First update on my Latarjet Operation & Biceps Tenodesis

My right shoulder problems started in Ecuador with my climbing accident on Cotacachi, 4,944 m, on 7 December 2013, being hit by falling rocks and suffering a traumatic right shoulder dislocation. On the five hour descent I fell three times on my dislocated shoulder, inflicting multiple injuries to it and permanent damages. Read more about it here: //adastra.jeandar.net/#post377.

In addition to that accident, I suffered another shoulder dislocation in the Hottentots Holland Nature Reserve in Western Cape, South Africa, on 16 December 2015, due to the damages already inflicted on the shoulder in Ecuador. Read more about it here: //adastra.jeandar.net/#post414. I also dislocated my right shoulder in Windhoek, Namibia, on 3 January 2016, but managed to relocate the humeral head back into the socket myself.

Above: My photo from S:t Görans Hospital in Stockholm, Sweden, on 9 June 2016, the day after my Latarjet Operation and Biceps Tenodesis.

These four shoulder dislocations had left the gleniod cavity of my right shoulder fractured and fragmented, and with damages to the labrum and the long head of the biceps tendon. Also, temporary damages to my axillary nerve have resulted in full atrophy in the terres minor muscle and partial atrophy in the deltoid muscles. The whole idea with my Latarjet Operation and Biceps Tenodesis is to stabilise and strengthen the shoulder as much as possible, preventing further dislocations while still having full shoulder mobility.

Latarjet Operation

Shoulder dislocations are common injuries, especially in young and active people. A Latarjet Operation can be done to prevent repeated dislocations. Once someone has dislocated their shoulder, repeated dislocations can become more and more common. Some people develop such severe instability in the ball and socket joint that dislocations can occur with simple activities or while sleeping.

The picture below: The coracoid is sawed off from its attachment to the scapula. The coracoid is then moved, with the short head of the biceps tendon still attached to it, a few centimeters to the front of the damaged glenoid. Once in position, the coracoid is fixed to the glenoid with screws.

A Typical damage to the shoulder joint starts as a torn ligament the first time the shoulder comes out of socket. This injury is called a Bankart tear, and is seen very commonly in patients who sustain an initial shoulder dislocation. During that initial dislocation, or with subsequent dislocations, additional damage to other structures can occur. Often cartilage or bone about the socket is damaged, and these injuries may be more difficult to repair.

The X-rays, CT-scan and MRI exams of my right shoulder showed a bony Bankart lesion. Bony Bankart lesions occur when some of the glenoid bone is broken off with the anterium labrum. This leads to loss of the normal bumper of the socket and also loss of bone, making the shoulder joint more unstable. Two bone fragments of 6 mm and 4 mm were also seen in the glenoid on these exams.

When bone damage occurs, the damage can either occur to the ball or the socket of the shoulder. Damage to the ball is called a Hill-Sachs lesion, and in my case it even engaged in some over-head movements, me risking easily further dislocations. Damage to the socket causes fractures and bone loss to the glenoid. When the glenoid is damaged, the socket may progressively get worn away. As this occurs, the chance of recurrent dislocation goes up. In fact, glenoid bone loss can get to the point where patients have a hard time keeping the shoulder in the socket at all.

https://youtube.com/watch?v=zQZLjRe5sUg%3Frel%3D0

The video above shows a Latarjet Operation.

The Latarjet Operation accomplishes two important tasks: First, it increases the amount of bone of the shoulder socket to restore bone that has been lost. Second, the muscles attached to the coracoid create a sling, supporting the shoulder in the front of the joint. The Latarjet is a very successful procedure at restoring stability to the shoulder joint.

The Latarjet Operation is not a minor surgical procedure, and rehab after surgery can be lengthy, at least 4-6 months. Mobility is restricted for the first few months while bone healing occurs. At that point, gradually the shoulder motion can be increased, followed by progressive strengthening.

Biceps Tenodesis

Biceps Tenodesis involves detaching the long head of the biceps from it’s superior labrum in the shoulder and reattaching it to the humerus bone, just below the shoulder. Tenodesis is preferable for more active people and uses modern fixation screws. The repair is strong enough to move the arm early after surgery.

https://youtube.com/watch?v=ODIgAbq7DxI%3Frel%3D0

The video above: My Biceps Tenodesis was performed at the same time as my open Latarjet Operation and not with Arthroscopy as in the video. However, the result is the same.

There have been damages to my supraspinatus tendon since the first accident in Ecuador, this I knew. But by performing the Latarjet Operation, it became evident that also the long head of the biceps tendon was suffering from a SLAP 1-2 damage. Therefore I had an open Biceps Tenodesis, in conjunction with the Latarjet, preventing it from further damage and risking a future rupture of the long head of the biceps tendon. My combined Latarjet Operation and Biceps Tenodesis took almost three hours to complete.

– I had my surgery done on June 8, and I’m getting better by the day!