Shoulder Unit

Recurrent shoulder dislocation in the young patient is usually resolved in the operating theatre, and is one of the most difficult problems to correct. The labrum repair technique is performed arthroscopically, but again, it is very important that your surgeon knows the characteristics of your shoulder, the associated injuries and all the necessary technical gestures, such as remplissage and capsular plication, to prevent the shoulder from continuing to dislocate.

Sometimes it is necessary to interpose a bone stop or perform a Latarjet technique that increases the surface of the glenoid, especially in case of reinterventions or bone loss at that level; such anterior bone stop procedures are very appreciated by the patient who usually recovers very quickly; these patients often come after one or several unsuccessful interventions and a permanent insecurity with the shoulder. Bone bumper and Latarjet techniques are performed arthroscopically in our medical centres.

Injury to the supraspinatus, infraspinatus and subscapularis tendons, as a whole or in isolation, is what we call a rotator cuff tear; it is extremely common over the age of 50-60 or in very active people, and causes pain on the lateral aspect of the shoulder, loss of lifting strength and pain at night; The most important thing when a rupture is confirmed in a patient < 50-60 years of age is not to delay surgical treatment too long, especially if there is constant, limiting pain and other treatments such as rehabilitation or infiltration have failed. Again, in expert hands the chances of complete cure and disappearance of pain are very high. In patients over 70 years of age, smokers and those with a longstanding injury, the success rate decreases, but is still favourable. Make sure you choose a surgeon who specialises in shoulder arthroscopy and follow his or her instructions to the letter. It is very important to respect the initial postoperative period of the first 6 weeks, when the repaired tendon/s heal. Full recovery is slow, and can take up to a year after surgery, but in many cases the patient is almost completely independent and pain-free by 4-6 months.

Rotator cuff tears sometimes progress to what we call irreparable tears due to the large retraction of the tendons and fatty infiltration of the muscle, making it unrecoverable. In these situations, more advanced techniques such as superior capsular reconstruction or tendon transfers are required to restore function and avoid pain. These techniques are mainly used in relatively young patients < 60 years of age in whom the placement of a prosthesis would be too early.

Superior capsular reconstruction is reserved for irreparable supraspinatus tendon ruptures when the rest of the tendons are intact or at least repairable; although it is a relatively recent technique, the results are very encouraging in selected patients, and the technique can be performed completely arthroscopically.

In our medical centres we keep up to date with the most effective and at the same time least aggressive techniques to restore function to young patients with irreparable rotator cuff injuries; the lower trapezius transfer is our choice in cases of infraspinatus tendon insufficiency to provide these patients with greater elevation and external rotation capacity. There are other useful transfers in case of insufficiency of other tendons such as the pectoralis major or latissimus dorsi transfer when the subscapularis tendon is not repairable. Fortunately, with the right experience, the vast majority of rotator cuff injuries are repairable, even in older people and long-standing ruptures.

Shoulder prostheses are advanced solutions designed to restore mobility and relieve pain in patients with severe damage to the shoulder joint, whether due to arthritis, fractures or degenerative injuries. This type of intervention replaces the affected joint structures with artificial components that mimic the shoulder’s natural function, allowing basic functions to be restored and improving quality of life. There are several types of prostheses, such as anatomical and inverted prostheses, each adapted to the patient’s specific needs and condition. The implantation of a shoulder prosthesis is a safe and effective procedure, performed by our team of specialists, offering excellent results in the recovery of joint functionality.