Latest news

Blog

Droit_1503565483_300X220_c_c_1_FFFFFF.jpg
07/Mar/2019

Consider this: A Young guy who is troubled by repeated dislocation shoulder treatment – his shoulder gets dislocated while playing sports or even while taking a shower.etc.

An athlete /cricket player /volleyball player who depends on his overhead shoulder movements for their sporting activity which is so essential for his daily life, but repeated shoulder subluxation makes all of the above impossible.An ordinary Mumbai local train commuter, whose shoulder and hands are used extensively to hold on or catch the train, bus etc. for commuting, but cannot do so anymore because his shoulder dislocates each time he tries to use his shoulder.

All these troubled young souls want only one thing- to get shoulder dislocation treatment and get rid of instability- to get on with their normal lives without any fear of impending dislocation. The “Latarjet procedure” in which a part of the coracoid along with the conjoint tendon is transferred to the glenoid, is the best procedure for solving this problem. One might ask – why is it the best? It has a reported recurrence of less than 1 % (yes that’s true!!!). Dr.Gilles Walch in France, who has done more than 2600 latarjet procedures, is the pioneer of this procedure in the modern world..

The best testament which will attest to the fact that latarjet procedure is one of the finest procedure in shoulder surgery is the Xray (see fig 1)of a patient who underwent this procedure 50 years ago by Dr latarjet himself and still has not had any recurrence even after 50 years of follow up- can you beat that?

Shoulder Xray 50 years after Latarjet procedure

There are 4 names to be remembered when we talk of the “latarjet procedure”. Dr Michele Latarjet – who did this procedure for the first time in 1954, Dr. Didier Patte who further improved on this procedure, Dr. Gilles Walch who taught the world how to do this procedure and who has the maximum experience in the current world and lastly Dr. Laurent Lafosse –who was the first surgeon to perform this procedure entirely through Arthroscopy.

Which other treatment for shoulder instability will allow the patient to return to full arm elevation and no feeling of instability as early as 4 weeks after surgery and daily activities after 6 weeks? (see picture figure 2). My personal experience with this procedure, both Arthroscopic and Open Latarjet has been excellent and people have gone back to playing sports at the same pre-injury level as early as 2-3 months. Why would people then offer any other procedure to the patients of recurrent dislocation, if results are all that matters?


blog.jpg
07/Mar/2019

The debate for the best shoulder pain treatment and recurrent dislocated shoulder treatment rests largely between the two procedures in the headline. Bankart repair consists of soft tissue capsulo-labral repair and Latarjet involves osteotomizing (cutting) the vertical half of the coracoid bone and fixing it on anterior glenoid surface. Since I have worked both in France and US, I‘ve had the good fortune of witnessing the debate on both sides very closely. Scientifically it is difficult to prove one is better than the other because of paucity of level 1 evidence. However there are multiple scientific articles that can be cited which speak of the high chance of recurrence after bankart repair. e.g. in JBJS B 2005, Calvo et al says 18 % recurrence after bankart repair, JSES may 2005 Tauber et all analysed 41 cases of recurrence after primary surgery and found highest number of recurrence(60%) occurred after bankart repair(25 cases).

 

There may also be couple of articles, which speak about low recurrence after bankart repair as well. Conferences usually are not the best places where people will frankly admit their failures. But secretly many people have admitted that failures after bankart repair have gone up as the length of follow up has increased. Since, most surgeons in India and many surgeons in western countries also do not keep a regular record, or have long follow ups, it’s hardly believable what any such surgeon would say without hard data. Historically most surgeons will do bankart repair and would stand by it, but will not be able to prove anything because they do not have long follow ups. Failures of bankart start appearing only after 1-2 years so long follow-ups are definitely needed to prove any theory. Proponents of bankart repair ask that since most patients in India are low demand non-athletes, why should we do an extensive procedure like Latarjet? One of the favorite lines of surgeons in US is “Why should you take a bomb where a small gun can work?” However what they would agree is that Latarjet would give better results under all circumstances. In Mumbai since an average person places high stresses on his shoulder on account of his local train, bus travel etc, he can hardly be called low demand.

If “consumer is king” and “patient’s good is the only good to be considered”, Latarjet is the by far the better procedure. The French definitely score ahead here (photo: Dr.Laurent Lafosse, me and other Orthopods in France).


Shoulder-Instability-1-1-1200x675.jpg
07/Mar/2019

    Have experienced these symptoms of late?

  • Pain caused by shoulder injury
  • Repeated shoulder dislocations
  • Repeated instances of the shoulder giving out
  • The shoulder persistently starts feeling loose, slipping in and out of the joint

If the answer is yes to any of these factors, consider visiting a shoulder surgeon / specialist. The above mentioned symptoms point to a troubling condition known as recurrent shoulder dislocation.

The shoulder joint in our body gels well with the term ‘feeling out of place’. Able to move in multiple directions, your shoulder can dislocate forward, backward or downward, completely or partially. Though on the other hand, it’s not that fragile too. It requires a strong force, such as a sudden blow to your shoulder, to pull the bones out of place.

But, in some cases, the shoulder acts tough to get in place. When a shoulder dislocation occurs, the ligaments, tendons, and muscles around the shoulder can become loose or torn. These results in a troubling condition called recurrent shoulder dislocation.

    Three common reasons behind this condition are:

  • Shoulder Dislocation:Severe injury, or trauma, often triggers the initial shoulder dislocation. A severe first dislocation can lead to continued dislocations.
  • Repetitive Strain:Repetitive overhead motion can stretch out the shoulder ligaments. This can loosen the ligaments in the shoulder and weaken the shoulder over time. This can result in a painful, unstable shoulder.
  • Treatment:A dislocated shoulder should be reduced to relieve the pain. When the condition becomes chronic and recurs repeatedly, surgery should be considered as the mainstay of treatment. And when it does come down to surgery, the preferred option is arthroscopic labral repair orlatarjetsurgery
  • Key to Recovery:God forbid, if you happen to experience these issues, ensure to follow your doctor’s treatment plan. This entire process may come across as long and tedious. But patience is key here, for your shoulder to get its groove back!

download.jpg
07/Mar/2019

    Have experienced these symptoms of late?
  • Pain caused by shoulder injury
  • Repeated shoulder dislocations
  • Repeated instances of the shoulder giving out
  • The shoulder persistently starts feeling loose, slipping in and out of the joint

If the answer is yes to any of these factors, consider visiting a shoulder surgeon / specialist. The above mentioned symptoms point to a troubling condition known as recurrent shoulder dislocation.

The shoulder joint in our body gels well with the term ‘feeling out of place’. Able to move in multiple directions, your shoulder can dislocate forward, backward or downward, completely or partially. Though on the other hand, it’s not that fragile too. It requires a strong force, such as a sudden blow to your shoulder, to pull the bones out of place.

But, in some cases, the shoulder acts tough to get in place. When a shoulder dislocation occurs, the ligaments, tendons, and muscles around the shoulder can become loose or torn. These results in a troubling condition called recurrent shoulder dislocation.

    Three common reasons behind this condition are:

  • Shoulder Dislocation:Severe injury, or trauma, often triggers the initial shoulder dislocation. A severe first dislocation can lead to continued dislocations.
  • Repetitive Strain:Repetitive overhead motion can stretch out the shoulder ligaments. This can loosen the ligaments in the shoulder and weaken the shoulder over time. This can result in a painful, unstable shoulder.
  • Treatment:A dislocated shoulder should be reduced to relieve the pain. When the condition becomes chronic and recurs repeatedly, surgery should be considered as the mainstay of treatment. And when it does come down to surgery, the preferred option is arthroscopic labral repair orlatarjetsurgery
  • Key to Recovery:God forbid, if you happen to experience these issues, ensure to follow your doctor’s treatment plan. This entire process may come across as long and tedious. But patience is key here, for your shoulder to get its groove back!

newblogimageone-1.png
07/Mar/2019

The biggest series of patients from Zurich published in the top ranked journal of orthopaedics (JBJS) proves beyond doubt that Latarjet is clearly the surgery of choice and much more superior to Arthroscopic bankart repair for treatment of anterior recurrent dislocation of shoulder.

People have been arguing back and forth in favor of arthroscopic bankart repair, while secretly accepting it has a high failure rate. The simplicity and the arthroscopy nature of the surgery make it an attractive choice for the treating physician, while at the same time it is prone to high chances of failure.

This biggest series of patients by Prof Gerber who is one of the most respected and top-notched shoulder surgeons of Europe says that arthroscopic bankart repair has a recurrence and failure rate of 30% which is quite unacceptable. Latarjet surgery on the other hand has a very low failure rate of only 3%.

Other advantages of latarjet are that the patient returns to normal activity in as less as 2-3 weeks after the surgery while after bankart repair it may take 6-8 weeks. The authors followed up their patients for a period of 10 years and found that as the follow up increased the failure rate of bankart repair also increased. Follow ups of latarjet surgery, however, did not show this trend and had very few failures on follow up.

My own series of approximately 100 latarjetpatients has shown excellent outcomes with no failures. The surgery also costs much less as compared to bankart repair. It’s actually a French procedure started by Michele Latarjetin 1954 and improved and popularized by Giles Walch from Lyon who is one of the geniuses in the world of shoulder surgery. The surgery involves cutting the coracoid at its base and transferring it along with the conjoint tendon through the subscapularismuscle and fixing it on medial glenoid neck with the help of two malleolar screws. Latarjet is also the treatment of choice in high demand contact athletes as their shoulders face higher stresses during contact sports.


shoulder-pain-960x750.jpg
14/Feb/2019

After an exciting win, an Indian cricket fan’s adrenaline levels can be judged by how frantically they move their legs and shoulders in sync to the screams of joy. But as time passes by, age catches up. Cricketers retire to move into commentary boxes and the once energetic fans suffice their craze by good ole clapping. A quick switch to the news and we hear another athlete undergo surgery, while the swift urge to change channels made the shoulder scream in pain.

Injuries to the shoulder can occur from a wide number of reasons. Some of the common reasons cited are manual labour, sporting activities and repetitive movement. The shoulders tend to host a number of issues as time passes, especially after hitting the retirement mark. This is because soft tissues tend to degenerate with age.

So, if your shoulder’s been more painful that productive of late, head straight to the doctor. Trust them to understand your issue and guide you through the ‘not so dreaded’ treatment of shoulder pain. And since the process can take a while and the general patience levels towards pain is quite well known, we bring to you some easy hacks. Hacks that aim to aid the treatment of shoulder pain with better ease.

  1. Icing:Ice bags are extremely efficient in alleviating shoulder pain. Reason – The cold temperature numbs the affected area which reduces pain and inflammation. But beware; do not place ice directly on the sink. It can cause frostbite.
  2. Hot Compress:Just like icing, warm bath or hot bags help in easing out shoulder pain and other related problems. Though it is advised to opt for hot bags after 48 hours of the injury occurring.
  3. Massage:A gentle massage eases out the stress and tension build up in your shoulder muscles. It is also known to improve blood circulation and reduce swelling. Using oil like coconut oil, olive oil, sesame oil etc. provide better relief. But try to get massages from professionals who know their way around it.
  4. Stretching:A likely cause of your shoulder ache can be stiff muscles. Poor posture or lack of use of the muscles can lead to stiffening. Sore and tight muscles respond well to stretching because it reduces muscle tension, promotes blood flow and improves flexibility. Just look out for sharp pain during stretching as they may be warning signs of bigger damage.
  5. Resting:In most cases, the cause of shoulder pain is overuse or exertion. For example, lifting heavy objects over a long period of time can induce pain. Refrain from exerting activities for a few days can prove to be helpful.

The above suggestions should hopefully help you ease you through the treatment of shoulder pain. But don’t stick to this only. Because a doctor is a better candidate for treatment than internet.



Mumbai Shoulder Institute


Provides services for all Shoulder problems with the formation of MUMBAI SHOULDER INSTITUTE™ in Mumbai.




Get in Touch


B407, Galleria mall, central avenue , Hiranandani
garden, Powai, Mumbai, Maharashtra 400076
Monday – Saturday 02:00 pm – 08:00 pm


Contact for Appointment


Call on: 022 25717084, 022 40717084, 022 62617084
(Between 02:00 pm – 08:00 pm)

In case the above number is inaccessible,
Please call Dr Dipit Sahu on +91 – 9619136962

© 2019. Mumbai Shoulder Institute. All rights reserved. | Design by City Business Group

WhatsApp chat