Friday, January 13, 2017

Guiding principles for shoulder surgery

Yesterday we had a wonderful time interviewing some incredibly bright candidates for our shoulder fellowship. We're confident that the future of our specialty will be in great hands and that these surgeons will responsibly guide the the practice of shoulder care in a way that assures maximum benefit to the patient.

During that interview, we had a chance to touch a bit on philosophy and referred back to our first shoulder book, published in 1994, Practical Evaluation and Management of the Shoulder.

This book is now out of print, but you can read it in the PDF accessed freely through this link.

At a time when many expensive new implants and technologies are brought to the marketplace each year, the preface to this book written 23 years ago seems even more relevant now. It presents an integrated practical method for the evaluation and management of patients with disorders of the shoulder based on five precepts:

"Normal shoulder function depends on four basic mechanical characteristics: motion, stability, strength and smoothness.

To be surgically treatable, a disorder must be defined in terms of disturbed mechanics. Therefore the clinician must determine both the patient's functional deficits and the mechanical reasons for these deficiencies.

These determinations can usually be made economically, using only the history, physical examination, and plain radiographs.

The goal of treatment is the restoration of the patient's function. Thus the success of treatment must be measured in terms of functional improvement.

The results of surgery are dependent both on the procedure and the surgeon performing it. Therefore, each surgeon is responsible for knowing the results of his or her own operations.

This book is directed at the type of practice we see evolving for the coming decades, when resources will not be as plentiful and increasing premiums will be placed on economy and effectiveness. In this spirit, we emphasize what can be accomplished with the basics: the clinical history, the physical examination, a few plain radiographs, simple patient-conducted rehabilitation programs, and well-characterized surgical procedures."

Now, almost a quarter of a century later, the practice of shoulder surgery has evolved, but the principles remain intact. New texts present new methods, but they should continue to remind us of the value of the basics, such as the axillary view shown on this cover which nicely demonstrates the pathology typically encountered in glenohumeral osteoarthritis on a plain axillary radiograph.


Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book.

Click here to see the new Rotator Cuff Book

Information about shoulder exercises can be found at this link.

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