Dedication We dedicate these volumes fi rst to our families, who have given us their fullest support and encouragement during our careers as shoulder surgeons. Without their constant love, we would have accomplished little. We next dedicate our work to the thousands of individuals who have consulted us regarding their shoulder problems with the hope that our efforts would enable them to regain comfort and function. Without their confi dence in our efforts, we would have been unable to develop the knowledge of what works best and when. Finally, we dedicate this book to all those who are captivated by the shoulder and who continue to pursue greater insights into its function, its malfunction, and the effective treatment of its clinical disorders. Without bright new minds applied to the many challenges presented by this complex and fascinating joint, our fi eld would not be better tomorrow than it is today. CAR FAM MAW SBL EVF JWS Foreword to the Fourth Edition I am grateful for the opportunity to offer this Foreword the initial concept, expanding and reorganizing materials for the fourth edition of this unique text on the in light of this new knowledge. We readers expect a shoulder—with an emphasis on the role of surgical careful display of surgical anatomy and biomechanics, treatment. new information about clinical evaluation and imaging, In the 1980s, when the fi rst edition of The Shoulder a rethinking of the directions for care of fractures about was conceived, there was a tremendous need for the the shoulder, a large section on the application of arthros- collection and organization of the information and wisdom copy to the evaluation and care of shoulder problems, that had been developed to date about the care of shoul- the introduction of new ideas about the care of rotator der injuries and diseases. Ideas were changing rapidly, cuff–related problems, carefully organized presentations and technology was advancing at a fast pace. on basic concepts that can be applied to the understand- There was an expanded understanding of the classifi ca- ing of shoulder instability, and many, many other lesser, tion of fractures of the proximal humerus, and there were but not unimportant, subjects, that all of us encounter in emerging improvements in fi xation methods. The impinge- the evaluation and treatment of patients. This text delivers ment syndrome was being embraced, and there was on the materials just listed and contains supporting chap- dramatically increased success with repair of torn rotator ters extensively referenced so that the readers can easily cuff tendons. Total joint arthroplasty had proven itself in access the information codifi ed by the authors. the hip and the knee; there was a question about whether We must be very thankful to these gifted educators this would translate effectively to the shoulder. The bio- who have chaired innumerable continuing medical edu- mechanics of shoulder instability were being developed, cation courses, who have developed fellowships, who and the applications of these basic concepts to clinical actively participate in clinical and basic research on the treatment were emerging. The arthroscope was being shoulder, and who have been involved with other texts applied effectively to the evaluation and care of rather for sticking with their original idea and actively pursuing simple knee problems, and there was a tremendous the incorporation of new materials. Readers can count on opportunity to develop and mature effective applications this as a reliable source, a database if you will, against of this tool for the shoulder. As easily recognized, there which other ideas can be compared. Readers not only was a steaming cauldron, if you will, of new knowledge will know where we stand on current issues after reading demanding an organized expression, and that demand this text but also will be able to understand how we was answered by this text. arrived at current thinking and treatment of a large variety The basic idea to fully collect the information, to organ- of subjects in this anatomic region. ize it, and to express it in a readable way was the genesis of The Shoulder. During the subsequent decades, the ROBERT H. COFIELD, MD information available about the shoulder through courses, Caywood Professor of Orthopedics journals (particularly international journals), and other Mayo Clinic College of Medicine more focused textbooks has literally exploded. Mayo Clinic It is a wish fulfi lled that these editors, with the contri- Rochester, Minnesota butions of many insightful authors, have carried on with October 2008 vii Foreword to the Third Edition Publishing companies do not re-issue books that are inac- diagnosis and management. Perhaps more importantly, curate, unused, or unpopular. So, there is a good reason the contributing authors also demonstrate a commitment to be excited about the third edition of The Shoulder, to the pursuit of better understanding and more effective edited by Drs. Rockwood, Matsen, Wirth, and Lippitt. Not treatments, rather than just relying on traditional methods. too long ago, as history is measured, we considered our- And, even more importantly, these authors are also dis- selves to be in the early stages of learning about the criminating about incorporating some of these newer shoulder joint—its functional anatomy, its injury patterns, techniques that may represent a triumph of technology and, very importantly, its optimal treatment. over reason. Since the fi rst edition of this book, our technical capa- Finally, some of you know, and most of you can bilities in imaging, instrumentation, and pain control have imagine, how much work it is to write and assemble a improved tremendously. Chapters dealing with these quality text such as this. It is our considerable good fortune aspects of shoulder care refl ect this heightened scrutiny. to have these editors at the forefront of our profession, Continuing interest in and understanding of both devel- willing and able to undertake this arduous task, and pro- opmental and functional anatomy allow us to compre- ducing a work of such outstanding breadth and quality. hend the biomechanics of not only the pathologic shoulder but also the normal shoulder. Without a clear picture of FRANK W. JOBE, MD normal shoulder function, our devising and refi nement Kerlan-Jobe Orthopaedic Clinic of correctional procedures would lack a clear direction. Centinela Hospital Medical Center The editors have succeeded in assembling a panel of Inglewood, California chapter authors with acknowledged skills in shoulder January 2004 Foreword to the First Edition It is a privilege to write the Foreword for The Shoulder and Elbow Surgeons and is an unusually talented teacher by Drs. Charles A. Rockwood, Jr, and Frederick A. and leader. These two men, with their academic know- Matsen, III. Their objective when they began this work how and the help of their contributing authors, have was an all-inclusive text on the shoulder that would also organized a monumental text for surgeons in training and include all references on the subject in the English litera- in practice, as well as one that can serve as an extensive ture. Forty-six authors have contributed to this text. reference source. They are to be commended for this The editors of The Shoulder are two of the leading superior book. shoulder surgeons in the United States. Dr. Rockwood was the fourth President of the American Shoulder and CHARLES S. NEER, II, MD Elbow Surgeons, has organized the Instructional Course Professor Emeritus, Orthopaedic Surgery Lectures on the Shoulder for the Annual Meeting of the Columbia University American Academy of Orthopaedic Surgeons for many Chief, Shoulder Service years, and is a most experienced and dedicated teacher. Columbia-Presbyterian Medical Center Dr. Matsen is President-Elect of the American Shoulder New York, New York ix