Five hospitals
Dr Cutbush visited five hospitals in China: Jiangsu No.2 TCM Hospital, Anhui University Medical School Affiliated Hospital, The First Affiliated Hospital of Jinan University, Foshan TCM Hospital, and Peking University Shenzhen Hospital.
The topics
The talks covered examination and repair of the rotator cuff, revision of retears, complications of the Latarjet procedure, bone defects in shoulder instability, and complex rotator cuff tears.
Much of the teaching was directed at younger surgeons, and the visits established useful contacts among Chinese shoulder surgeons.
The rotator cuff and its repair
The rotator cuff is a group of four tendons that wrap around the top of the upper arm bone and hold the ball of the shoulder in its socket while rotating and lifting the arm. Tears occur through injury, through gradual wear with age, or through a combination of the two. Not every tear requires surgery, and the assessment that decides this rests on history, physical examination and imaging taken together. Examination of the cuff involves testing each tendon's function separately, which is why it is a teaching subject in its own right.
Where repair is appropriate, the torn tendon is freed, the bone surface prepared, and the tendon drawn back to its attachment and held with anchors placed into bone while it heals. A retear is a repair that has not held, and revision surgery is more demanding than the original operation because the tendon is shorter, scarred and of poorer quality. Complex tears, where more than one tendon is involved or the tendon has retracted a long way, may need different techniques again. Individual results vary.
Instability, the Latarjet and its complications
A shoulder is unstable when it dislocates or partly dislocates, or feels as though it is about to. Repeated dislocations can chip or wear bone from the front rim of the socket, and once a significant amount of bone has gone, repairing the torn ligaments and labrum back onto the rim has less to anchor to.
The Latarjet procedure addresses that by transferring a small piece of bone, the coracoid, with its attached tendon, to the front of the socket, deepening it and adding a restraining sling of soft tissue. It is a technically demanding operation close to important nerves and blood vessels, and the recognised complications include problems with how the transferred bone heals into position, hardware issues, nerve irritation, stiffness and recurrence of instability. Teaching the complications alongside the technique is deliberate, because recognising and avoiding them is a large part of doing the operation well. Individual results vary.