By Elizabeth Hofheinz, MEd, MPH
Orthopedics This Week

October 28, 2008

When a "Bull" falls on his wrist or a "Sox" slides into home on his elbow, Dr. Mark Cohen, Professor and Director of Hand and Elbow Surgery at Rush University Medical Center, is there to pick up the pieces. But Dr. Cohen, team physician and consultant for the Chicago White Sox and the Chicago Bulls, is loathe for anyone to think there is high glamour in this work. More on that later.

Born and raised in suburban Chicago, Dr. Cohen was surrounded by the love and guidance of his parents and two older sisters. "My middle sister was previously a school teacher. My older sister, now a college professor in psychology, stressed the importance of studying and pushed me to excel academically. I was no math or science ace, but I did fairly well in those subjects. When I entered college I had no interest in medicine and actually did poorly in my first classes...with the exception of biology. My college roommate wanted to be a doctor and I wanted to pursue engineering, law, or political science. We both realized that neither of us were star students in our chosen fields, however, and he ended up heading towards law, while I signed on as a biology major. I figured that there is enough diversity in medicine such that I could set a career path without too much difficulty. I applied to 20 medical schools with no idea where I would end up."

His time digging into the details of cell theory and genetics paid off. Harvard Medical School admitted Mark Cohen in 1982. He would graduate four years later magna cum laude. "Dr. Richard Smith, a leading hand surgeon at the time, was responsible for my initial interest in orthopedics. When I attended a lecture he gave, I was intrigued and then followed up with a month on his service. He was the most dynamic, magnetic person imaginable, and he could lecture for an hour without any pictures or slides."

Dr. Cohen continues, "While at Harvard I met an orthopedic surgeon on sabbatical from the University of California San Diego (UCSD)-Dr. Richard Gelberman, a full professor and hand surgeon. He and I got along well and he asked me to consider coming to UCSD for a residency under his tutelage. I took him up on his offer and had an incredible residency experience. Dr. Gelberman taught me the importance of research and academic study. My residency hospital was a level 1 trauma center, where we often worked all night and saw an incredible array of medical situations."

In 1992 he would undertake a year of honing his hand skills and learning to manipulate tiny needles with the help of a microscope. Dr. Cohen: "I undertook a hand, upper extremity and microvascular fellowship at the Indiana Hand Center, the largest hand center in the country. They had an unbelievable collection of brilliant orthopedic surgeons, with every single person I met being smarter than the last. I was introduced rather quickly to microvascular surgery, as during my first week there someone cut his hand off. I was in awe of my instructors, as I had no indication of how to treat this. It took two teams 16 hours to reattach the patient's hand. Fortunately for him, it had been a sharp cut, which, unlike irregular cuts, most often means that the hand can be reattached."

From 1993 until today Dr. Cohen has served patients and refined his skills at Rush University Medical Center. He is brave enough to take on a recalcitrant part of the anatomy that is often unpopular with orthopedic surgeons...the elbow. "Not many surgeons like to work on the elbow because it is intolerant of trauma and is the hardest injury to recover from. This may be due to the anatomy, which is composed of three joints. While other joints have one articulation, the elbow has three within its capsule. Or it may be because it is the tightest fitting joint in the body. Even small injuries to the elbow can lead to tremendous morbidity. But we don't think about the elbow much...until there is a problem."

And when there is, the minutiae of life will suddenly appear front and center of one's existence. Dr. Cohen: "The elbow has a tremendous propensity for stiffness and loss of mobility and function. If you have a stiff shoulder you can still use your arm, whereas if you have a stiff elbow you can't bring your hand to your face to eat, and you can't perform regular tasks associated with hygiene. I find it very fulfilling to take someone's problem elbow and free it up via an elbow release."

Regarding his other specialties, Dr. Cohen notes, "Wrist fractures are the most common fractures in the body. Why? Because so many people fall, and when they do, they try to catch themselves with their outstretched hands. Sometimes in the winter months we see three or four fractures in the morning after a snowfall. Fortunately, there have been a lot of advances in the technology and now many wrist fractures can be treated safely and easily, with the patient returning to work fairly quickly. One of these new technologies is a plate and screw system for the wrist where the surgeon can lock screws into the plate. As such, there is no more friction between the bone and plate. It has become so popular that there are now approximately 20 different companies manufacturing it. As for the hand, form and function are linked in this part of the body as they are nowhere else. Most people don't like to operate in the vicinity of the hand because of all the blood vessels and nerves. I find it to be a fascinating area."

When asked what societal trends have resulted in unusual hand, wrist, or elbow trauma, Dr. Cohen mentions something found in thousands of American homes. "There are a lot of minor overuse injuries occurring from the new rage in video games, the Wii. Users are swinging tennis rackets which are projected on TV; people are overswinging and creating excessive force on their muscles and joints. And it's not just in the under-20 crowd...a number of middle-aged people are also experiencing the highs and lows of the Wii."

Everyone has something that puts a spring in their morning step. For Dr. Cohen, it's the thought he'll have another day to teach eager, bright trainees. "I am so proud that on several occasions I have received the University Excellence in Teaching Award given by residents and medical students. Foremost in my mind when I speak to them is that I want them to choose a field they will find interesting and personally exciting. There is enough variety in medicine that they should be able to find something that feels rewarding and fun. And when they leave our program, I would like them to remember that preparation is key to having a successful surgical outcome."

As for the less-than-glamorous world of treating professional athletes, Dr. Cohen says, "While this work is interesting, it is also very time-consuming. My colleagues and I split up the work, with each of us sharing time to cover the entire baseball Spring training period in Arizona. In Chicago, we cover all of the games, arriving two hours before and staying one hour after each game to ensure that the players are attended to. At times there is the extra pressure of treating a high-profile person. Recently, we rearranged our schedule because one of the best players on the White Sox team, Carlos Quentin, broke his wrist. He had really been on a roll, taking the lead in home runs and being recognized as an MVP candidate. We are hoping to get him back on the field in time for this year's play-offs."

A private person who enjoys family time, Dr. Cohen notes, "Our family has changed recently, as my wife and I have added two loveable, time-consuming twins to our family. At present I no longer have time for my hobbies of tennis, cycling and in-line skating. Perhaps later I can do these things with the twins."

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