Why this handout?

I think most people find going to see the doctor a difficult and emotional experi-ence that I think is made more stressful when surgery is considered. While many of the things we discussed are simple, the details may be easily forgotten. Hopefully, this letter will serve as a reminder of our meeting and will answer any questions that arise.

What is wrong with your shoulder?

The ball is slipping in the socket. Some amount of slipping is normal but too much slipping results in the shoulder coming part way out of the socket (subluxation) or all the way out (dislocation). Almost always, the excessive slipping is painful. The ball (hu-meral head) slips because of damage to the ligaments, bone or sometimes the ligaments and the bone. A ligament connects one bone to another bone. Often, what appears as a minor injury causes the ligament to give way. On occasion, a single injury will cause the problem. What is the purpose of the surgery?

In this situation we need to substitute for the ligament with non damaged muscles and ligaments from other parts of your shoulder. If the bone is damaged we need to replace the missing piece with bone from other parts of

your shoulder. Fortunately, I can accomplish both with the Latarjet operation. When you arrive at Texas Orthopedic Hospital a nurse will have you sign the Op-erative Permit. The name of the operation I will be doing is “Latarjet Repair.”

What is the surgery like?

The surgery is done through a 4 inch incision in the front of the shoulder. Through the incision I insert special instruments that allow me to repair the ligaments and move the bone and muscle into position. The bone and muscles are held in their new position with 2 metal screws. They do not have to be removed. The screws will not set off airport sensors.

Latarjet Operation

What kind of anesthesia is used?

Since this type of surgery cannot be done with local anesthesia we use general anesthesia that allows us to work deep inside your shoulder.

How long will you stay in the hospital?

You will enter the hospital in the morn-ing, have the surgery and stay in the recov-ery room 2-3 hours until you recover. If you wish to stay overnight in the hospital then you will be taken upstairs to the hospital and stay in the hospital overnight. If you want to re-cover at home, then after the anesthesiolo-gist and nursing staff agree that your condi-tion is satisfactory, a nurse will take you downstairs in a wheelchair to your automo-bile.

Will you need to wear a brace?

No. A regular sling is all that you will use. Patients wear the sling for 1 week but remove it for bathing and dressing.

What about complications?

Shoulder surgery is a complex and delicate process designed to repair damaged struc-tures deep within the human body. Compli-

cations can occur. Fortunately, these are rare. The most common complication in-volves the bone screws, which occurs in less than 1% of patients. I use these metal im-plants to attach the bone.

There is always a possibility that I would have to remove them surgically if they loosen or cause irritation. Infection can require oral antibiotics, antibiotics by injection and rarely surgery. Wound problems includ-ing swelling, bleeding, delayed healing, un-sightly or painful scar. Bone infection or frac-ture could occur. Joint problems including stiffness or arthritis could occur. Failure to achieve the desired result is not strictly a complication but it can be a source of disap-pointment. This operation may result in in-complete motion, strength or function. Nerve injury is the most serious but fortunately very rare. Nerve injury may result in temporary or permanent, partial or complete loss of feeling and/or movement in the arm. My purpose in listing the types of complications that could possibly occur is to inform, not frighten you. While it would be preferable if we could per-form surgery without any risk, this is not the case. The complications are rare (less than 1%) but regrettably, in spite of our best efforts, they do occur. I feel it is your right to know.

How successful is the surgery?

This type of surgery is successful about 90% of the time. No shoulder opera-tion is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. Whether you can return to your previous activity level is an individual matter and depends on the damage to your shoulder, how well it heals, how well you re-habilitate and how strenuous is your desired level of work or sports. Because of the many

variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible. Full recovery takes about one year.

When can you return to routine activities?

You will be able to use your fingers, wrist and elbow immediately after surgery. You may shower or bathe with regular soap and water 24 hours after surgery. Bend from the waist and let your operated arm move away from your side; then use your good arm to wash under your armpit. Try and keep your arm in the sling as much as possible. Do not lift more than 1-2 pounds with your oper-ated arm.

When can you return to work?

For most sedentary jobs I recommend taking 2-3 days off work. Some people are able to return to work sooner. When you re-turn to work your arm will be in a sling (for 1 week after surgery), but you should be able to manage as long as you do no lifting, pushing, pulling or carrying with the operated arm. It is safe to eat, write or use a computer. Re-turn to heavy lifting or overhead sports may require 3-6 months.

How is the shoulder rehabilitated?

Fortunately, the exercises you need you can usually perform by yourself at home.

When do you return to the doctor’s of-fice?

Your first office visit is 1 week after surgery so that I can examine the surgical incision and get an xray of your shoulder. I will give you instructions for exercises and discuss your allowed activity level. Depend-ing on your progress, your next visit will be about six weeks after surgery. At the 3

month visit i repeat the xray to see if the bone is healed. Once the bone is healed, full activi-ties and sports are safe. Regular office visits are a critical part of your care. How much does the surgery cost? Insurance coverage is a complicated business with no fixed rules, please check with your insurance carrier in regard to the specifics of your proposed shoulder surgery. Also note that the hospital bill is not some-thing that I can control, so please direct any questions regarding the specifics of the hos-pital, x-ray, laboratory and anesthesia bill to the hospital billing office. The insurance code for your surgery is 23462. Operations such as the Latarjet operation are complex and require a trained surgical team. I work with another fully trained physician who assists me during the operation. Normally this is Steven Hammerman, M.D. You will receive a bill for his services. What if I have more questions?

We encourage you to return to the office for a further discussion at any time. There is no charge for preoperative confer-ences.

When is surgery performed? I perform surgery on Tuesday and Thursday.

How do you schedule surgery?

Contact Evelyn by phone at (713) 799-2300. Call her on a Tuesday, Thursday or Friday so that she can spend time with you on the phone and answer all your questions.

es16@fondren.com DrGartsman.com

Latarjet Operation