takes only one hour and its now considered out patient surgery. In the past, a shoulder replacement was at the top of the most difficult and painful surgeries to recover from but now knee replacement, followed by hip replacement are more problematic than shoulder replacement.

I'm curious if there are any tennis players out there that in the past few years had shoulder replacement surgery? If so, I'd like to hear your feedback. My main objective is to comeback and at least be able to hit powerful groundstrokes.....the kind of force that a 5.0 player would hit with. It would be icing on the cake if I could return to hitting booming serves and overheads, but my thinking is that the serve probably causes the most trauma to the joint. I'd be willing to give up serving or at least give up hitting booming serves in order to preserve the life of the new joint and components.

Any feedback is much appreciated.

P.S. I'm meeting with my surgeon in mid-July and I'll be asking him these questions, but I'd also greatly value real life experience from fellow players. I only know of one person who knows another player who had a replacement surgery and his return to tennis performance was better than ever......and he is a 5.0 player. So, I'm cautiously optimistic about at least returning to the game hitting stronger groundstrokes and giving up serving if that makes sense.

Shoulder surgery, like "Tommy John" surgery, is highly complex, especially the techniques required to restore a professional athlete's ability to what the athlete possessed before injury.

I would ask the surgeon doctor: Are you experienced in sports surgery and are you experienced in noticing results of a player-patient after the surgery?

To be sure, rehab to, hopefully, full recovery will take a long, long time.

Even among highly experienced sports surgeons, no outcome is certain. Nothing is cookie-cutter in sports surgery.

However, in my case, if I couldn't play tennis the way I expect to play at a given age, I'd find a quality surgeon and tell the surgeon: "Have your way with my shoulder, but you better get it right."

 

[Mirdad]

Shoulder surgery, like "Tommy John" surgery, is highly complex, especially the techniques required to restore a professional athlete's ability to what the athlete possessed before injury.

I would ask the surgeon doctor: Are you experienced in sports surgery and are you experienced in noticing results of a player-patient after the surgery?

To be sure, rehab to, hopefully, full recovery will take a long, long time.

Even among highly experienced sports surgeons, no outcome is certain. Nothing is cookie-cutter in sports surgery.

However, in my case, if I couldn't play tennis the way I expect to play at a given age, I'd find a quality surgeon and tell the surgeon: "Have your way with my shoulder, but you better get it right."

The doctor I'd be using passed all your questions with flying colors. He's basically the inventor of the way most surgeons perform this surgery today.

 

[Yamin]

What is your issue? I had a complication resulting in 4 surgeries. I'm still tearing through scar tissue, but I'm recovering past what anyone ever expected given I had many complications. When not at a "weak point" in my recovery, I'd definitely answer your question with yes, you can easily generate the same pace as some 5.0 players if you were able to before. I was actually generating greater pace than I ever have when I was at an earlier stage in my recovery when my range of motion was limited.

I wouldn't recommend surgery unless it was absolutely needed. I don't think someone else would be able to handle the suffering I've gone through haha.

 

[Mirdad]

What is your issue? I had a complication resulting in 4 surgeries. I'm still tearing through scar tissue, but I'm recovering past what anyone ever expected given I had many complications. When not at a "weak point" in my recovery, I'd definitely answer your question with yes, you can easily generate the same pace as some 5.0 players if you were able to before. I was actually generating greater pace than I ever have when I was at an earlier stage in my recovery when my range of motion was limited.

I wouldn't recommend surgery unless it was absolutely needed. I don't think someone else would be able to handle the suffering I've gone through haha.

I'm bone on bone and also have a large bone spur that prevents me from hitting ground strokes, but the good news is my rotator cuff is intact and don't have any major tears. The entire results of my MRI are posted earlier in the thread in case you wanted to view the detailed version........Good to hear you've persevered and are doing well. Great news about going for big hits on the ground strokes!

 

[LuckyR]

I haven't yet made the decision to have the shoulder replacement surgery.

The main reason is I have recently experienced pain in my knee. About 8 years ago I had a micro fracture surgery on my knee. I don't know if it's a meniscus problem or if the tissue formed from the micro fracture surgery has worn out? Getting old sucks......

Please keep in touch and let me know how your recovery goes.

Good luck to you..........

Hey thanks, had the surgery yesterday. Thank heavens for scalene blocks. Have only needed Advil and Tylenol. I was mildly suprised to hear that the bone cement reaches maximum strength in 10 minutes, so the reason for the recovery period is to wait for the rotator cuff tendon that is cut to give access, to heal. Doing home Range of Motion exercises, PT to start in 6 weeks. Hopefully can play some dink ball by Xmas.

 

[LuckyR]

2 and a half weeks out. Essentially pain free (no Advil or pain pills) for a week.

Make sure to find out if you're a candidate for a stemless implant or not (better outcome, better recovery).

Basically the hard part at this point is restraining yourself from doing stuff you think you can.

One important word of advice: bidet.

 

[dkmura]

Can you do much lower body work to keep your legs and feet active? After such a major surgery, I wonder what is allowed or recommended for early recovery.

 

[LuckyR]

Can you do much lower body work to keep your legs and feet active? After such a major surgery, I wonder what is allowed or recommended for early recovery.

Yeah, I can do anything with legs, core and left arm. But my surgical arm is quite limited (by precautions, not pain). Though I'm not anticipating losing a lot of strength and stamina by taking it easy overall for 6 to 12 weeks, so that's my plan.

 

[esprits4s]

Watching closely as I consider learning to serve with my left arm

 

[LuckyR]

Watching closely as I consider learning to serve with my left arm

Next milestone is at 6 weeks, start physical therapy, can drive, can sleep on the operative side etc. It's in a week and a half. I'll post about it.

 

[esprits4s]

Wow, seems like good progress. I haven't been able to sleep on my bad shoulder for years.

 

[LuckyR]

Okay, 6 weeks out. Saw Physical Therapy. They're happy with my Range of Motion at this point (having just taken it easy for 6 weeks). Started passive Range of Motion stretching. Will start strength work at 3 months. Ditched the sling (which I was only using in public, for protection from jostling). I'm driving manual. Sleeping (the most difficult part of recovery) pretty much as good as before surgery, perhaps a little better. I was planning on just doing some mini-tennis or net work at 3 months, but I'm betting I'll be playing about 80% by that time. Surgeon anticipates full (ie. normal) Range of Motion at about 6 months to a year. I'm thinking the short end of that scale.

 

[esprits4s]

Thanks for the update!

 

[mctennis]

Okay, 6 weeks out. Saw Physical Therapy. They're happy with my Range of Motion at this point (having just taken it easy for 6 weeks). Started passive Range of Motion stretching. Will start strength work at 3 months. Ditched the sling (which I was only using in public, for protection from jostling). I'm driving manual. Sleeping (the most difficult part of recovery) pretty much as good as before surgery, perhaps a little better. I was planning on just doing some mini-tennis or net work at 3 months, but I'm betting I'll be playing about 80% by that time. Surgeon anticipates full (ie. normal) Range of Motion at about 6 months to a year. I'm thinking the short end of that scale.

Glad to hear you are doing so well. Keep up the good work and good luck to you in the future with your shoulder recovery.

 

[Injured Again]

@LuckyR You bombing serves on the court yet?

 

[LuckyR]

@LuckyR You bombing serves on the court yet?

Nope, coming into week 8 (tennis is at week 12, approximately Xmas). But my Range of Motion is already better than preop, after 2 weeks of Physical Therapy.

 

[tennishabit]

Can you do much lower body work to keep your legs and feet active? After such a major surgery, I wonder what is allowed or recommended for early recovery.

yep it's said 'tennis' played by legs' actually should be combined power generating sequence proportionally shared by the size/volume of different body parts 1 after another. looks good n most importantly feels wonderful if got it right lolololololol, absolutely addictive n never tired even hitting 24/7/365 w/o injuries lolololololololol..............