1. PATIENT EDUCATION REVERSE SHOULDER PROSTHESIS Reverse ® Shoulder Prosthesis Patient Education

2. Nathan T. Formaini, D.O. ACMH Hospital Specializing in Shoulder and Elbow Surgery, Hip and Knee Replacement, Sports Medicine Reverse ® Shoulder Prosthesis Patient Education

3. Overview Shoulder Anatomy Shoulder Conditions Rotator Cuff Deficiency Reverse Ball & Socket Concept Reverse® Shoulder Prosthesis Recovery

4. SHOULDER ANATOMY Reverse ® Shoulder Prosthesis Patient Education

5. INTRODUCTION TO THE SHOULDER JOINT Complex structure which consists of the humerus, scapula and clavicle. The motion created by the shoulder is considered greater than any other joint in the body. Supported and moved by 30+ muscles, ligaments and tendons. Reverse ® Shoulder Prosthesis Patient Education

6. HUMERUS Half circle-shaped portion of humerus for the shoulder joint Points of attachment for the rotator cuff Surgical neck is a common point of fracture Mid-humeral shaft and also a common fracture point Reverse ® Shoulder Prosthesis Patient Education

7. SCAPULA Shoulder blade - Attached to the axial skeleton by muscles, giving it mobility on upper back Reverse ® Shoulder Prosthesis Patient Education

8. NORMAL SHOULDER BIOMECHANICS Balance between the ascending forces of the deltoid and the descending forces of the rotator cuff muscles Reverse ® Shoulder Prosthesis Patient Education

9. ROTATOR CUFF DEFICIENCY Reverse ® Shoulder Prosthesis Patient Education

10. ROTATOR CUFF DEFICIENCY Over 100,000 Americans undergo surgical rotator cuff repair annually (Praemer et al 1999) Full thickness tears are present in up to 25% of all people over age 60 (Fuch et al 1999) Cuff-tear arthropathy may develop in 4% of patients with a complete rotator cuff tear (Neer et al 1983) Reverse ® Shoulder Prosthesis Patient Education

11. KINEMATICS OF SHOULDER FUNCTION C L C L HEALTHY SHOULDERRC DEFICIENT SHOULDER Reverse ® Shoulder Prosthesis Patient Education

12. KINEMATICS OF SHOULDER FUNCTION HEALTHY SHOULDERRC DEFICIENT SHOULDER x x x Reverse ® Shoulder Prosthesis Patient Education

13. ROTATOR CUFF REPAIR Space is increased between the acromiom and the rotator cuff tendon The torn tendon is trimmed and a rough area is made on the humerus The tendon is secured to the humerus sutures anchors tacks Reverse ® Shoulder Prosthesis Patient Education

14. “REVERSE BALL & SOCKET” SHOULDER CONCEPT Reverse ® Shoulder Prosthesis Patient Education

15. WHY A REVERSE BALL & SOCKET? Delivers most mechanically efficient method to “neutralize” the vertical forces of the deltoid muscle and maintain joint stability Provides enhanced stability of the glenohumeral joint Optimizes the length-tension curve of deltoid muscle to provide a stable fulcrum for elevation Reverse ® Shoulder Prosthesis Patient Education

16. CLINICAL SOLUTION Reverse ® Shoulder Prosthesis Patient Education The Reverse® Shoulder Prosthesis is an exclusive semi-constrained design concept that reverses the shoulder anatomy by lateralizing the shoulder joint to effectively resist the superior pull of the deltoid muscle and optimize soft tissue balancing.

17. REVERSE® SHOULDER PROSTHESIS This innovative surgical alternative is designated to provide patients with the potential for pain relief, restored function and improved stability. Reverse ® Shoulder Prosthesis Patient Education

18. REVERSE® SHOULDER PROSTHESIS Cementless Glenoid Encased Poly Humeral Socket FDA Clearance in March 2005 2 nd Generation Reverse Ball & Socket Prosthesis

19. RECOVERY Varies from patient to patient Most perform light exercises the day after surgery Your surgeon will prescribe the best recovery plan to fit your needs and lifestyle Active and passive physical therapy are very helpful in aiding the recovery process Reverse ® Shoulder Prosthesis Patient Education