Shoul­der sta­bil­i­sa­tion suc­cess

Cynon Valley - - BOOK SHELF -

NOR­MALLY, the shoul­der has a wide range of mo­tion, mak­ing it the most mo­bile joint in the body. Due to this flex­i­bil­ity, how­ever, it is not very stable, is eas­ily in­jured, es­pe­cially in con­tact sports, and can de­te­ri­o­rate with con­stant use over time. Where ap­pro­pri­ate, the Latar­jet sta­bil­i­sa­tion pro­ce­dure is used, which has a very high suc­cess rate.

Mr Rhys Wil­liams, a se­nior or­thopaedic sur­geon spe­cial­is­ing in shoul­der and knee surgery, who prac­tises pri­vately at the Nuffield Health Cardiff & Vale Hos­pi­tals and in the NHS at the Uni­ver­sity Hos­pi­tals of Wales and Llan­dough in Cardiff, is well-placed to ex­plain about shoul­der sta­bil­i­sa­tion, which he has been per­form­ing for many years.

Mr Wil­liams ex­plained: “Ba­si­cally, the shoul­der is a gir­dle with lots of mus­cles which need to func­tion in a co-or­di­nated man­ner. It is im­por­tant to take age­ing and the per­son’s occupation and life­style into ac­count when mak­ing the di­ag­no­sis. As ten­dons age, they are less able to tol­er­ate stress, are less elas­tic and are eas­ier to tear. Shoul­der in­sta­bil­ity hap­pens most often in young peo­ple and ath­letes. When mus­cles and lig­a­ments that hold it to­gether are stretched be­yond their nor­mal lim­its, the shoul­der be­comes un­sta­ble.

“I’ve been do­ing shoul­der sta­bil­i­sa­tion op­er­a­tions for 20 years and in ap­pro­pri­ate cases have al­ways done the Latar­jet pro­ce­dure. It should be the op­er­a­tion of choice in pa­tients with bone loss, failed key­hole surgery and, more re­cently, has be­come the right choice in col­li­sion of sports­men and women.

“Whereas arthro­scopic (key­hole) surgery in col­li­sion sports like rugby car­ries a fail­ure rate up to 15%, in the last three to five years it’s be­come more com­mon to choose a Latar­jet open sur­gi­cal pro­ce­dure which car­ries a fail­ure rate of be­low 3%.

“In brief, the op­er­a­tion has three parts which are es­sen­tial for op­ti­mum re­sults. The lig­a­ments and soft-tis­sue socket edge are re­stored by pre­ten­sion­ing and re­pair, as in key­hole tech­niques. Then the socket is aug­mented with a bone block taken from an­other part of the shoul­derblade. Fi­nally the ten­don that is at­tached to that bone block is used to pro­vide a mus­cle sling at the front of the shoul­der.

“The op­er­a­tion takes an hour to do, the pa­tient is in a sling for six weeks and to­tal re­ha­bil­i­ta­tion time is 16-20 weeks for a re­turn to full sport.

“Physio starts even in the sling but full re­hab com­mences when the sling comes off and con­tin­ues for about three to four months in to­tal. There are pa­tients from as far as Hong Kong who have come to Nuffield Health in Cardiff for this surgery.”

To find out more about shoul­der surgery at Nuffield Health, please ring 01443 449251 or for a free event on shoul­der surgery on the evening of Mon­day, Oc­to­ber 22, book on­line: www.nuffield­health.com/ hos­pi­tals/cardiff-and-vale/events

Con­sul­tant or­thopaedic sur­geon Mr Rhys Wil­liams, who spe­cialises in knee and shoul­der surgery at Nuffield Health

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