ANCHORAGE MEDICAL GUIDE: A passion for shoulders

Dr. Kevin Paisley lists three things above all others that he loves in this world — his daughter, his Denver Broncos and the human shoulder.

“The thing that gravitated me to shoulders the most, to start with, was the complexity of the anatomy and how it’s such an amazing composition of parts that have no inherent stability whatsoever, and yet it has the most motion of any joint, and the complexity around the structures around the cuff, as well as the labrum,” Paisley said. “I also love surgeries and how you can do everything from minimally invasive small surgical procedures, all the way to full joint replacements and trauma where people have fractures. There’s not a lot of sub-specialties where you get the full gamut like that.”

A two-time Press Picks winner for Best Orthopedic Surgeon, and one of Alaska’s only shoulder fellowship-trained surgeons, Paisley has been practicing in Alaska since 2014. In 2020 he ventured out from his previous partnership to start Alaska Shoulder Orthopaedic Institute, located on the campus of Alaska Regional Hospital. Starting a new business is never easy, and during a pandemic it’s doubly hard, as Paisley found out last spring.

“Before COVID hit I had about a two-month wait list for surgery and when COVID hit that jumped up to about four months. I had something like a 70-shoulder operation wait list, which is a lot,” he said. “Most people who operate on shoulders, they might have maybe five or six that need surgery and get to them in a week or two.”

Whether because of municipal Emergency Orders halting non-emergency surgeries, or patients’ reluctance to venture out during the pandemic, putting off medical attention is potentially damaging to a patient’s ultimate recovery, Paisley said.

“If you had a delay for, say, six months, there may be some negative changes you couldn’t reverse,” Paisley said. “With rotator cuff tears and muscle and tendon ruptures the main reason delaying care is that the muscle can begin to atrophy; you could get fatty infiltration and that could lead to a form of arthritis. If it was dealt with in a more timely fashion, it would lessen the likelihood of a re-tear and potentially arthroplasty, which is the fancy way of saying joint replacement.”

Like all doctors during the pandemic, Paisley relied heavily on telemedicine.

“I believe (telemedicine) is here to stay to a certain extent, but it’s just not enough to rely on telemedicine 100% for all pre-op care,” Paisley said. “A huge component in orthopedics is to ask, ‘where does it hurt?’ You need to be able to feel and touch in the area for points of pain or dysfunction. It’s also difficult if you’re doing strength testing, test their resistance and restrain their movement and motion.”

In an effort to improve the telemedicine experience for patients and physicians alike, Paisley began developing an app to mitigate telemedicine’s shortcomings.

“The way I was thinking was potentially using an iPhone, which already has sensors built into it, and to generate software that could recognize those sensors,” Paisley said. “For example, a bear hug test. For that a patient raises their right shoulder and pins it against their chest on the left side — almost like they were reciting the Pledge of Allegiance. If someone has pain doing that then that would be a positive bear hug test. You can’t reproduce that in telemedicine, but maybe the sensor in the phone could apply pounds per square inch.”

A Florida native, Paisley did his residency at the University of Missouri where he discovered a new passion of his craft from the patient’s vantage point of an operating room.

“I was training for a triathlon and I was on a bike on a small, backcountry road and a Chevy Silverado came out of nowhere at 55 mph, hit me and smashed my arm. I had an open Olecranon fracture, a rib fracture, and thank God I was wearing my helmet,” Paisley recalled. “I was banged up pretty badly and had emergency surgery, but I healed up from that and way able to compete three months later. Unfortunately, the next year I was snowboarding and went down awkwardly. Because of the surgery I’d had, my triceps was a little weakened, so I was vulnerable and wound up partially tearing my triceps. That took surgery and screws and a year later I was snowboarding and fractured my clavicle. My third, fourth and fifth year of residency I had injuries and surgeries.”

The third injury cut short his vacation, and after undergoing surgery on a Sunday, he was back in the operating room, his arm in a sling.

“As a chief orthopedic resident, you have a junior resident or two with you, so they were able to essentially be my left hand,” he said.

After residency at Mizzou, Paisley did a year’s fellowship at the University of Texas-San Antonio, which is where he found his calling in shoulder surgery.

“I love shoulder replacement surgery and one of the reasons I spent an extra year in San Antonio was to really master the skill set for doing shoulder replacement surgery. Most of the research is shoulder replacement surgery, but I view myself more as a shoulder preservationist,” Paisley said. “If there are technologies that could potentially preserve someone’s shoulder joint I will go the extra mile in order to go on a treatment plan with a patient that will allow them to maintain their normal anatomy for as long as possible.”

Paisley’s passion for shoulder surgery has him traveling all around the country regularly on speaking and teaching engagements.

“I love teaching whether it’s shoulder anatomy, surgical procedures — it’s something I do on a national basis, whether it’s to present some of my research or different teaching techniques, it’s very rewarding for me and fulfilling,” Paisley said. “One thing that’s for certain is that I am 100 percent doing what I was meant to do — there’s not another thing in the realm of medicine I would rather be doing. This is it for me — shoulders are an absolute passion.”