When a proximal humerus fracture is severe or complex, it can lead to lasting pain and loss of shoulder function. In these situations, reverse shoulder arthroplasty for proximal humerus fractures has become a trusted solution, especially for elderly patients or those with rotator cuff deficiency or poor bone quality.
At our Austin practice, fellowship-trained shoulder and sports medicine surgeon Benjamin W. Szerlip, DO, specializes in reverse shoulder arthroplasty and other advanced procedures to restore mobility and strength after serious shoulder fractures. If you’re dealing with shoulder pain after a fracture, contact us today to schedule an evaluation and discuss your options.
“Got checked in and into my appointment on time. Dr. Szerlip was prompt and very informative, while allowing any questions I may have had to be addressed while explaining my condition. He explained both a rotator cuff repair and a replacement for me to choose what will be best for me. He wasn’t trying to pressure me to choose without looking at both options. He was very supportive of the procedure I decided on and very supportive.” — Dale C.
Reverse shoulder arthroplasty for proximal humerus fractures is a type of shoulder arthroplasty designed to treat complex proximal humerus fractures, especially when the rotator cuff is torn or the bone is too weak for plate fixation.
Unlike traditional or hemiarthroplasty, this approach uses a reverse shoulder prosthesis, switching the ball and socket of the shoulder joint. The artificial ball is placed on the shoulder blade (glenoid), and the socket is placed on the humeral head side. This design allows the deltoid muscle to power shoulder movement instead of the damaged rotator cuff.
Reverse total shoulder arthroplasty is often used for acute proximal humeral fractures, fracture dislocation, or comminuted fractures where the bone fragments cannot be reconstructed.
Before your surgery, Dr. Szerlip will conduct imaging such as X-rays or CT scans to evaluate the fractures of the proximal humerus and plan the surgical technique. You may also undergo a medical clearance exam to ensure your heart and lungs are healthy for anesthesia.
Preparation steps include:
During the operation, the damaged humeral head and portions of the proximal humerus are carefully removed. The reverse prosthesis is implanted using specialized instruments to ensure stable fixation.
The tuberosities (bone areas where tendons attach) are often repaired or secured with sutures or a bone graft to enhance tuberosity healing. A properly repaired greater tuberosity contributes to improved external rotation and overall shoulder rotation.
Throughout the procedure, the axillary nerve and biceps tendon are protected to reduce the risk of axillary nerve injury or brachial plexus injury. The surgeon ensures the inferior glenoid rim is appropriately aligned to minimize glenoid loosening and scapular notching, both known risks of reverse shoulder arthroplasty.
Following surgery, your arm will be supported in a sling for several weeks. Early movement exercises begin under supervision to prevent stiffness and promote circulation. Over time, guided physical therapy helps restore shoulder rotation, strength, and stability.
Some of the benefits of reverse shoulder arthroplasty include the following:
Like any surgical intervention, there are potential complications. Some of the risks of reverse shoulder arthroplasty include the following:
However, with meticulous surgical technique and careful post-op management, most patients experience excellent clinical outcomes.
Most patients regain functional motion within 4–8 months, though full recovery may take up to a year. Ongoing follow-up ensures stable humeral component fixation and the absence of late complications such as scapular notching or loosening.
At each visit, Dr. Szerlip reviews progress, adjusts therapy as needed, and ensures the bone tendon junction and tuberosity fixation are healing properly. The goal is lasting strength and pain-free function for daily activities.
If you’re struggling with a proximal humerus fracture or complex shoulder fracture, our expert shoulder surgeon in Austin can help you regain mobility and comfort through advanced shoulder arthroplasty for proximal humerus injuries. Contact Benjamin W. Szerlip, DO, in Austin, Texas, to schedule a consultation and learn whether reverse shoulder arthroplasty is right for you.
Most patients begin gentle movement within weeks and regain strength over several months. Full recovery and return to daily activities often take 6–12 months.
Hemiarthroplasty replaces only the humeral head, while reverse shoulder arthroplasty reverses the joint structure, allowing the deltoid muscle to lift the arm even with a rotator cuff deficiency.
It’s primarily recommended for acute proximal humeral fractures, displaced fractures, or complex proximal humerus fractures, especially in older adults with poor bone quality.
Possible risks include infection, nerve injury, tuberosity nonunion, scapular notching, or glenoid loosening, though these are uncommon with modern implants and experienced surgeons.
According to studies in the Journal of Bone and Joint Surgery (J Bone Joint Surg Am), most patients experience excellent functional outcomes and significant pain relief when treated with this method for fractures in elderly patients.
