Reverse shoulder replacement for irreparable rotator cuff tear with high riding humeral head

Rotator cuff deficiency with a high riding humeral head remains a challenging problem to solve. Shoulder replacement surgery in those individuals is highly technical in terms of correct positioning of implants or soft tissue balancing. Muscle transfers is an alternative solution in the treatment of the rotator cuff deficient shoulder as they can increase the range of motion of shoulder, however they have unpredictable results and they do not address the arthritic pain. If there is arthritis at the glenohumeral joint then is it unlikely that a muscle transfer will provide better quality of life. 

A reverse shoulder replacement can provide solution in cases that the active elevation of the arm is below 90 degrees. Further reading at the JBJS study:  http://dx.doi.org/10.2106/JBJS.K.01206

It must be highlighted though that if the active elevation of the shoulder is at 90 degrees or more then a reverse shoulder replacement may not provide significant benefits.

Below is an example of an elderly person with loss of motion (<90 degrees) and a high riding humeral head treated with a reverse shoulder replacement. The coronal CT shows the high riding humeral head and the sagittal oblique CT shows the significant atrophy of the supraspinatus and the contact of the humerus with the acromion making the repair of the rotator cuff impossible (Goutallier stage 3)