“SICOT meets SICOT” Fellowship Report from Bad Neustadt Shoulder Centre, Germany
I am glad to report about my fellowship in Bad Neustad Shoulder Centre because it was an unforgettable period of my life. I think I am one of the first doctors from Uzbekistan to be selected for the SICOT Fellowship Programme. I want to thank SICOT and Professor Frank Gohlke for giving me a chance to improve my knowledge and professional skills in shoulder surgery.
I reached Germany on 1 May. Bad Neustadt is a small and beautiful city in the Northern part of Bayern. The Shoulder Centre which is located here is a famous centre on shoulder surgery.
The first day when I reached Bad Neustadt Shoulder Centre the secretary introduced me to the Professor and doctors. They asked about my clinical interest and my professional activity and I was explained about the working schedule of the centre. This centre has four operation days and one outpatient department day. After the introduction we went to the theater. I was informed about the rules in the theatre. The Shoulder Centre has 2 operation rooms and 6-7 surgeries are performed per day. In a few minutes Professor Frank Gohlke began to perform surgery, namely reverse shoulder arthroplasty. This was a very difficult case with severe osteoarthritis of the shoulder and defect of the glenoid. To tell the truth, it was my first shoulder reverse arthroplasty surgery that I had watched in theatre. Shoulder arthroplasties are not done in our country. Then I observed other arthroplasty surgeries too. Another three shoulder athroscopic operations were performed in the next operation room. From the first day I realized that I had come to one of the largest centres of Germany on shoulder surgery and I would work with highly qualified professional doctors.
With Prof. Frank Gohlke
Every day began with visiting patients (clinical rounds) who had undergone different shoulder surgeries. Necessary recommendations are given by doctors depending on the patient’s condition and type of surgery. I noticed that physiotherapy is recommended at an early recovery period after surgery. This leads to full range of motion which results in the success of the surgery.
Every Wednesday doctors of the Centre discuss every surgical case after clinical rounds. And every Wednesday doctors work in the outpatient department. On average 50 patients are seen per day by doctors of the Centre on Wednesdays. I saw many interesting cases in the outpatient department. In this department I paid attention to how I should examine patients, interpret MRI, computed tomography and X-rays in different views. I didn’t hesitate to ask questions to the Professor and doctors as my aim was to improve my knowledge and professional skills on shoulder patients. Every time I asked questions I received a full answer including pathogenesis of the process, anatomy and MRI, CT signs.
In the theatre I observed shoulder and elbow surgeries, including open and arthroscopic surgeries. Arthroscopic surgery is my subspecialization. I paid attention to differential approaches in shoulder arthroscopic surgeries depending on the diagnosis, age, gender and constitution of patient. For example, there are indications for tenotomy and tenodesis of the long head biceps tendon in tendinitis. I was explained that tenotomy is done in older and fat patients, and tenodesis is done in relatively young, especially male, patients.
The majority of patients with shoulder impingement suffered from shoulder pain and restricted range of motion. Arthroscopic bursectomy, acromioplasty and acromioclavicular joint resection are done in these type s of cases. It is necessary to take into account the types of acromion, especially in cases of os acromiale and os mesoacromiale which require caution during acromioplasty.
After 2 weeks, I asked the Professor to scrub in surgeries as an assistant. I then participated in many open and arthroscopic surgeries. I was also allowed to use instruments in order to feel some structures of the shoulder during arthroscopic surgeries.
With Dr Robert Hudek during a shoulder arthroscopy
I discovered two news in shoulder arthroscopy: arthrolysis and acromioclavicular joint resection. In cases of stiff shoulder, when range of motion is limited, an arthrolysis is indicated. It helps to increase range of motion. Acromioclavicular joint osteoarthritis results in pain on this area. Resection of this joint is done with arthroscopic, and sometimes with open, technique. It is necessary to take into account soft tissue structures during shoulder arthroscopy and open surgeries. Supraspapularis, axillary nerves and cephalic vein require careful work in order not to damage them.
During arthroscopic surgery with Dr Ayman
Another new thing for me was elbow joint arthroscopy. Despite the fact that the number of elbow arthroscopies was lower, these surgeries were performed in a professional level.
Beside reverse arthroplasty surgeries, anatomic shoulder replacement surgeries are also performed in this centre. For anatomic replacement surgeries the rotator cuff must be intact. The rotator cuff’s state is important in arthroscopic surgeries too. In cases of fat atrophy of the rotator cuff muscles its repair is not indicated. In cases of significant atrophy the torn rotator cuff is not repaired. The Goutalier classification is used by doctors of the Centre to evaluate the state of the rotator cuff.
Instability of the shoulder is treated after very careful investigation of the shoulder, including MRI, CT and X-rays in different views. SLAP injuries are performed arthroscopically. I paid attention to the arthroscopic portals during these surgeries. I think the success of the surgery depends on this.
The defect of the glenoid is an important item in shoulder recurrent dislocations for shoulder stabilization surgeries. In recurrent shoulder dislocations with a glenoid defect an autobonegraft from iliac crest is put to the anterior edge of the glenoid in order to increase the articular surface of the last one. They use the Eden-Hybinette procedure, which was also new to me. I asked the Professor a lot of questions about instability of the shoulder. He explained many shoulder stabilization surgery methods. I realized that it is necessary to investigate a patient carefully. A MSCT of the shoulder can reveal defects better than other methods.
During my fellowship I improved my skills on shoulder disease and injuries. Also I understood some aspects of the German medicine system. The knowledge I obtained in this Centre will help me in my professional activity in future. Since shoulder arthroplasty and arthroscopic surgeries are just only developing in my country, I hope that the knowledge obtained in this Centre will be very useful. I would like to express my thanks to SICOT for the opportunity it has given me to be trained in one of the largest Shoulder Centres. Finally, I would like to express my special thanks to Professor Frank Gohlke and his team for their support during my fellowship.