Orthopaedics is becoming increasingly specialized, and the generalist may find it hard to keep up -with developments in all the subspecialties in which he or she is expected to be knowledgeable. With the explosion of interest in shoulder surgery there has inevitably been an increase in the number of publications and books, especially large ref¬erence tomes. However, a need has remained for a book detailing clearly the technique of operative procedures required for the management of the majority of shoulder patients.

Operative Shoulder Surgery is in no way an exhaustive account of every possible shoulder operation that can be performed, but rather a description of particular procedures that are required and used on a daily basis and have been useful and successful in my personal practice.
For the general orthopaedic surgeon it may be bewildering to choose among ten different procedures to treat a particular problem, and it may be difficult to determine which among them is the most promising procedure to use. This book addresses these problems.
The chapters have been structured consistently for ease of use. The references, which have been deliberately kept to a minimum, provide a guide for further reading and indicate the original sources of the various procedures described, as well as the most influential articles on the specific topics of the chapters. This allows speedy access to the most important information. Inevitably, as this is mostly a single-authored book, individual bias has crept in, and the book reflects my particular experience and interests. This is particularly so in the chapter on shoulder replacement. As I have developed my own prosthesis, this chapter reflects my own experience, but hopefully I have mitigated this tendency toward personal bias by describing other procedures as well.
My interest in shoulder surgery was initially stimulated by Professor Lipmann Kessel during my time as Lecturer at the Royal National Orthopaedic Hospital in London. Professor Kessel was the most intellectually challenging, stimulating, and fun person to work with. Every viewpoint was challenged and all arguments had to be justified. There could have been no finer training. The other great influence on my development as a surgeon has been the doyen of shoulder surgery, Dr. Charles Neer. There is no question that his has been the most dominant influence on the development of shoulder surgery worldwide. On meeting and working with him, one can be left in no doubt as to the reasons for this. He has been unfailingly supportive and his enthusiasm remains undimmed. What started as respectful homage burgeoned into warm friendship.

After my subsequent appointment in Reading in 1979, I began my practice in general orthopaedics at a busy district general hospital. Almost immediately, however, I devel¬oped my interest in shoulder surgery. It was during this time that I developed from the orthopaedic generalist to the shoulder specialist.
Interestingly, the shoulder specialist's practice evolves through several phases. First, one sees a large number of local patients requiring common shoulder procedures. Next, one sees more interesting, clinically difficult problems as a result of having patients referred from a wider geographical area. Finally, one sees increasingly difficult cases involving patients who have undergone prior surgical procedures that have either failed for no obvious reason or that were wrongly indicated in the first place. This last group of cases, although very difficult, gives invaluable experience, especially in recognizing surgical indications and reducing complications.
I am indebted to Rolfe Birch for his contribution concerning nerve injuries. His experience is enormous and his advice to me over the years invaluable. My thanks must also go to Alex Benjamin for his chapter on Benjamin's osteotomy—who better to write this than the originator?
My admiration for Gillian Oliver and Philip Wilson, the illustrators, knows no bounds. They have managed to transform my sketches into the most magnificent line drawings. This book is very much the fruit of their endeavors in finding out exactly "what I want."
The manuscript was typed with unflagging cheerfulness by secretaries Susan Carter, Angela Elliott, and Sandra Jones. Their help and support has been greatly appreciated. Finally, I believe my family was equally relieved as myself when the completed manuscript was finally parcelled up and sent to Churchill Livingstone. I perhaps had not fully appreciated this until one of my children said, "Does that mean you can come out of your cage now?"—I hope so.

Stephen Copeland, F.R.C.S.


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