Reversing Anatomy Remakes Shoulders


Carol Driesen wanted to make sure her second shoulder replacement would be done right. Even at 76, she was still active, a busy woman who often baby-sat her toddler granddaughter. 

I really wanted to make sure that this time it would be done right.

- Carol Driesen, patient, Stanford Hospital & Clinics

Driesen's surgeon, John Costouros, did a fellowship in Switzerland with one of the world's foremost experts in reverse shoulder procedure. By the time Driesen came to see Costouros at Stanford, he had completed more than 300 reverse shoulder surgeries. 

In the last 10 to 15 years, we've really seen an explosion in our understanding of the anatomy and biomechanics of the shoulder and of things that happen at the molecular level.

- John Costouros, MD, orthopaedic surgeon, Stanford Hospital & Clinics

Its boney structure is simple−the ball at the top of the arm bone, or humerus, and the socket, the curved portion of the scapula, called the glenoid.

It has the widest range of motion of any joint in the body, and so is prone to a variety of unique injuries.

The motion of shoulder is enabled by soft tissue structures: the circular set of muscles that form the rotator cuff provide elevation and rotation of the shoulder; the deltoid muscle; a part of the biceps muscle; ligaments; tendons; joint capsule; and several bursa, fluid-filled sacs that act as buffers between the bones and tendons.


Ironically, the more active we are the more likely we are to injure the shoulder. Age is another aggressor against the shoulder as are genetics: Osteoarthritis often affects the shoulder joint.

The most commonly injured part of the shoulder is the rotator cuff, the combination of muscles, tendons and ligaments that provides the shoulder its widest range of motion. Unfortunately, the rotator cuff is sensitive to repetitive motions like pitching a baseball, swinging a tennis racquet, or swimming. Contact sports like wrestling or football, however, often cause sprains, strains, dislocations and occasionally tears of important structures of the shoulder.

Many shoulder injuries can be treated with injections of anti-inflammatory medications, physical therapy and activity modification. Surgery might be required if conservative treatment fails or will not cure the problem. Many procedures to repair the shoulder are now possible with the minimally invasive approach called arthroscopic surgery, performed through small incisions and as an outpatient procedure.

Outcomes and longevity of shoulder implants today are far superior, enabling patients to obtain predictable pain relief and function that in past years was not possible.

-John Costouros, MD, orthopaedic surgeon, Stanford Hospital & Clinics