After more than two decades as a yacht broker in South Florida, 68-year-old retiree Karl Saulpaw could see nothing but smooth sailing ahead. “Flipping houses” in a booming real estate market was a perfect second career and hobby for a trim carpenter, work he continued after moving back to his native Tennessee.

But as the boom turned to bust, so did his right shoulder – thanks to an unintended “flip” of his own, falling down steps into the basement of his Knoxville home. Crash landing on his elbow, the impact ripped two tendons away from his rotator cuff and split the remaining two.

 “Massive rotator cuff tear” was what Parkwest Medical Center orthopedic surgeon Paul Brady, MD, called it, explaining that two tendons and muscles that attached Saulpaw’s arm to his shoulder were damaged beyond repair.  

It’s the kind of injury that is technically challenging even for the most skilled orthopedic surgeons. Fortunately for Saulpaw, Dr. Brady, a fellowship-trained, board certified surgeon who has authored orthopedic textbooks, had the solution: a minimally invasive arthroscopic procedure known as superior capsular reconstruction (SCR). The superior capsule is the upper lining of the shoulder that holds the arm in the shoulder joint.

“It’s kind of like building a ship inside a bottle,” explained Dr. Brady. “You’ve got to work through a small opening and do a lot of work on the inside. Fortunately, we have the technology – and I definitely credit Parkwest and Covenant Health for giving us the technology to do this.”

The procedure involves incisions so small that Dr. Brady refers to them as little more than “nicks in the skin” that don’t even require stitches. The patient’s arm is then filled with a saline solution which allows the surgeon to insert a small camera, called an arthroscope, into the shoulder joint. The camera images guide the surgeon as he works with miniature surgical instruments to reconstruct the ligaments from cadaver tissue, holding the humerus (long bone that connects the scapula to the lower arm bones) in place.

“It took me about six months to get to Dr. Brady…I didn’t want to waste his time. I was just procrastinating. I was hoping something would happen and it would be better, but that’s a pipe dream. When you’ve got something like that, you need to do something with it. But I think it just got worse because I kept trying to use it and the next thing I knew that I couldn’t take it anymore.”

Today, however, Saulpaw’s shoulder has no pain and full range of motion. He’s back to hammering, using a 10-foot gas-powered pole saw, mowing the lawn, pulling the rope starter on his chainsaw, painting, doing trim work and anything else he wants.

“I would recommend him to anybody who had any question about anything. That’s an out-and-out advertisement but he did a great job for me. The only person I’d see for shoulder problems would be Dr. Brady. I just couldn’t imagine seeing anybody else doing it better. I was impressed, and I still am impressed.”