Seven months after my reverse, a new sharp pain right on top of the shoulder and I can't lift the arm like last week. No fall. What could it be?

I have read this board since before my operation but never posted. Reverse on the right in March, I am 74. It has been a really good recovery, honestly better than I expected. By the summer I was hanging out washing, reaching the top cupboard, I even went back to my aqua class.

Then on Tuesday, nothing dramatic, I lifted a full casserole dish out of the oven and felt something on the top of the shoulder, at the back, like a hot spot. Since then there is one spot I can put my finger on that is very sore, and lifting the arm out in front is suddenly painful and weak, it sort of gives up halfway. I did not fall. No redness, no temperature, the scar looks the same as ever.

I keep telling myself it is a pulled muscle and to give it a week. My husband thinks I should ring. Has anyone had a sudden new pain this far on?

Your husband is right. I say that as the bloke who tried to give it a week with every problem I have had in this shoulder saga. A shoulder that was good and suddenly isn't, without a fall, is exactly the sort of change the surgeon told me to report rather than sit on.

Brenda, please ring them. I am not going to guess what it is, but the pain being in one spot on the top and the arm suddenly not lifting is something I remember my surgeon describing before my own reverse, a thing that can happen to the bone up there months later because the deltoid is doing all the work now. I hope it is a pulled muscle. But that is for them to say with a scan, not us.

Ring them, and be specific when you do. Put your finger on the spot and describe that, and say exactly what the arm could do last week that it cannot do now. When I described a problem vaguely I got a vague answer. When I said "this spot, since Tuesday, and I can't lift past here," they had me in within days.

Rang. Seen in clinic this afternoon. Plain X-ray looked fine to them but the surgeon said the tenderness is in the place he worries about with reverses and he wants a CT scan to be sure. Arm back in the sling until then. I am quite shaken that it might be something after seven good months.

BrendaK74 said:

Plain X-ray looked fine to them but the surgeon said the tenderness is in the place he worries about with reverses

Brenda, you did exactly the right thing, and quickly, which matters here. I am a patient, not a clinician, so I will not guess at your scan. But I can tell you what your surgeon is checking for, because it is a recognised complication of reverses and the site has just written it up properly.

A reverse makes the deltoid do the lifting, and the deltoid hangs from the acromion and the spine of the shoulder blade. In a minority of reverses, around 4% in a large review of nearly 3,000 shoulders, that bone develops a stress fracture, usually with no fall, and on average around nine months after the operation, though it can be earlier or much later. The pattern people describe is very like yours: a good recovery, then a new sore spot on the top or back of the shoulder and a lift that suddenly gives up. And it is known for being hard to see on an ordinary X-ray, which is why a CT is the usual next step when the X-ray looks normal and the story fits. That is your surgeon being thorough, not alarmed.

If it does turn out to be that, most are treated without surgery, with a sling or brace for some weeks and a slower return to lifting, though recovery can be slower and less complete than the original one. The full account, including the honest outcome figures, is in acromial stress fracture after reverse shoulder replacement, and the general list of what can go wrong with a reverse is in shoulder replacement risks and complications. Your surgeon will be able to tell you which applies to you once the scan is back. And if it is the pulled muscle you hoped for, all the better.

Scan done. It is a small crack in the acromion, not moved, and they caught it early. Sling for six weeks, no lifting, then physio again. The surgeon was very straightforward that it may not heal perfectly but that most people end up comfortable. I read Douglas's article twice before the appointment so I knew what questions to ask, which helped more than I can say.

I nearly gave it a week. To whoever is reading this with a new sore spot on top of a reverse: ring.