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Dr. Evan Flatow: Innovating Shoulder Surgery


August 02, 2010

Evan L. Flatow, M.D., has been practicing medicine for almost thirty years. He received his medical degree from Columbia University in 1981 and is currently chair of the Department of Orthopedic Surgery at Mount Sinai Hospital in New York, New York.

A leading expert in his field, Dr. Flatow has published five books and over two hundred papers and text chapters. New York Magazine has voted him one of the “Best Doctors in New York” every year 1999 through 2009, and he has appeared on the Today Show discussing shoulder injuries.

He’s won numerous awards, including the Neer Award for Excellence in Shoulder Research in 1992, 1994, 1996, and 2004 and the Lifetime Achievement Award in November 2009.

Dr. Flatow has wanted to be a doctor since he was six years old. He was impressed by a friend’s father

How to Prevent Shoulder Injuries

  • Warm up and stretch before playing sports or exercising

  • If you haven’t played sports or exercised recently, ease into them

  • Forget the old notion of ‘no pain, no gain.’ If you feel pain, back off and consider seeing a doctor.

  • who was a doctor, and even from a young age he was fascinated by science.

    In medical school, Dr. Flatow studied under Charles Neer, thought by many to be the founder of modern shoulder surgery. Dr. Flatow had already chosen to focus in field of Orthopedics, but studying with Dr. Neer pushed him towards specializing in shoulder surgery. “He was just such a dynamic and creative thinker,” Dr. Flatow reminisced. “It was sort of exciting. I became really interested in shoulder because he was such a great teacher.”

    There have been many exciting innovations in the field over the past ten years. The three major innovations are the use of regional blocks instead of general anesthesia, the development of reverse shoulder replacement, and the rise of arthroscopic surgery and minimally invasive treatments so that many surgeries can be done with tiny incisions or only punctures.

    Before recent years, shoulder surgery required general anesthesia. Patients had tubes down their throats and their breathing was controlled by respirators, which is harsh on the body. Now, nearly all shoulder surgeries, including shoulder replacement, can be done with just a regional block that numbs the arm and a sedative that allows patients to sleep the way they’d sleep naturally in their beds at home. According to Dr. Flatow, “Because of this, shoulder surgery is often an outpatient procedure, and even when patients are admitted, this is much gentler on them.

    Reverse shoulder replacement is a revolutionary technology in improving function and relieving pain for patients who have rotator cuff tears and arthritis. “Traditional shoulder replacement simply provides new joint surfaces, but it still needs muscles to move it,” explained Dr. Flatow. “If patients don’t have the muscles because of a rotator cuff tear or because they’re missing a lot of muscles in the shoulder, then the reverse shoulder replacement provides a fulcrum so that the deltoid muscle can lift the arm without the rotator cuff.

    In recent years, orthopedicians have learned how to fix fractures with minimally invasive percutaneous techniques using pins and screws placed through small incisions. According to Dr. Flatow, “We’ve learned how to do all kinds of surgery arthroscopically, including most recently repairs of the subscapularis and the sections of the suprascapular nerves and the axillary nerves, which have in the past needed open incisions. So it’s been exciting to do that all closed with minimally invasive surgery.”

    In order to prevent shoulder injuries, use common sense with sports and recreation. Warm up and stretch before beginning to play or exercise. If you haven’t played sports or exercised in awhile, you need to ease into it and not expect to be able to do everything right away. “If you’re going to start playing tennis and you haven’t played tennis in a long time, it’s good to just hit with a pro for a little bit in the beginning and maybe practice your strokes and ease on up,”

    Innovations in Shoulder Medicine

  • Regional blocks instead of general anesthesia—gentler on body and allow many shoulder surgeries to be outpatient procedures

  • Development of reverse shoulder replacement, which provides a fulcrum so that the deltoid muscle can lift the arm without the rotator cuff

  • Rise of arthroscopic surgery and minimally invasive treatments so that many surgeries can be done with tiny incisions or only punctures

  • New shoulder replacement that uses tantalum, a metal that allows for bone in growth without the use of cement
  • said Dr. Flatow. “Don’t play two hard sets of competitive tennis with your college roommate that you’ve always wanted to beat your first day out.”

    The notion of ‘no pain, no gain’ should also be tossed out. According to Dr. Flatow, “If you feel pain, you should back off and perhaps see an orthopedist to have things check out. Some things, like rotator cuff problems, are easy to treat when they’re very small, but if you get a big tear, it can be too late for surgery to be effective. You want to treat things early.”

    Dr. Flatow’s biggest challenge is helping people continue their activities despite shoulder problems as they age. People want to stay active older and older. “Today people want to keep being active with all of their sports even as they get into their sixties, seventies, and even eighties,” said Dr. Flatow. “So our challenge is keeping people active and allowing them to be active without hurting their shoulders.”

    He considers the most rewarding part of his profession to be seeing patients get their lives back. “When you have a patient who has bad shoulder arthritis, can’t sleep through the night, can hardly move their arm, and has trouble getting dressed, and you give them an almost painless shoulder and they’re back to golf and tennis, it’s just a fabulous feeling. It makes it all worthwhile.” He discussed one particular patient whose memory stuck with him. “I had one woman who was in terrible pain from bilateral shoulder arthritis and I replaced both of her shoulders and she won or placed in about twenty golf tournaments and took her club title over the next fifteen years. That was very gratifying.”

    View Dr. Evan Flatow's Mount Sinai Medical Center profile

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    Last updated: 02-Aug-10