Date of injury: February 15th, 2008
Date of operation: July 3rd, 2008

I thought I would write this little piece as it may offer some advice or ideas to those out there who suffer from injuries similar to my own.

Despite having watched a lot of ‘House’, I am no medical professional. I will try to avoid attempting to describe those things I do not understand, and stick to what I do – namely the experiences described here. An Anterior dislocation is where your shoulder pops out and forwards, typically when the arm is extended above the head in a ‘deodorant commercial’ pose. A posterior dislocation occurs when the shoulder is pushed out and back through the joint (but not necessarily out the back), e.g. when putting your arms out to brace when falling off a horse.

History: Multiple anterior dislocations of the left shoulder from April – December 2007 (first injury was in 1998, but thanks to Jack Daniels’ finest, barely registered on the pain scale the following day), culminating in a very serious and painful separation of the left shoulder while in Kashmir, India in Feb 2008.

The separated shoulder could not be replaced in the normal manner, and required a visit to hospital to be replaced under general anaesthetic. This is the longest period of dislocation I have experienced, at some 7 hours.

Snowboarding was resumed after a rest period of 7 days, with the injured limb duct-taped to the torso across the upper arm. A similar taping support to that used to support an injured or separated AC joint. It is advisable to use medical (strappel) tape for this purpose, provided you thought to pack enough of it in the first place.

Once back in Europe, a Donjoy Shoulder Stabiliser was bought from www.physioroom.co.uk, which does a much better job of supporting the injured joint (it allows you to variably restrict the movement of the joint in 3 axes) than the duct tape, and is far less painful to remove. Thus 3 weeks’ of restrained but always enjoyable snowboarding were had for the additional expense of £160.

Following a personal recommendation I made contact with a specialist surgeon, Dr Elvire Servien, working at the Centre Livet in Lyon, to look at a permanent solution to the problem. This advice came from a guide working for Evolution 2 in Val d’Isere, France, who had been treated 18 years previously and had not suffered a dislocation since, despite continuing to push his skiing, windsurfing and paragliding to higher levels.

Treatment:

The original procedure for treatment of anterior shoulder instability is called the Trillat procedure, more commonly known as a Bone Block procedure. This involves chipping a lump from the top of your upper arm bone (the humerus) and screwing it into the scapula bone to effectively close up the shoulder joint and reduce the range of movement of the arm and mechanically block the shoulder from moving out of joint. It sounds pretty brutal and I am glad that the good Dr had something more advanced up her sleeve.

After an initial consultation Dr Servien recommended the Latarjet-Patte procedure, which involves chipping slightly less bone, but more importantly a bit with a tendon on it, so that the re-configured joint will have support across it’s front from the ligature, as well as a greater range of movement once fully recovered. It’s a more delicate procedure, but luckily she’s one of the best in the world at performing it. Each operation comes with a complimentary 35mm titanium bolt or two.

It’s a day procedure (meaning I could leave the hospital about 4 in the afternoon), with 2 identifiable recovery periods:

For the first 3 weeks you are pretty much laid-up; should keep your arm supported in a sling and take lots of drugs which leave you feeling very jet-lagged and confused.

After this, it’s back to work with you, and a recommended 6 months of recovery with specific exercises to re-train the muscles and get the body fit again, then you are allowed out to play.

Most of my initial conversations with Dr Servien and her most capable and helpful secretary, Florence Bondoux, were conducted by email. Once I was happy to go ahead with the procedure it was quickly arranged on a date which suited me. The cost of the procedure itself came in at around 1500€, plus other expenses such as accommodation and flights brought the total cost up to around 2500€.

I spent a total of 7 days in Lyon – a pre-op consultation on the Wednesday, the operation on the Friday and then a final check up on the Tuesday of the following week before flying home on the following Wednesday.

It’s not the most painful thing in the world – certainly less than the dislocations that preceded it. The hard bit is how much mobility and strength you loose post-op. Prior to the operation my shoulder was bearing up well in most normal movements, and the muscles surrounding it were very strong. There were a few warning signs from odd or unexpected movements, but to convince myself to go through with the procedure all I had to do was remember the sheer agony of my last injury, and the frustration of being a pedestrian boarder for the rest of the season.

With most simple dislocations you can be up and active again fairly quickly, especially if you support the joint. Sadly, each time you dislocate your shoulder it is permanently damaged, and will be more susceptible to injury in the future.

It’s certainly not an essential procedure, but if you do intend on continuing with your sport then it should, with careful training and care, reduce (if not prevent completely) the injuries and lost time you will incur otherwise with a weakened shoulder.

The scar is still raw, and the joint still stiff and painful in the mornings, though less so every day. Daily yoga and running, as well as specific exercises are helping it to recover well, and I should be good and ready to don some garish clothing and go charging into solid objects once more when winter arrives. Rock on.


Addresses:

Dr Elvire Servien:

Email: elvire.servien@chu-lyon.fr


Centre Albert Trillat - Hôpital de la Croix-Rousse
Hospices Civils de Lyon
8 rue de Margnolles
69300 LYON- CALUIRE
FRANCE

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