Paul Re, MD, an orthopedic surgeon with Orthopedic Affiliates, Inc., talks about his specialty — the shoulder — and why he decided to write a book on it.
You specialize in diagnosing and treating shoulder problems, correct?
Yes. I'm a sports medicine specialist, but the shoulder has always called to me, mostly due to its uniqueness. Its flexibility and range of motion is unmatched by any other joint; as a result, it is somewhat unstable. The shoulder depends on the muscles and ligaments surrounding it to maintain dynamic balance. The shoulder is complex; for example, one rotator cuff is not like another in terms of how you need to repair it. It's like opening up a puzzle and figuring out where you need to go.
What motivated you to write your book, "A Surgeon's Guide to the Shoulder"?
The goal was to educate my patients. If someone has suffered a shoulder injury, I want them to understand the unique nature of the shoulder, because this will help throughout their treatment and recovery. I wrote the book and did the illustrations, which include anatomical details and demonstrate a variety of exercises. My brother, Louis P. Re, MD, who is an orthopedic surgeon also specializing in the shoulder, served as editor. The process of writing the book reaffirmed my thought process of how I evaluate, diagnose and treat shoulder injuries.
Recovering from shoulder surgery is known to be difficult.
Yes, it is complex but much better than it was in the past due to our newer techniques. But still, many things have to happen on the way to recovery, which is why I want my patients to understand the process of recovery: getting their posture back, followed by scapular stabilization and mechanics, then flexibility and finally strength. It is not unusual for patients to get disappointed during their recovery, so we educate them prior to the procedure and often have to remind them and re-educate them along the way.
Shoulder surgery has improved so much from the larger, open procedures we used to perform. With today's minimally-invasive shoulder surgery, patients experience far less pain than they used to. That can present a problem, because when people feel less pain, they can get a bit too aggressive with their recovery, despite the fact that the shoulder hasn't healed. This is another thing we often have to educate and remind our patients about.
What are the most common shoulder injuries you see?
I would say bursitis, tendonitis, rotator cuff tears, fractures and dislocations, along with shoulder instability and arthritis. There's definitely a genetic predisposition to arthritis. In some people, the cartilage breaks down sooner than it does in others. Many patients come in with bursitis or tendonitis, which can be treated with anti-inflammatories or pain injections using our ultrasound machines in the office. This allows us to hit the exact location and give the lowest dose.
Your book opens with a word of advice having to do with prevention.
Yes: the best way to cure a shoulder problem is to avoid it. As I tell my patients, keep your shoulders back and down. When you continually slump forward, a cascade of injury can occur. When you open yourself up, it's good for your shoulders. Keep your core strong and your body flexible, in correct axial alignment. The book includes illustrations that show simple exercises that my patients who had shoulder surgery need to do. But I suggest that everyone do these exercises three or four times a week to stay healthy.
My book explains how, as we evolved from hunters to farmers and on to today, we've tended to lean over more and roll our shoulder blades forward. Our bodies can't take it. We need healthy shoulders because they provide the platform that allows us to use our hands, whether it's to throw a football or hold a paintbrush. We set our shoulders first, and then we do what we want to do.