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Advanced “reverse” shoulder replacements can dramatically restore function to patients with torn rotator cuffs, but the stakes are high during rehab, according to former baseball star turned orthopedic surgeon Dr. Brent Stephens, Class of 2009.

“Baseball helps (my understanding of) the physics of it and also from the standpoint of when a shoulder hurts, what should be done to help rehab and what helps to not do,” he said. “I played baseball and had constant shoulder problems. I can draw from my experiences. It’s not always text book. It’s more living through (the experiences).”

Post-surgery patients feel good for about a week before some pain occurs giving some a change to be too aggressive in returning to strenuous activities, he said. “Once you explain to them that just because you feel good does not mean that it’s healed they typically ease off,” he said. “When you tell them that ‘if you ruin what I do, I can’t do it again,’ they listen. The revision is a lot more difficult and the outcome would not be the same.”

Q: Did you always expect to go into medicine as a career?
Stephens: My dad is a judge so I ruled out law early on. I was an athlete, baseball, and my plans were to play professionally. I was supposed to get drafted but hurt my ACL and ended up getting surgery. I shadowed an orthopedic surgeon there and that’s how I got into medicine.

Q: Where and when did you choose your specialty?
Stephens: Funny, even when I got to medical school I was torn between plastic surgery and orthopedic surgery because I’m into aesthetics and making things look good. Ultimately, orthopedics was more interesting to me. It was a good choice because of my background.

Q: What procedures do you perform most often?
Stephens: I do shoulder replacements and rotator cuff repairs. So really, any shoulder level injury I treat from age 16 and older. So it’s the young athletes and the older replacements. Most of the younger ones are athletes but the older ones are still active. I kind of get the whole spectrum. It’s a little bit different than hip and knee because a lot of times they just want to be able to walk. Mine want to be able to go play tennis and golf. With some older patients it’s about getting the quality of life back; with the younger patients it’s about getting their sports back. The rotator cuff tear is probably the most common injury in orthopedics.

Q: What advanced procedures are you performing now?
Stephens: A reverse shoulder replacement is the area that is kind of unique. That’s where a lot of shoulder specialists are honing in on doing the most we can do. On a normal shoulder you have a ball and socket. With a reverse shoulder replacement, you put the socket where the ball used to be and the ball where the socket used to be. It has a similar range of motion but not the same. You go from 40 degrees of lifting your arm to 130 degrees. I did one on a 75-year-old who couldn’t lift his arm because he had a real bad shoulder and rotator cuff tear. He can now get his arm up to 170 degrees. I saw him (recently) and he was hugging me because he can now mow the lawn by himself and can do things without asking for help, which is what he couldn’t do before. He can play tennis or golf if he wants to but for him its just getting back to the things he does every single day. Even the small things, you realize that’s the quality of your life.

Q: Did your experience with baseball influence your choice of specialty?
Stephens: Yes, absolutely. I think the shoulder is a fascinating joint. It’s one of the joints people don’t realize they are more complicated than you think. A hip can move some, a shoulder you can move 180 degrees all around with 30 plus muscles.

Q: Has there been progress made in your specialty since you started in school?
Stephens: Actually, the reverse shoulder replacement came into existence one year before I started and now it’s one of most common shoulder replacements that is being performed. The shoulder and elbow world is the newest area in orthopedics that’s really picking up. The joint replacement for hips and knee have been around for 40 years.

Q: Are the materials used metal and plastic?
Stephens: Similar to a hip or knee replacement using metal and plastic. It’s the procedure. The materials are similar. How to do the procedure is unique. That’s why I did the fellowship in shoulder and elbow training. You want to know how to do it correctly. People do better than I thought they would initially. When you can put your arm above your head two or three days after surgery, it’s a big difference.

Q: What are the factors in getting the maximum life span out of an artificial joint?
Stephens: Following the early rehab protocol. If you do too much too soon even when it feels good, you risk the longevity of it. If you don’t enough, you’ll be stiff. It’s about following instructions for the first three months which will give you longevity for a long time. It’s different than hip and knee. With the shoulder, there are 30-plus muscles so you are balancing moving with rest because if you move too much you are going to tear those muscles. I have them move them the first day out of the hospital but it’s basic movements and not any exercise.

Q: What advice would you give the parents of elite young baseball players to help protect their shoulders and elbows long term?
Stephens: Rest and interval training are important: meaning take time off. If you use it all year round you are going to injure yourself and I did that to myself when I was 12. Have periods of built-in rest throughout the year when you are not using that body part. Take time to do other stuff. Pick different sports because that uses different parts of your body. I blew out my knee because of that very reason. Same thing applies to the older patients as well. You can’t overdo it. While I support them being active, you have to listen to their bodies.

Q: What is your favorite part of your job?
Stephens: I had a guy come back a year after shoulder replacement surgery who can do what he likes to do now without asking for help. His level of independence has gone up and with that his quality and happiness has improved. He was happy about making that change in his life. It changed everything about what he can do. The best part of my job is when you see the end result.

Q: What is a difficult or frustrating part?
Stephens: When you want to help but you know that you can’t do too much to make a difference.

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