On August 1, our 2023-2024 class of orthopaedic surgery fellows started across our nine subspecialties.
Nearly 14 years ago, Bassem Elhassan, MD—co-chief of the Massachusetts General Hospital Shoulder Service, within the Department of Orthopaedic Surgery, and director of the shoulder surgery fellowship—and his former colleagues at the Mayo Clinic were stumped as to how to treat a certain group of patients with major damage of the nerves, with or without bony and soft tissue loss, in the shoulder, elbow and hand. With no other options to mitigate this issue, Elhassan pioneered several procedures to increase function and reduce pain in these patients, who in certain cases were typically told their only options would be to live with a non-functional arm or sometimes amputation.
Q: What makes your work unique?
A: After hard work in the anatomic and biomechanical labs, I have been able to design at least 20 novel procedures that have never been done before elsewhere, on the shoulder, elbow and hand. These procedures were able to help patients who have paralyzed muscles which could happen from birth injury, or trauma or after certain surgeries like a shoulder replacement. Historically, there were not any options for these patients. However, with these procedures we were able to help many patients that were told there was no way to restore more mobility and function.
Q: What are these procedures?
A: For the joint to function it requires functional muscles around it. Some of these procedures entail taking one muscle from another area to replace the deficient or paralyzed muscle. For example, the lower trapezius can be used to reconstruct the rotator cuff, and pectoralis major muscle can be used to reconstruct a paralyzed deltoid. Most times the muscle transfer is performed locally without taking it completely out of place. Although this does not restore patients’ function and mobility completely, it improves the function enough that most patients are very happy with their outcome. For patients who have no function in their upper extremity, a little is a lot.
Q: How did you develop this surgery?
A: Shortly after I started at the Mayo Clinic, a respected surgeon approached me and asked me if there was anything I could do to help patients with a paralyzed arm to restore shoulder motion. He mentioned that nerve surgeries have been helping the elbow but not as much the shoulder. So, I went to the lab and designed the first novel muscle transfer—the lower trapezius transfer—that could help with shoulder rotation. Of course, in addition to confirming its feasibility through an atomic feasibility study, we performed extensive biomechanical studies to confirm it would biomechanically restore the function of the lost muscle.
Q: What are your goals as you start here at Mass General?
A: Very sincerely, I am here to try to help more patients, and I am really hoping that what I was able to learn and develop over the years I will keep evolving to make sure the outcomes improve based on research. Other than relieving pain and enhancing quality of life for our patients, I want to restore hope to patients who, until the advent of these procedures, believed they would no longer regain function and pain relief.
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