Justice Breyer surgery, According to Supreme Court spokesperson Kathleen Arberg, Associate Justice Stephen Breyer underwent reverse shoulder replacement surgery for a proximal humerus fracture at MedStar Georgetown University Hospital on the morning of April 27th.
The fracture was sustained in his right shoulder after a fall from his bicycle on the afternoon of April 26th, where he was taken to the hospital by an ambulance.
This is the third biking mishap for Justice Breyer. Two years ago, he fractured his right clavicle (collarbone) after he fell near his home in Cambridge, Mass. He suffered a collapsed lung and multiple rib fracures in 1993 when he was struck by a car as he was riding his bicycle in Harvard Square.
Apparently surgeons elected to use a technique using a prosthetic device called “reverse shoulder replacement surgery”. A conventional shoulder replacement device simulates the normal anatomy of the shoulder: a plastic cup is fitted into the shoulder socket (glenoid) and a metal “ball” is attached to the top of the upper arm bone (humerus). In a reverse shoulder replacement operation, the socket and metal ball are reversed. The metal ball is fixed to the socket, while the plastic cup is fixed to the upper end of the arm bone or humerus.
A reverse shoulder replacement is a better choice for people with so called “cuff tear arthropathy” because it relies on a different set of muscles to move the arm. Rotator cuff tear arthropathy occurs when a patients has a rotator cuff tear as well as arthritis of the shoulder joint.
In a healthy shoulder, the four muscles comprising the rotator cuff help to allow an optimal position and range of motion as the arm is moved. A conventional shoulder replacement device essentially utilizes the four muscles of the rotator cuff to function normally.
However, in a patient with a significant rotator cuff tear along with cuff tear arthropathy, the rotator cuff no longer functions optimally. The reverse total shoulder replacement, however, relies on the strength of the deltoid muscle as opposed to the muscles of the rotator cuff to position move and power the arm.
Reverse shoulder replacement was initially developed in Europe in the 1980s, and the FDA approved the use of this surgery in the US in 2004.
Reverse shoulder replacement surgery is a highly technical procedure, and may be indicated in the following situations:
1. Cuff tear arthropathy
2. A completely torn rotator cuff that is not able to be repaired.
3. Intractable shoulder pain, and difficulty lifting your arm away from your side or over your head.
4. Failure of conservative therapy for chronic shoulder pain: (rest, steroid injections, physical therapy)
5. Previous unsuccessful shoulder replacement surgery.
Factors that influence a surgeon to perform a reverse shoulder replacement are the funtionality of the deltoid muscle, as well as the functional demands and age of the patient. In general, reverse shoulder replacements are pursued for patients with a limited level of activity and functional demands.
It is unclear what clinical conditions prompted surgeons to pursue a reverse shoulder replacement in the setting of Justice Breyer’s proximal humerus fracture. It is possible that he had severe arthritis of his shoulder, previous rotator cuff instability or significant acute rotator cuff trauma, making surgeons more apt to pursue the reverse approach for more optimal function in the long term.
Some surgeons have expanded the indications for the reverse approach and have more recently performed the procedure on selected patients with proximal humerus fractures at risk for poor healing as well.
Justice Breyer will likely spend several days in the hospital following his surgery, and then begin a post-operative rehabilitation program including range of motion exercises which will help to build strength and restore function.
The fracture was sustained in his right shoulder after a fall from his bicycle on the afternoon of April 26th, where he was taken to the hospital by an ambulance.
This is the third biking mishap for Justice Breyer. Two years ago, he fractured his right clavicle (collarbone) after he fell near his home in Cambridge, Mass. He suffered a collapsed lung and multiple rib fracures in 1993 when he was struck by a car as he was riding his bicycle in Harvard Square.
Apparently surgeons elected to use a technique using a prosthetic device called “reverse shoulder replacement surgery”. A conventional shoulder replacement device simulates the normal anatomy of the shoulder: a plastic cup is fitted into the shoulder socket (glenoid) and a metal “ball” is attached to the top of the upper arm bone (humerus). In a reverse shoulder replacement operation, the socket and metal ball are reversed. The metal ball is fixed to the socket, while the plastic cup is fixed to the upper end of the arm bone or humerus.
A reverse shoulder replacement is a better choice for people with so called “cuff tear arthropathy” because it relies on a different set of muscles to move the arm. Rotator cuff tear arthropathy occurs when a patients has a rotator cuff tear as well as arthritis of the shoulder joint.
In a healthy shoulder, the four muscles comprising the rotator cuff help to allow an optimal position and range of motion as the arm is moved. A conventional shoulder replacement device essentially utilizes the four muscles of the rotator cuff to function normally.
However, in a patient with a significant rotator cuff tear along with cuff tear arthropathy, the rotator cuff no longer functions optimally. The reverse total shoulder replacement, however, relies on the strength of the deltoid muscle as opposed to the muscles of the rotator cuff to position move and power the arm.
Reverse shoulder replacement was initially developed in Europe in the 1980s, and the FDA approved the use of this surgery in the US in 2004.
Reverse shoulder replacement surgery is a highly technical procedure, and may be indicated in the following situations:
1. Cuff tear arthropathy
2. A completely torn rotator cuff that is not able to be repaired.
3. Intractable shoulder pain, and difficulty lifting your arm away from your side or over your head.
4. Failure of conservative therapy for chronic shoulder pain: (rest, steroid injections, physical therapy)
5. Previous unsuccessful shoulder replacement surgery.
Factors that influence a surgeon to perform a reverse shoulder replacement are the funtionality of the deltoid muscle, as well as the functional demands and age of the patient. In general, reverse shoulder replacements are pursued for patients with a limited level of activity and functional demands.
It is unclear what clinical conditions prompted surgeons to pursue a reverse shoulder replacement in the setting of Justice Breyer’s proximal humerus fracture. It is possible that he had severe arthritis of his shoulder, previous rotator cuff instability or significant acute rotator cuff trauma, making surgeons more apt to pursue the reverse approach for more optimal function in the long term.
Some surgeons have expanded the indications for the reverse approach and have more recently performed the procedure on selected patients with proximal humerus fractures at risk for poor healing as well.
Justice Breyer will likely spend several days in the hospital following his surgery, and then begin a post-operative rehabilitation program including range of motion exercises which will help to build strength and restore function.
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