Teaching in Singapore
In the Arthrex lab in Singapore, demonstrating a new all-arthroscopic method for fixing acromioclavicular joint dislocations.
With thanks to Arthrex and Device Technology for the invitation to teach a shoulder course at the facility. Teaching surgeons from a range of countries is one of the more rewarding parts of the work, not least because the questions differ depending on what each of them has available to operate with.
The acromioclavicular joint and its injuries
The acromioclavicular joint, usually shortened to the AC joint, is the small joint where the outer end of the collarbone meets the acromion, the bony projection at the top of the shoulder blade. It is held in position by ligaments running between the collarbone and the shoulder blade.
A fall onto the point of the shoulder, common in cycling and in contact sport, can tear those ligaments. The collarbone then rises relative to the shoulder blade, which is often visible as a step at the top of the shoulder. Lesser separations are generally managed without surgery. More severe ones, and injuries that remain symptomatic, are sometimes reconstructed, which means restoring the position of the collarbone and rebuilding the restraint that normally holds it there. Individual results vary.
Why surgical skills laboratories exist
A skills laboratory is a facility where surgeons practise operations on models or on cadaveric specimens, using the instruments and implants they would use in theatre. Courses of this kind exist because arthroscopic technique cannot be learned from a description. The surgeon works from a screen, with instruments passed through portals a few millimetres across, and the hand movements have to become familiar before they are performed on a patient.
A laboratory also allows a step to be repeated, interrupted and discussed, none of which is possible on an operating list. For a technique that is new to a group of surgeons, that is the only practical way to teach it to several people at once.
Related information
See our post on arthroscopic ACJ reconstruction and our AC joint arthrosis page, along with our shoulder injuries and shoulder anatomy pages.