Case Study: Repeated Shoulder Dislocations and the Latarjet Procedure

Recently, we had an interesting case with a young man in his early 20’s. The patient had dislocated his shoulder “100 times” following a previous surgery (anterior labral repair) performed by another physician. Shoulder dislocation is not only painful, but debilitating. The patient stated that any movement would cause the shoulder to dislocate – even in his sleep. 

A CT Scan was performed to look at the structure of the shoulder bones and revealed that the glenoid bone (the socket of the shoulder) was missing (see pictures). The repeated dislocations likely caused the loss of the front of the glenoid bone. If not repaired, the shoulder would continue to dislocate. 

Normal Glenoid

CT Scan of Missing Bone on Glenoid

In this case, we opted to perform an open surgery known as the Latarjet Procedure. The Latarjet procedure was first performed in France by a French surgeon, Michel Latarjet. The procedure has excellent success rates in patients with recurrent dislocations and recurrence of injury is low. 

In the Latarjet procedure, a portion of bone is taken from scapula (shoulder blade) called the corocoid. The corocoid is a hook of bone located in the front of the shoulder blade. In the Latarjet procedure the corocoid is removed from the scapula, with the muscles still attached. The corocoid is then screwed into the shoulder socket where it replaces the lost bone (see picture below). The attached muscles are then secured to offer support in the front of the shoulder. 

In this case, the surgery was a great success. The patient was in a sling for 4 weeks following surgery to protect the repair. He then performed physical therapy 3x/week for 16 weeks and is no longer dislocating his shoulder. The patient is very happy with the results. 

Latarjet Repair - Bone restored to prevent dislocation

John Vitolo, MD is a board certified orthopedic surgeon specializing in injuries and conditions of the shoulder and knee. With over 25 years of experience, Dr. Vitolo is an expert in the field. To make an appointment, please call 973-300-1553 or visit advocareorthosportsmed.com to learn more.

 

Advocare Orthopedic and Sports Medicine Goes to New Orleans

Orthopedic Surgeon, John Vitolo, MD recently attended the annual American Academy of Orthopedic Surgeons meeting (AAOS) in New Orleans, LA. The meeting is focused on continuing education and the latest advances in orthopedic surgery. Dr. Vitolo stated, “As a surgeon, extremely important to stay connected with peers and learn what others are doing. This meeting allows us to re-connect and continue the learning process. By sharing experiences, we can ensure that we are taking the best possible care of our patients.”

As part of the meeting, John Vitolo, MD was featured as a contributing writer to the AAOS sponsored website, anationinmotion.org. This website features prominent orthopedic surgeons, patient stories and articles about orthopedic surgery. Dr. Vitolo’s articles and profile are featured on the site.

Dr. Vitolo was excited to share with colleagues that the office recently implemented a system that follows up on surgical outcomes for 2 years post-surgery. Surgical Outcomes Systems (SOS) tracks patients at various intervals to see how the progress post-op. This system allows the office to see how patients are doing well beyond the required follow-up office visits.

In other recent news, for the second year in a row, John Vitolo sponsored the United Way’s scholar athlete program. Vernon’s Jinan Andrews, was awarded a $1,000 scholarship towards his college education. Dr. Vitolo says, “It is a great honor to sponsor these athletes and this program. Athletes work hard, and it is wonderful to be able to give them some help toward college tuition.”

John Vitolo, MD and Scholar Athlete Jinan Andrews

Advocare Orthopedic and Sports Medicine, the office of John Vitolo, MD, is located in Sparta, New Jersey. The practice focuses on treatment of the shoulder and knee, specifically sports and workplace injuries. For more information about the practice, please visit www.advocareorthosportsmed.com.

Rotator Cuff Tears

Rotator cuff tears are one of the most common injuries of the shoulder. The anatomy of the shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff is comprised of 4 muscles and keeps the arm in the shoulder socket and provides stability.
 

There are two main types of tears:

1. Partial Tear
2. Full Thickness or Complete Tear

Tears are primarily caused by acute injury or overuse. Acute tears are the result of injury, such as falling on an outstretched arm or lifting a heavy object. With acute injuries, it is not uncommon to see other injuries present as well. 

Tears caused by overuse or degeneration occur over time and can be the result of the following:

•  Repetitive motion of the shoulder (i.e.  lifting, throwing, overhead work)
• Blood supply – as we age, the blood supply to the rotator cuff tendon decreases leaving the rotator cuff more susceptible to injury
• Shoulder impingement

Symptoms of a rotator cuff tear include:

• Pain at rest and/or at night
• Pain with lifting
• Weakness
• Cracking in the shoulder

Treatment of rotator cuff tears depends on the severity of the tear. Partial tears can often be treated non-surgically with physical therapy, rest, ice and anti-inflammatory medication. For full thickness tears, surgical intervention is recommended. Surgery is performed arthroscopically through a small incision in the shoulder. 

In surgical repair, bio-absorbable anchors are used to reattach the rotator cuff to its anatomically correct position. In our practice, we use a “double row” technique to reinforce the repair, reduce the risk of a repeat tear and enable healing. 

Some physicians recommend moving the shoulder immediately following surgery, however, we disagree. We recommend immobilizing the shoulder for approximately 3-4 weeks post-op. The Center for Special Surgery agrees and published an article on how immobilization following rotator cuff surgery leads to better healing. For a full overview, please see our previous post from August 2012. 

Rotator cuff tears are common and treatable. Early intervention in the case of degenerative tears can help prevent the need for surgical intervention. Advocare Orthopedic and Sports Medicine is here to help. Call to schedule your appointment: 973-300-1553 or follow us at facebook.com/johnvitolomd.