Latarjet operation on the shoulder joint

The Laterger procedure is a surgical intervention aimed at stabilizing the shoulder joint in cases of habitual dislocation of the humerus. During this process, the surgeon moves the scapula and its muscle tissue to the affected area, which is located in front of the glenoid cavity. He does this to replace missing bone fragments. Moving the muscle in this way eliminates repeated dislocations through additional support. Modern methods of surgical orthopedics include the use of arthroscopic equipment, thanks to which the traumatic nature of the operation is minimized and recovery occurs in a short time. According to statistics, complications after this operation are extremely rare and occur no more often than in 1% of cases.

You can undergo shoulder joint surgery according to Laterje at the Traumatology Orthopedics Department of CELT. Our clinic is multidisciplinary and has been operating in the capital’s paid medical services market for more than a quarter of a century. The traumatology department sees doctors of the highest category, doctors of medical sciences and professors. Their scientific and practical experience spans decades. They perform minimally invasive surgeries that eliminate trauma to healthy tissue and the presence of unsightly scars. The recovery period after them is also minimal. In order to find out the price of Latarje surgery, go to the “Services and prices” tab. We regularly update our price list, however, to avoid misunderstandings, we recommend checking the numbers with our information line operators.

Transposition of the coracoid process (Laterger operation) (excluding the cost of consumables) - 120,000 - 160,000 rubles.

1.5 – 3 hours

(duration of operation)

1 day in hospital

At CELT you can consult an orthopedic traumatologist.

Initial consultation – 3,000
Repeated consultation – 2,000

Make an appointment

Indications and contraindications for Laterger shoulder surgery

As already mentioned, habitual glenoid dislocation manifests itself as the humerus popping out, which either tears off the labrum or is pressed into other anatomical structures. In the first case, small bone fragments entering the capsule cause an unpleasant snapping sensation or block the joint.

Indications

Regular dislocations and fears arising from them;
Painful symptoms;
Limited movement;
Impaired functions of the upper limbs in the shoulder area;
Anatomical anomalies of congenital structures.

Contraindications

Hypermobility of the shoulder joint;
Acute heart failure;
Infectious processes in the acute stage;
Blood diseases that are characterized by disorders of blood clotting;
General poor condition of the patient.

Symptoms

Habitual shoulder dislocation usually has its own characteristic manifestations. The main symptom is severe pain. The hand stops moving normally. The joint changes its shape and interferes with the normal functioning and position of the limb. Edema develops quickly. Swollen muscles and displaced bones compress nerve endings and blood vessels. When the shoulder is dislocated, the ligaments supporting the joint become involved in the inflammatory process, weaken and are no longer able to maintain its articulation.

Over time, dislocation will occur from small loads. But it also becomes easier to adjust due to the weakening of the surrounding tissues. The patient experiences pain, but not as severe as with the first injuries. It lasts no more than a day, and then gradually subsides.

If help is not provided in time, dislocations begin to recur regularly. They can happen even due to minor efforts. It will be enough for a person to try to reach somewhere, forcefully throw an object or make a rapid movement, and it will immediately happen. Over time, a habitual dislocation can occur even when trying to comb one's hair, fasten one's clothes, or in an awkward position in sleep.

The shoulder may heal, but the muscle-tendon system will remain deformed. Therefore, with a secondary injury or inadequate load on the limb, dislocation will occur again. Osteoporosis gradually begins to develop in the bones. In this case, it is no longer possible to achieve complete recovery on your own. Surgery required.

Preparation for the Laterger operation for shoulder dislocations

During the period of preoperative preparation, CELT surgeons prescribe a comprehensive diagnosis to the patient, which eliminates contraindications and allows a detailed intervention plan to be developed. The patient is asked:

Take a general blood and urine test;
Take a biochemical blood test;
Take x-rays in various projections;
Have an electrocardiogram;
Undergo a computed tomography or magnetic resonance imaging scan;
Take a test for an allergic reaction to anesthesia.

Habitual dislocation

The most common indication for shoulder arthroscopy remains instability of the joint. The shoulder has a high range of motion. This is due to the fact that the articular surface of the scapula is flat and not concave. Movement is limited only to the lip, which has a cartilaginous structure. Undoubtedly, freedom of movement is an advantage, but it also carries certain disadvantages. The shoulder is quite easy to dislocate. And in the absence of adequate treatment, dislocations recur and degenerative changes in the joint progress.

The indication for arthroscopy is not only habitual dislocation, but also its first episode, if the patient’s age is less than 30 years. This is due to the fact that relapses occur much more often in younger people. If in elderly patients the risk of recurrent dislocation is only 2-3%, then in patients under 30 years of age it reaches 38%.

When the shoulder is injured, the cartilaginous labrum is often injured. As a result, joint stability is lost. Its loss is also associated with a defect in the bony component of the scapula (glenoid).

Stages of Latarjet surgery on the shoulder joint:

Administration of anesthesia;
Making an incision at the level of the top of the shoulder;
Providing access to the joint and assessing the extent of damage;
Removal of bone fragments, if any;
Sawing and processing of a fragment of the beak-shaped area;
Placement of the graft into the glenoid cavity;
It is fixed with titanium screws;
Suturing the wound and applying a sterile dressing;
Putting on a Deso bandage, which reduces the load on the joint.

Depending on the patient’s individual indications, one of the following methods may be used:

The first provides for reliable fixation of bone tissue and soft structures, as well as an increase in the size of the joint. The coracoid scapular process is used as an implant;
The second involves blocking the bone tissue of the coracoid process, which makes it possible to enlarge the glenoid cavity. Fixation is achieved by crossing and moving the tendon of the subscapularis muscle tissue.

Clinics and cost of Latarge in Moscow and regions

To receive quality medical care, you do not have to go to Israel. Russian doctors cope with the task remarkably well, but require less funds for therapy. The cost of Latarje surgery differs depending on the chosen clinic (private or public).

Table 1. Popular clinics

Description of the clinic	Address
Clinic of Traumatology and Orthopedics.	105187 Moscow, st. Fortunatovskaya, 1
Treatment and rehabilitation center of the Ministry of Economic Development of Russia.	Moscow, Lomonosovsky Prospekt, building 43, clinic No. 2.
Curare Medical Center, surgery on the Shchukinskaya metro station	Moscow, Polessky proezd, 16с6 district North-Western Administrative District, Pokrovskoye-Streshnevo district

On average, the price of the operation ranges from 50,000–60,000 rubles. In regional and private clinics the cost may be lower. The price is also affected by the qualifications of the doctor. To find the most suitable surgeon and save money, consult at several medical centers.

Reviews of doctors providing the service - Laterger surgery

Several months ago, Igor Grigorievich performed arthroscopic surgery on my acromioclavicular ligament.
Installed dogbone implant. Everything is great, I lead an active lifestyle and play sports. I already forgot which side it was from! Read full review Alexey

25.11.2019

Dear employees, dear management of the Endosurgery and Lithotripsy Center, good afternoon! 2 months ago I had hip replacement surgery performed by specialists from the Center: Vladimir Sergeevich Zubikov - orthopedic traumatologist, doctor of medical sciences, doctor of the highest category, ... Read full review

Pershin Vladimir Alekseevich

20.08.2018

Rehabilitation

After arthroscopy, the patient can return to normal life much earlier than after open surgery. The sutures are removed in the same way, after 10-14 days, and the bandage - after 3-4 weeks.

You can begin physical therapy exercises under the supervision of a specialist from the second postoperative day, gradually increasing the load. The first workouts involve only healthy joints. If the prognosis is favorable, from 4-5 days the operated shoulder joint is put into work to restore blood circulation to the immobile muscles. At the same time, a course of drug therapy consisting of antibacterial, anti-inflammatory and painkillers is prescribed. Additionally, the doctor may recommend physiotherapy and massage of the shoulder joint for more effective treatment. But you can use this only a month after the intervention.

You should immediately report pain during exercise to your doctor to avoid relapse and adjust the course of rehabilitation. Full recovery occurs 3-6 months after the operation.

Rehabilitation after Latarjet surgery and complications

If the operation was performed with open access, the patient remains in the hospital for at least ten days. Sutures are removed no earlier than ten to fourteen days later. Recovery after Latarget surgery will require the patient to follow a number of rules:

Wearing a bandage or bandage, including at night;
Sleep on your healthy side or on your back;
Elimination of any stress on the sore arm.

Returning to work after surgery is possible no earlier than two to three months. This is exactly how long it will take for all anatomical structures to fully heal. As already mentioned, the risk of complications after this operation is minimal. Only in 1% of cases is it possible for the fixing screws to dislodge, which impairs the mobility of the joint. In some cases they have to be removed, but often there is no need for this and after the implant fuses with the bone tissue, motor activity returns.

Do you want to be sure that the operation will be successful? Sign up for a consultation with our clinic specialists. Call.

Make an appointment through the application or by calling +7 +7 We work every day:

Monday—Friday: 8.00—20.00
Saturday: 8.00–18.00
Sunday is a day off

The nearest metro and MCC stations to the clinic:

Highway of Enthusiasts or Perovo
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Driving directions

The shoulder joint is the most mobile, spherical, sharply incongruent and multi-spinous joint of the human body, connecting the head of the humerus and the articular surface of the scapula.

Shoulder instability is a chronic condition of repeated dislocation or subluxation of the humeral head.

The lion's share (95-98%) of all dislocations are anterior (subcoracoid and subclavian) or so-called anterior-inferior dislocations, the remaining percentage is shared by posterior and multiplanar shoulder dislocations.

Causes of chronic instability:

Consequence of traumatic dislocation (fracture-dislocation)
Hyperelasticity syndrome (Ehlers-Danlos, Marfan Syndrome), which affects 10-15% of the population
Hypermobility of the shoulder joint caused by repetitive movements with maximum amplitude, some professions and sports are at risk, such as swimming, volleyball, tennis (throwing sports - “throwing athlete’s shoulder”)
Dysplastic changes - a difference in the size of the humeral head and the glenoid cavity of the scapula, its planar position
Features of the structure of the articular labrum and glenohumeral ligaments

The diagnosis is made based on examination and complaints; MRI and X-ray CT are used to clarify structural damage.

Treatment of instability is exclusively surgical; attention has been paid to this pathology for many centuries; the first mentions begin with Hippocrates (400 BC) - he used cauterization with a hot iron. Over the entire history of attempts to prevent dislocation, about 150 methods of surgery and about 300 of their modifications have been invented. There is still no treatment method that would relieve the patient of the problem with 100% certainty, but with the advent of arthroscopy there was a breakthrough in the surgical treatment of shoulder instability. The operation became as anatomical as possible, it became possible to see the joint from the inside and identify concomitant pathologies about which there was not the slightest idea before.

Common features of arthroscopic operations on the shoulder joint are: performing the intervention through punctures, using high-definition video equipment, and instruments for minimally invasive surgery.

Pain relief for patients is always multicomponent; in our clinic we combine conduction anesthesia (blockade of peripheral nerves with an anesthetic) with the use of a laryngeal mask.

Interventions are carried out with the patient in special positions: “on the side” with the arm abducted, or “chaise lounge”

To fix damaged structures: capsules, ligaments, tendons, osteochondral fragments, anchors are used (anchor - anchor fixator, metal and polymer: non-absorbable and biodegradable).

There are fixators of various sizes and shapes, made of different materials, with specific purposes - for dense cortical and loose cancellous bone. Some are holes that become clogged and require drilling, others are self-tapping screws that are screwed into the bone. Everyone is united by super-strong threads running inside.

Bankart injury is the most common in shoulder dislocation - separation of the cartilaginous lip (labrum) from the glenoid cavity of the scapula. The tendon of the long head of the biceps brachii muscle (biceps) is attached to its upper section, and powerful ligaments woven into the capsule are attached to the anterior and posterior sections.

This is what lip avulsions in the upper (SLAP) and anterior-inferior (Bankart) sections look like in the diagram (English surgeon Arthur Sidney Blundell Bankart, 1879 - 1951).

It is worth noting that multiple (speaking of the number, patients often talk about more than 50, 100 episodes, and some have long lost count, since dislocations that often occur in sleep are corrected on their own) dislocations of the shoulder, not a trace remains of the labrum, The glenohumeral ligament (GHL) and capsule are torn, the anterior chamber of the joint increases in size, and the articular surface of the scapula narrows.

Inside the shoulder diagram of the seams after reconstruction

There are many types of ruptures of the glenoid labrum, capsule, and ligaments, but it is necessary to say about the bone damage that accompanies the dislocation:

The Hill -Sachs fracture (Harold Arthur Hill (1901–1973) and Maurice David Sachs (1909–1987)) is an impression (depressed) fracture of the humeral head. The longer the humeral head is in a state of dislocation, the higher the energy of the injury, the worse the quality of the bone (osteoporosis), the more pronounced the defect will be and the cartilaginous covering of the humeral head will decrease, and therefore the risk of relapse will increase - repeated slipping into the usual place. With this pathology, depending on the size of the defect, bone grafting or, for example, a remplissage .

(French remplissage - filling)

Bone Bankart is a fracture of the glenoid cavity of the scapula.

This injury is accompanied by a decrease in the area of the articular surface of the scapula; it must be diagnosed as soon as possible, since the choice of conservative and surgical treatment tactics depends on this. The standard projections used for radiography of the shoulder joint often do not reveal a fracture of the anterior edge of the glenoid, especially if it is small. Therefore, the examination standards include magnetic resonance and x-ray computed tomography with 3D reconstruction.

Arthroscopy remains the best diagnostic and treatment method.

Depending on the size of the defect (lack of bone mass - b), age of the fracture, number of dislocations, quality of bone tissue, the volume of surgical intervention is planned:

refixation of an avulsion fracture, plastic surgery of the ligamentous apparatus, or osteoplastic surgery using an autograft (bone block taken from the patient) from the iliac crest. Or use of the coracoid process of the scapula (coracoid) - Latarget operation (Bristow-Helfet-Latarget).

Rehabilitation after stabilizing operations on the shoulder joint usually begins after 3-4 weeks with passive development - the patient is helped to restore the range of motion of the limb using the healthy arm. Instructions from a physiotherapist and assistance from a massage therapist are required. After achieving the required amplitude within 7-10 days, you can begin active development - “switching on” the muscles of the shoulder girdle - active movements of the operated arm; at this time, the advice of a physical therapy instructor is very important. The average time for consolidation and fusion of ligaments ranges from 6 to 12 weeks, so loads are prohibited during this time. You can start active sports no earlier than after 4-6 months.

The long head of biceps tendon (LCT) and the pathology associated with it should be considered separately. The interest lies in the structural features and its intra-articular location. Often there is persistent pain in the anterior part of the shoulder joint, provoked by load, excessive motor pattern or injury. At the same time, when examining patients, tenosynovitis or tendonitis of the SDGB, sharp palpation pain in the projection of the intertubercular groove are detected, and MRI and arthroscopy reveal damage to the structures that support the tendon of the apparatus, often dislocation of the tendon or separation of the upper part of the articular labrum, discussed above. If conservative measures do not give the desired effect, tenodesis - securing the tendon in the intertubercular groove.

This can be done both externally and intraarticularly, using an interference bioabsorbable screw or anchor fixators. In old age, the muscle belly has almost no contour on the shoulder (especially in women), and tenotomy of the SDGB is permissible - cutting it off from the place of attachment, without any fixation. This has virtually no effect on the function of the arm; the range of motion in the shoulder and elbow joints does not suffer. A small cosmetic defect in the photo of the man on the left.

Calcific tendinitis is an inflammation of the rotator cuff tendon, accompanied by pain, limitation of movements, as well as the deposition of calcium salts (deposits of basic phosphates, more often Ca10(PO4)6OH - hydroxyapatite in the supraspinatus tendon, the type of calcification in the diagram and radiograph).

Causes.

It is assumed that the development of the disease is based on both local and general factors. Hydroxyapatite crystals are deposited in the initially damaged tendon, which explains the typical localization of these crystals in the tendons of the shoulder joint. As a rule, frequently injured and poorly supplied areas of tendons undergo calcification, sometimes with foci of necrosis, which contributes to a local increase in the concentration of calcium and phosphorus. Such a region is the area of the supraspinatus tendon near its attachment to the greater tubercle of the humerus - the Codman area, where calcifications are most often detected radiographically. In turn, calcification contributes to the further progression of degenerative changes, as well as the development of an inflammatory response. However, the frequent bilateral and multiple localization of deposits suggests the existence, along with local ones, of common predisposing factors, such as diabetes mellitus, thyroid diseases, and hyperphosphatasia. Familial cases of the disease have been described. Deposition of hydroxyapatite crystals in tissues has been described in many conditions, including in patients with chronic renal failure on long-term hemodialysis. Hydroxyapatite crystals are present in soft tissues in systemic scleroderma, dermatomyositis, mixed connective tissue disease, causing multiple calcification. Finally, calcification of periarticular tissues is known after previous intra-articular injections. The causes and mechanisms of calcification in all of these conditions remain unclear. (RMJ).

In our practice, it has been noticed that the prevailing number of patients are women whose professions involve prolonged forced positioning of the arm (microtraumatization), often abduction. For example, hairdressers, teachers, painters, doctors (ultrasound diagnosticians and dentists), etc.

Treatment is possible using physiotherapeutic methods; good results are observed after courses of extracorporeal shock wave therapy, with the help of which it is possible to achieve the dissolution of calcifications. In the case of massive salt deposits, after unsuccessful conservative therapy, it is possible to loosen the salt layer invasively under ultrasound guidance by injecting an anesthetic under the acromion process of the scapula. In advanced cases, with dense calcification, arthroscopic subacromial bursoscopy and removal of deposits through punctures cannot be avoided. Sometimes tendinitis with large calcifications spreads to all layers of the tendon mass of the rotator cuff , and after their removal, a tissue defect is formed that must be closed, i.e. stitch, repair a tear.

The rotator cuff is a joint tendon for several muscles: supraspinatus, infraspinatus and teres minor, which are a group of external rotators of the humerus attached to the greater tubercle of the humerus. There is also an internal rotator of the shoulder, which is part of the cuff - the subscapularis muscle (subscapularis), the tendon of which is attached to the lesser tubercle. Despite the intricacy of the tendon fibers of all four muscles and their structural unification, each has its own function, the common one is the stabilization of the head, its pressing and centering in the glenoid cavity of the scapula.

Rotator cuff tendon, muscles, top and side views.

There are many types of tendon ruptures and rotator cuff tears, some affecting function and others causing pain. Massive damage does not allow a person to care for himself, since the rotators are responsible for everyday, habitual movements. Personal hygiene becomes difficult (combing your hair, washing, etc.), sometimes impossible, especially if the dominant hand has been injured.

Treatment involves restoring the integrity of the structure - suture of the rotator cuff, performed arthroscopically in our clinic. Options for single-row and double-row fixation (anchor with threads and tapes).

Suture diagram (A) and arthroscopic view (B) after reconstruction

Rehabilitation

In the postoperative period, it is necessary to wear, for 3-4 weeks, an orthosis (retainer) - an immobilizing bandage with possible abduction and rotation of the arm in order to unload the muscles.

Then physiotherapy, massage, physical therapy are necessary, the prescription of drug therapy is justified, since the age of patients with rotator cuff injuries often ranges from 45 to 65 years.

Continuing the topic of older patients, it is necessary to mention degenerative damage in the absence of injury as such.

Impingement syndrome.

A condition in which the rotators are compressed, colliding with the acromion process of the scapula, during movements. And taking into account the suffering blood supply to this zone, damage to the cuff occurs, sometimes not full-thickness, partial ruptures (partial ruptures PASTA - partial articular supraspinatus tendon avulsion). They are accompanied by severe pain in extreme positions of the shoulder and are often difficult to diagnose even on MRI:

Age-related changes , such as: thinning of the cartilaginous layer, narrowing of the subacromial space, rigidity of the ligamentous apparatus, coupled with the anatomical structure, predisposition of some people, can lead to a similar disease (3 types of acromions, see below).

Problems arise with types 2 and 3 of the process; they serve as an obstacle to the greater tubercle and injure the cuff (supraspinatus tendon). There are also frequent cases of osteophytes appearing on the process, so-called spurs (examples on radiographs).

Y-projection to assess the shape of the acromion process and spur

True AP view for assessing joint space and subacromial space

Treatment is arthroscopic subacromial decompression, consisting of removal of the subacromial bursa (bursectomy) and spur, resection of the acromial process of the scapula (acromioplasty, see below).

For significant partial tears, in addition to expanding the space between the humerus and the scapula, the suture described above is also necessary.

Shoulder joint replacement is the replacement of worn, injured and irretrievably lost parts of the joint with artificial ones (metal, ceramic, polyethylene), a surgical method for treating pathologies such as:

Osteoarthritis of the shoulder joint (arthrosis), often developed as a result of injury or professional activity
Arthropathy of the shoulder joint occurs after a massive rupture of the rotator cuff tendons (English - Cuff tear arthropathy)
Hass disease - aseptic osteonecrosis of the head of the humerus, osteochondropathy in which bone tissue cells die
Congenital dysplastic disorders (abnormal development) of the humeral head and glenoid cavity of the scapula
Comminuted fractures and fracture-dislocations of the proximal humerus, glenoid cavity of the scapula, the synthesis of which obviously disrupts the function of the shoulder joint.
Rheumatoid arthritis.

For each pathology there is its own, strictly defined, depending on the damaged part, method of endoprosthetics:

Riserfacing - replacement of the surface of the destroyed cartilaginous layer, most often the head of the humerus, with a metal one (diagram and x-ray)

Unipolar endoprosthetics - replacement of one of two damaged structures, most often replacement of the head and neck of the humerus in case of fractures of its upper part (diagram and x-ray)

Total arthroplasty is the replacement of two components of the joint, i.e. the use of riserfacing techniques for contacting surfaces, or an anatomical prosthesis on a stem, with the replacement of the glenoid cavity of the scapula, as well as reverse arthroplasty (the reverse - the concave part is transferred to the pedicle of the shoulder, and the convex head to the articular scapula cavity), used, for example, in cases of arthropathy due to irreparable tears of the rotator cuff.

Below are examples of radiographs of total endoprostheses

Shoulder arthroplasty is a precise, high-tech operation, performed more often in patients of the older age group, the purpose of which is to return lost arm movement and relieve the patient of pain. The sooner the patient consults a doctor, the fewer complications will be avoided and you will be able to return to your favorite activities!

Rehabilitation begins with passive movements already 2-3 days after surgery, after pain has reduced, after 5-7 days it is possible to begin active physical therapy, the postoperative wound heals on days 10-12 and the sutures are removed. As the load increases and the range of movements increases, the patient consults with the operating surgeon and control X-ray examinations are carried out.

Shoulder capsulitis or frozen shoulder

The general term scapulohumeral periarthritis (described by Durlay in 1882), the above-mentioned term “Frozen shoulder” (suggested by Codman in 1932), adhesive capsulitis (used in ICD - 10) is also applicable - a neurotrophic disease characterized by inflammation of the synovial membrane, retraction and fibrosis of the capsule, i.e. a decrease in the volume of the joint and stiffness.

The reason is not fully understood; there is a connection with, sometimes minor, trauma - awkward movement, which led to severe pain and forced limitation of movements. Occurring separately, this disease often develops against the background of concomitant pathology. For example, in diabetes mellitus - up to 30% of cases, hyperthyroidism, previous myocardial infarction and stroke, oncopathologies, fibromatosis - connective tissue diseases. Females are more often affected (5:1), hormonal disorders, and a stress factor can be a possible cause of the disease, which has 3 phases (4):

“red” - duration from 3 to 12 months - pain at rest, not associated with specific movement, worse at night.
“red-white” - lasts from 4 to 12 months - painless severe limitation of movements, especially rotation. This is the freezing stage, with the shoulder pressed to the body and the forearm to the stomach.
“white” - from 12 to 24 months the process is completed by the stage of “getting rid of stiffness”, the phase of development, pliability.

In general, the duration can take from 1.5 to 4 years according to different authors; the duration of each subsequent phase depends on the time of the previous one.

There is an opinion that one should not interfere with the disease process, since recovery always occurs - self-resolution. There have been cases of incomplete restoration of function, which many patients do not pay attention to. A number of other patients wish for a speedy recovery and restoration of function of the shoulder joint due to long-term disability.

Treatment boils down to relieving pain in the first phase with anti-inflammatory drugs. The use of glucocorticosteroids in the second phase, their intra-articular administration with an anesthetic, preferably under ultrasound control, physiotherapy, massage, shock wave therapy, active exhausting development of movements. Surgery is also possible - arthroscopic capsulotomy - dissection and redressing.

Continuing the topic of neurotrophic diseases, it is necessary to mention shoulder pain, sometimes associated with the above-mentioned pathologies, but caused by nerve compression or damage. These processes are best suited by the names “tunnel syndrome” and “neuropathy.” Anatomy has once again rewarded us with many forms. For example, below are 6 types of notch of the scapula in which the suprascapular nerve passes - n.suprascapularis (SSN).

Top view: 1 - scapular notch 2 - coracoid process 3 - superior transverse ligament 4 - suprascapular artery 5 - suprascapular nerve 6 - supraspinatus fossa 7 - scapular spine 8 - neck of the scapula 9 - inferior transverse ligament 10 - acromial process

The a.suprascapularis artery passes over the transverse ligament, as shown in the figure above, and the nerve lies in the notch of the scapula in the subglottic space. Compression of the nerve in these areas can be caused by the anatomical structure, muscle retraction due to rotator cuff tears, ganglion cysts, synovial cysts - benign fluid formations, etc. Determination requires accurate MRI and ultrasound diagnostics; needle electroneuromyography is used.

MRI and diagram of a cyst compressing a nerve

Clinically, pathologies associated with compression of the SSN are manifested by pain in the scapula with radiation to the shoulder joint, weakness, and sometimes atrophy of the rotator muscles. Damage to the suprascapular nerve occurs during sports such as weightlifting, basketball, volleyball, etc. The mechanism of injury is nerve pinching during arm movements in the shoulder joint, which is caused by rapid swings of the arm from behind the head. Suprascapular neuropathy results in persistent, dull pain behind the shoulder joint and weakness in arm abduction and external rotation.

Treatment consists of decompression (release) of the suprascapular nerve; surgical interventions are performed endoscopically - through punctures. Arthroscopy of the shoulder joint comes to the rescue again - it is possible to open and evacuate the contents of the cyst, dissect the transverse scapular ligament, depending on the found anomaly of the notch. In the early stages, it is possible to take NSAIDs, physiotherapy, carried out, if necessary, under ultrasound control, nerve blockade with anesthetic solutions in combination with glucocorticosteroids.

Pterygoid scapula is a rare neuropathy of the long thoracic nerve (LPN) n. thoracicus longus - arising as a result of its damage (overextension). Causes paresis or paralysis of the serratus anterior muscle, which is manifested by a wing-shaped position of the scapula. A similar unusual position of the scapula can occur with paralysis of the rhomboid and trapezius muscles as a result of traumatic injury to the accessory nerve, but in this case the lower angle of the scapula deviates outward, whereas in NDHN the lower angle of the scapula, on the contrary, deviates inward towards the spine. As a result of damage to all three muscles, in rare cases, varus alignment of the scapula occurs with progressive posterior subluxation of the shoulder. A type of pterygoid scapula is paralytic vara (loss of the serratus, trapezius and rhomboid muscles), combined with posterior subluxation of the shoulder (described by P. Ya. Fishchenko in 1967), examples in the photo below.

The arrows below indicate n. thoracicus longus and serratus anterior muscle

Treatment is aimed at stimulating the muscles of the shoulder girdle, improving nerve nutrition, standard physiotherapy, massage and exercise therapy are complemented by drug therapy, surgery is not required unless a rupture has occurred.

Damage to the axillary (axillary) nerve n.axillaris. The axillary nerve is mixed in function. The motor fibers of the nerve innervate the deltoid and teres minor muscles. The sensory fibers of the axillary nerve are part of the superior lateral cutaneous nerve of the shoulder and innervate the skin of the outer surface of the shoulder. Damage to the axillary nerve is possible due to a number of reasons. In most cases, neuropathy is caused by trauma, such as a fracture or dislocation of the shoulder, a gunshot wound, prolonged compression of nerve fibers (for example, by crutches), incorrect positioning of the shoulder during sleep or anesthesia, etc. Clinically, damage to this nerve is characterized by the fact that the patient cannot move his arm to a horizontal level, which is explained by the development of paralysis and atrophy of the deltoid muscle. Looseness appears in the shoulder joint - paralytic subluxation. The sensitivity of the skin of the outer surface of the upper third of the shoulder is also impaired.

Axillary nerve neuropathy can be treated conservatively. It consists of physical therapy and interstitial electrical stimulation. If there is no improvement within six months, an operation is indicated - neurolysis - freeing the nerve from surrounding scar adhesions or its transplantation (transposition). The results of such operations are usually favorable; the sensory function of the nerve is restored before the motor function.

Damage to the musculocutaneous nerve n. musculocutaneus.

The motor fibers that make up the musculocutaneous nerve innervate the biceps, brachialis and coracobrachialis muscles. Sensitive nerve fibers innervate the skin on the outer surface of the forearm. When the musculocutaneous nerve is damaged, atrophy of the biceps brachii, brachialis, and coracobrachialis muscles is noted. There is a loss of the flexion-elbow reflex, as well as a violation of all types of skin sensitivity on the radial surface of the forearm and tenor. Causes and treatment may be similar to those described in the previous section (axillary nerve).

Considering the shoulder joint, it is necessary to talk about the most common traumatic injuries in it, especially in old age. These are intra-articular, fragmentary, comminuted fractures of the head and neck of the humerus with avulsions of These injuries are almost always multicomponent, combining ligament ruptures, muscle damage, fracture-dislocations and displacement of bone fragments.

Therefore, surgical treatment should be comprehensive. Osteosynthesis is always combined with restoration of tendon integrity, reduction of dislocations and, if necessary, joint replacement - endoprosthetics .

The future of shoulder surgery lies in the development of bioengineering technologies. The use of “patch patches” from biocompatible materials for rotator cuff defects, the use of growth factors (PRP - Platelet-Rich Plasma - platelet-rich plasma), expansion of indications for minimally invasive arthroscopic surgery, development of new surgical techniques.

Scheme for using a patch for a defect in the supraspinatus tendon.

Most people with the above diseases of the shoulder joint cannot fully care for themselves. They do not find the right specialist, they are treated by general practitioners, they turn to therapists, neurologists or surgeons. And only an orthopedic traumatologist can help them, for consultations with whom patients come already in chronic and advanced stages. Our clinic offers a full range of examinations and treatments for your joints. Currently, arthroscopy is a minimal risk, the key to successful treatment and predictable recovery of our patients, regardless of age.

The text and illustrations are intended solely to inform about diseases and their treatment options. Do not forget: self-medication can harm your health.

Contact your doctor.

If you have any questions, you can ask them by sending an email to: [email protected] or by making an appointment.

Traumatologist-orthopedist of the National Health Institution "Road Clinical Hospital at Voronezh-1 station of JSC Russian Railways" Genyuk Yuri Vladimirovich

What to do after the joint has been realigned?

After reduction of the dislocation, immobilization is traditionally performed - immobilization of the joint. This is necessary in order for the ligaments and labrum torn during dislocation to heal. In our country, plaster casts of the Deso, Smirnov-Weinstein type are still sometimes applied, which are bulky and extremely inconvenient for the patient for a period of 3–4 or even more weeks.

On the left is a Deso plaster cast. On the right - Smirnov-Weinstein bandage

Wearing such a bandage for several weeks is very painful. Modern medicine has long come to the conclusion that such bandages are completely unnecessary. In civilized practice, comfortable and practical slings are used.

Sling bandage

Recent scientific research shows that the incidence of recurrent dislocations is the same between immobilization for one week and three or more weeks. Accordingly, there is no need for long-term immobilization. In addition to the sling bandage, there is also an option for immobilization in abduction.

Immobilization in lead

Immobilization in this position leads to the fact that the anterior capsule of the joint is stretched and the articular lip, torn off in the anterior section, is pressed against the bone. This increases the chances that the lip will grow back and dislocations will no longer occur. This method of immobilization is less convenient than a sling bandage, but the frequency of re-dislocations after immobilization in abduction is lower.

Possible complications

If the operation was performed by an experienced doctor, and the patient followed all his instructions, then the risk of complications is reduced to zero. However, a tiny percentage still exists. What can happen:

inflammatory processes may begin in the joint capsule;
damage to nerves and blood vessels;
damage to bone tissue;
hematomas and swelling may form and last longer than expected.

If you feel an increase in body temperature or the operated area, you have lost sensitivity in your hand, or if you experience severe pain during exercise therapy or at rest, you should immediately consult a doctor.

Drug therapy

For pain relief after a sprain, anti-inflammatory drugs in tablets or capsules are usually used: paracetamol, ibuprofen, ortofen, nimesulide, meloxicam, etc. In the first 2-3 days after a dislocation, it is recommended to cool the joint to reduce swelling and reduce pain. It should be noted that no dietary supplements, drugs based on chondroitin and glucosamine sulfate (Dona, Artra, Theraflex) and vitamins help with dislocations or promote ligament fusion. It’s not worth spending money on this; moreover, such experiments can even be hazardous to health.