Dr. Howard Routman

10/24/2026

Some advice that applies to any surgeon, not just me.

Bring someone with you to your appointment. We give a lot of information in a short visit, and studies have shown that if a patient retains thirty percent of what was discussed, they were really paying attention.

And if you want to record the conversation on your phone, ask — I'm always happy to say yes. It means you can go back and listen again rather than trying to remember it.

If you're coming to get someone's opinion, you should be able to remember what the opinion actually was.

Board-certified orthopedic surgeon treating shoulders only, in Palm Beach County for twenty-five years.

10/23/2026

Rotator cuff surgery has a reputation. People hear it’s one of the most painful operations in orthopedics, and some put off getting help because of it.

In my experience, that’s not what my patients go through.

The reason is the pain protocol. We get ahead of the pain instead of chasing it. Medicines start before surgery, a long-acting nerve block numbs the shoulder, and the medicines stay on a schedule afterward so the pain never gets a chance to build. Most of my patients never need strong opioids like oxycodone.

That’s one of a few things I do differently. I wrote them all down in one place: the pain protocol, GPS navigation for shoulder replacement, recovery at home after a reverse replacement, and all-arthroscopic rotator cuff repair, which I’ve been doing since 2001.

Link in the comments.

10/17/2026

A piece of history most of my patients don't know.

The first reverse shoulder replacement performed in South Florida was done in July, 2003, as part of an FDA investigation before the implant was approved in the United States. I did it.

That operation has since changed shoulder surgery worldwide. It's the reason we can now help people whose rotator cuff is beyond repair — patients who twenty-five years ago would have been told there was nothing to be done.

It has been an interesting career to have started when I did.

What a reverse shoulder replacement is, why the ball and socket are swapped, and who it is for. Dr. Howard Routman, shoulder surgeon, Palm Beach FL.

10/10/2026

A young athlete dislocates a shoulder, it goes back in, and everyone moves on. That moment deserves more thought than it usually gets.

What happens next depends a great deal on what the patient does. Contact athletes typically benefit from early surgical stabilization. The less violent the sport or recreational activity, and the older the patient, theless likely it is that surgery will be needed — unless there is major structural damage in the shoulder resulting in pain or recurrent instability.

Timing matters in a specific way. Early on, the problem can often be solved with an arthroscopic, minimally invasive procedure. If the shoulder keeps dislocating, it frequently progresses from a soft tissue injury to a soft tissue and bony-deficiency problem, and that one needs a larger open incision.

And the question every athlete asks first: down time varies, but shoulder stabilization is usually a season-ending operation, not a career-ending one.

If you are dislocating in your sleep, you have probably waited too long.

A shoulder that has dislocated or keeps slipping out: why it recurs, how it is assessed, and when it needs stabilizing. Dr. Howard Routman, Palm Beach FL.

10/03/2026

There is more than one kind of shoulder replacement, and the difference matters.

In an anatomic replacement, the new parts sit the way your own shoulder is built — a ball on the arm bone, a socket on the shoulder blade. It depends on a working rotator cuff to move the arm.

In a reverse replacement, the ball and socket are swapped. The ball goes on the shoulder blade and the socket on the arm bone, so the deltoid does the lifting instead. That's the operation for a shoulder whose rotator cuff is gone or can't be repaired.

Deciding between them is most of the work of the consultation, and it turns largely on the state of your rotator cuff.

www.howardroutman.com

09/26/2026

Something patients are surprised to hear from a surgeon: not every rotator cuff tear needs to be repaired.

Plenty of people do well with physical therapy, changing what they ask the arm to do, anti-inflammatory medication, or an injection. Whether a tear needs surgery depends on the tear itself, on your age, and on what you actually need your shoulder to do.

An 82-year-old who wants to dress herself without pain and a athlete who wants to play their desired sport have completely different definitions of a good outcome. My job is to work out which one I'm looking at before deciding anything.

09/19/2026

A patient told me last month she was fine until she reached up for a bag in the overhead bin on an airplane. She thought it weighed ten pounds. It weighed thirty.

That's one of the most common ways I see a rotator cuff tear happen. Not a car accident, not a fall from a ladder — an ordinary reach with more weight on the end of it than the shoulder expected.

If you couldn't lift your arm properly afterwards, that's worth having looked at rather than waiting to see if it settles.

09/14/2026

09/12/2026

People ask why I only do shoulders.

When I was training, shoulder reconstruction was a young field. Hips and knees had been going on for a while. Arthroscopic shoulder surgery was just being born, and the people putting a camera inside a shoulder were considered a little bit cowboy.

So I grew up orthopedically at a moment when the shoulder was where the interesting problems were. Twenty-five years later that hasn't changed.

09/06/2026

Frozen shoulders are incredibly common. Mostly in peri-menopausal females, and usually treated successfully without surgery. The condition results in significant disability, but it is reliably temporary.

Adhesive capsulitis: why the shoulder stiffens, what it stops you doing, who gets it, and how it is treated. Dr. Howard Routman, Palm Beach FL.