In his novel A Dry White Season, André Brink described the protagonist: “He continued the sluggish motion that carried them forward step-by-step. Looking ahead, we tended to lose courage. But looking back it was impossible to deny the length of the road already travelled.” And so it is with the world of shoulder and elbow surgery. These thoughts came to me recently when we were interviewing fellow candidates and I was describing my own circuitous route to the world of shoulder surgery.
In 1975, while playing professional golf, I hurt my own shoulder, and I saw Dr Carter Rowe at Massachusetts General Hospital for it. I had no idea who he was. It was only when I entered medical school and my residency at Duke University that I found out he was one of the few shoulder specialists in the United States. Looking back now, there were very few.
I remember well that in 1985, as a junior resident, when a Duke attending orthopaedist asked me what I was interested in, and I told him I wanted to be a shoulder surgeon, he responded, “Well, nobody really does that. It's not even a subspecialty in orthopaedics. You can't specialize in it.” He did not know that the American Shoulder and Elbow Surgeons had been formed in 1982 and the Japan Shoulder Society was almost concurrent with it, nor that the Société Européenne pour la Chirurgie de l'Épaule et du Coude would be formed in 1987. It was an exciting time to be getting into the new specialty.
In 1986 I attended my first course on shoulder surgery, in Charleston, South Carolina, organized by Dr Richard Friedman. There I had my first look at some of the giants of the field—Charles Rockwood, Bob Cofield, Bob Neviaser, Richard Hawkins, and Rick Matsen. In talking to them between lectures, I was a little disappointed that there were only a few shoulder fellowships available in North America. I was fortunate to obtain one of them, spending time in London, Ontario, Canada, with Rich Hawkins.
At the time, there were also only a few international experts in shoulder surgery. Japan had the recently departed Hiro-aki Fukuda and India had A.J. Saha, while Britain had a few, notably Lippman Kessel. Sadly, I never had the opportunity to meet any of them.
We have come a long way. There are now over 30 fellowship programs in shoulder and elbow surgery in North America, with up to 50 positions open each year for fellows. And worldwide there is probably the same number, with fellowships offered in several countries in Europe, as well as Japan, Korea, and Australia. The American Shoulder and Elbow Surgeons has well over 300 members in 2009, with over 100 of these international corresponding members, and the Société Européenne pour la Chirurgie de l'Épaule et du Coude is much larger. As one can see from our cover, many other nations and regions have shoulder and elbow societies. The specialty not only exists, but is growing all the time, in almost all countries, and has become one of the more popular specialties among orthopaedic trainees.
But when we look at where we are, like Brink's hero, we may get discouraged because there is still much we do not understand, do not know. One of my science heroes was the Cornell astronomer Carl Sagan, who in the 1970s popularized science in the United States with his books and television programs. He said in his popular book The Dragons of Eden that now was the best time to be a scientist, because 500 years ago, we did not know enough to ask the right questions, while 500 years from now, all the answers may be known. But this era, this century, this decade, he said, was the time when we could actually ask the right questions and try to find the answers to them.
And thus it is with the world of shoulder and elbow surgery. As we have gotten larger, from a specialty that only 24 years ago was even unknown to a top academic orthopaedic surgeon, to where we are now, I think this may be the best time to be a shoulder and elbow surgeon. One hundred years ago, only Codman even thought of the right questions to ask. And I hope a few hundred years hence, we will know what causes rotator cuff disease, and how to fix it with consistent results, and the answers to all our other seemingly unfathomable shoulder and elbow problems.
So when we face our difficult clinical problems that seem to have no answer, have faith. Don't lose courage, but instead remember the length of the road we have already traveled.
FULL TEXT