Patient story: Harriet's shoulder stabilisation surgery
Harriet thought she would never ride again after her shoulder dislocation
Harriet Tucker's original injury happened when riding her horse at a point-to-point. When approaching an open ditch, the horse attempted to abort. Harriet was unseated and fell to the ground. Although in great pain, she passed the doctors assessment and was back on board shortly after the accident. Unbeknown to Harriet, she had significantly damaged her right shoulder.
Harriet started racing horses at the young age of 16 when she joined the British Racing College. She worked with two well-known horse trainers during her early career, regularly riding at point-to-points.
Two years later, Harriet went on to join Paul Nicholls’ Racing Yard at the age of 20, where she was given the opportunity to ride Pacha Du Polder in the Foxhunter Chase at Cheltenham Festival. During the race, Harriet's shoulder dislocated at the second-to-last fence, when she raised her arm forward to encourage the horse. She went on to win the race.
It was thanks to a second opinion from Simon Gregg-Smith, consultant orthopaedic surgeon, that Harriet's complex shoulder injury was identified and an appropriate surgical solution advised.
After a series of shoulder dislocations, Harriet saw a chiropractor and physiotherapist but nothing seemed to help. She went to the Injured Jockey’s Association, who suggested she see a specialist shoulder surgeon. The first shoulder specialist broke the awful news that she was dreading: she had significantly damaged her shoulder. Her dream of racing again was hanging in the balance.
Harriet went on to get a second opinion from Mr Simon Gregg-Smith, a consultant orthopaedic surgeon at Circle Bath Hospital. Mr Gregg-Smith identified a complex shoulder problem and recommended an operation. Harriet was confident that she was with the right person after doing her homework and discovering that her surgeon had operated on rugby players who had gone on to play professionally again.
Dislocating shoulders are a common problem which most shoulder specialists deal with regularly. When patients dislocate their shoulders they damage the ligaments – they literally rip the ligaments off the bone. Patients then have looseness or weakness in the shoulder. The ball, controlled by the ligaments, moves over the edge and dislocates. This is a common injury in men and women, especially those involved in the sport.
The surgeon needs to put the ligaments back in place, which stops the ball from sliding off the socket. This surgery takes time but gets a good result. It’s a long rehabilitation process.
Unfortunately, in Harriet’s case, she had a more complicated shoulder problem. Where the ball had knocked the edge of the socket, it had broken off a corner of bone. This had reduced the size of the socket by 30%, so with one-third of the socket missing dislocation was frequent. The problem is that if the ligaments are tightened it simply doesn’t work, as the ball still drops off the socket, resulting in continuous dislocation.
With a complex shoulder problem, such as Harriet’s, it’s important to determine the exact problem so that the surgeon can plan and design the operation around the patient’s needs. For Harriet to continue her high demand sport what she doesn’t need is a shoulder which keeps dislocating in the middle of a race.
The key with Harriet’s injury was to work out how bad the damage was and how to rebuild the socket. The CT scan shows the surgeon a three-dimensional view of the shoulder. The radiologist then altered the image by removing the ball from the socket. These provided a very clear view of the damaged socket, from every direction, enabling the surgeon the see the defect and decide how to rebuild the shoulder.
Simon Gregg-Smith performed a Latarjet procedure to stabilise Harriet’s shoulder. This involved using a piece of bone from the shoulder and moving it to perfectly fit the damaged area of the socket. The socket was rebuilt to its original size and shape with the support of the surrounding muscles and tendons.
Find out more about having treatment at Circle Bath Hospital on our treatments page.
Circle Bath Hospital is a recognised Centre of Excellence for shoulder surgery. Consultant surgeons in the unit are leading experts.
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