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Reverse Total Shoulder Replacement by Fellowship-Trained Surgeon Puts the Sparkle Back into Maria’s Life


For the past 13 years, Maria Farano lived in pain. Her journey with shoulder pain began years ago when she had torn her rotator cuff while reaching for a can of tomatoes. She later had a rotator cuff repair. Unfortunately, due to family circumstances, she could not dedicate the time to allow her shoulder to heal.

Over the next few years, Maria’s shoulder function diminished and her pain worsened. She missed countless social gatherings, couldn’t raise a fork to her mouth to eat, and finally had given up putting her earrings on each morning. “I was in terrible pain everyday, everyday,” Maria admits.

Despite being in pain all of the time, Maria was consistently told that due to her previous injury, there was nothing that could be done to help her. Then one day her primary care doctor informed her of a new type of shoulder surgery, the reverse total shoulder replacement. Hopeful, Maria and her daughter began researching this procedure and found Dr. Brad Carofino.

Dr. Carofino is one of the few fellowship trained shoulder surgeons in the state of Virginia. In 2016, he and his surgical team performed over 100 shoulder replacements, the most in Hampton Roads and in the top 5% nationally. Over 50% of his shoulder replacements were the reverse total shoulder procedure.

The reverse shoulder is a relatively new type of shoulder replacement that allows surgeons to treat difficult problems for which there were previously no treatment options. It is used to treat rotator cuff tears that can’t be repaired or tears that have failed a prior repair such as Maria’s. It is also commonly used for revision shoulder replacements. The reverse replacement was first introduced in France and has been used in the United States for approximately fifteen years. In a standard shoulder replacement the ball and socket of the shoulder are replaced with a metal ball and plastic socket. When a reverse replacement is performed, the ball is placed where the socket was previously located and the socket is placed where the ball was located. The anatomy is “reversed.”

Due to Maria’s previous shoulder injury, she was the perfect candidate. “People don’t need to suffer,” Dr. Carofino emphasizes. “It can really improve their quality of life, regardless of age.”

During Maria’s appointment, Dr. Carofino explained the procedure with care and clarity. He showed her pictures of what would happen during the surgery and discussed what to expect. “I really like to spend a lot of time with my patients,” Dr. Carofino reports. “It’s very important they understand their options, and choices, so they can make the right decision for themselves.”

After returning home to think things over, Maria called to schedule her surgery. “I felt extremely confident,” she explained.

On the day of her surgery, Maria arrived at the Sentara Princess Anne Hospital for the first time. She marveled at the beautiful hospital and was comforted by the wonderful surgical staff. After surgery, impressing both Maria and her daughter, Dr. Carofino’s staff pulled up pictures from surgery to show them.

Like most patients who undergo joint replacement surgery, Maria was prepared for a brief hospital stay. That weekend, even though he was not on call, Dr. Carofino went to check on her. “I think it’s important for my patients to see a familiar face,” Dr. Carofino explains. He then decided to discharge her to go home, where she began her rehabilitation process.

At her six week follow up, Maria had a surprise for Dr. Carofino. “Look! I did this all by myself for the first time in two years AND I am pain free too,” Maria said as she proudly flashed her earrings to Dr. Carofino. “Thank you so much for improving my quality of life. This procedure is a true miracle.”

It is in moments like this when Dr. Carofino celebrates his patients’ achievements. “It’s not just technical for me, it’s about choosing the right thing for each patient. I am emotionally invested in their success.”