Restoring Shoulder Function to Those Who’ve Lost Hope
His father was a professor of orthopedic surgery at the University of Havana in Cuba
When the Martinez family left the island nation, they eventually landed in Odessa, Texas. As a teenager, the future doctor would actually scrub up and accompany his father into surgery or the emergency room. He recalls, “You could do that in Texas back in the day.”
Even though Dr. Martinez’s destiny seemed clear, the road nearly took a couple of turns. During medical school, the doctor says, “I wanted to do everything.” First, it was obstetrics. It was exciting the first time he followed a patient through her journey into the delivery room.
However, he laughs, “After about twenty babies, I thought this isn’t for me.” Next was cardiology. But when he could not detect the sound of a mitral valve snap, a sound that his colleagues claimed to hear through their stethoscope, he thought once again “this is not for me.”
“Every surgical rotation just felt right. I really enjoyed all of the medical tools and fixing abnormalities of the human body. In orthopedics, you can fix broken bones and abnormal muscles and people get better.”
A former tennis player who blew out his shoulder, Dr. Martinez says, “Most orthopedics are frustrated athletes,” especially ones like him who were injured in their sport.
In fact, the doctor met his future wife on the tennis courts at Odessa College; she was a National Juniors Champion in Chile. After tying the knot, the two worked in his father’s medical practice for a number of years before relocating to Southwest Florida.
The couple knew they wanted to live in Florida. Dr. Martinez was familiar with Miami, having visited the area numerous times with his family. However, he was not convinced that was the best place to raise his children. When he crossed Alligator Alley for a job interview more than 20 years ago, the hotel he checked into had “Welcome Bob Martinez” on the marque. He remembers thinking, “Wow they really want me.” Bob Martinez was the governor at the time… he was also visiting.
In the late 80’s, Dr. Martinez was one of the first orthopedists in this region to perform a shoulder arthroscopy
Today, he continues to be among the first in his field to use cutting edge technology and unique approaches to repairing joints. The “reverse total shoulder” is one such operation.
The procedure may seem counter-intuitive, but it has proven successful in patients who’ve been told there is nothing that can be done to help them regain function in their arm.
The reverse total shoulder originated in France as a way to treat patients with a broken or fractured humeral head, or shoulder. Dr. Martinez began doing the same locally, then gradually expanded the procedure for use in shoulders with torn rotator cuffs where arthritis had also set in.
When a rotator cuff is torn and the patient doesn’t have it repaired, the muscles atrophy and the humeral head rides up against the acromion or the collarbone for the sake of visualization.
Dr. Martinez is one of only a few orthopedists who has not only embraced the reverse shoulder but also regularly performs the procedure, saying in amazement, “It looks crazy but it works.” That’s because while most joint replacements are done in a manner that mimics the natural joint, this one is the complete opposite.
In the past, the ball would be replaced but if the rotator was torn, the muscles still weren’t in the right spot to hold the ball or power it. Movement of the arm was still severely compromised.
In this new approach, Dr. Martinez places a socket where the ball used to be and a ball where the socket used to be. The geometry of this backward-looking apparatus allows the shoulder to pivot and use the deltoid alone to lift the arm. It’s a process that is best understood when seen, so Dr. Martinez has a scale model of the shoulder that he takes apart for demonstration and education.
Preparing for a reverse shoulder surgery, Dr. Martinez takes a CT scan of the patient’s shoulder. The image is then used to create a 3D computer model. Calculating precise measurements and placements, he actually practices the surgery online before going into the operating room for best results. “We’re working with a small bone so we have to make sure everything fits in the right way.”
Candidates for this procedure are people who can shrug their shoulder but can’t raise their hands to their head or above. This can even happen in patients who previously had a shoulder replacement. Regardless of previous surgery, the rotator cuff muscles can still give out.
Besides being painful, the lack of mobility makes getting dressed nearly impossible. Patients also have difficulties rotating their arm in the manner needed to take care of important personal hygiene.
People suffer for years, functioning with one arm, never seeking help because they’ve been told there is none. Others are simply afraid of surgery. Dr. Martinez cautions, “Some people are OK with having one good arm, but if one shoulder failed, the other might too and then you have nothing. It’s better to fix one while the other still works.”
Surgery is the last option for treating shoulder pain according to Dr. Martinez, who first tries injections and the likes to reduce inflammation. However, he says, “When there is a mechanical disruption, none of those things work. Mechanical problems need mechanical solutions.”
Within 5-6 months after reverse shoulder surgery, most patients are able to resume most of their normal activities and wonder why they waited so long to get help.
If you are suffering from shoulder pain and limited mobility, it’s time to get some relief. Call Dr. Martinez at Gardner Orthopedics.
3033 Winkler Ave, Fort Myers