Del Mar surgeon and Padres’ head team physician recognized for his breakthrough research and inventions
He and his father, both of whom didn’t like public speaking, a definite asset for preachers, broke with family tradition by becoming physicians.
Today, his father is a retired pathologist in Del Mar and he — Dr. Heinz Hoenecke Jr., also of Del Mar — is a Scripps Clinic orthopaedic surgeon, head team physician for the San Diego Padres, team physician for the U.S. Ski Team, an avid pilot and a researcher/inventor recognized for his breakthrough research in the treatment of shoulder injuries.
Hoenecke Jr. presented his research findings gathered over the past eight years to this year’s annual national conference of the American Academy of Orthopaedic Surgeons last month in San Diego.
He unveiled his latest contribution, a new iPad app developed by his research team at Scripps to help Padres’ trainers monitor the day-to-day health of Padres’ pitchers, and revisited last year’s introduction of a modified Nintendo Wii gaming device to digitally monitor range-of-motion in pitchers’ shoulders. Both are ‘firsts’ in Major League baseball sport medicine
We interviewed the 54-year-old surgeon in his ocean-view home.
“Find a problem, fix a problem and make a difference,” Hoenecke says. “That’s what I am trying to accomplish with the research and inventions.”
Hoenecke was born in Kittery, Maine, where his father was serving in the Navy. He was the second eldest of four children. He attended high school in Phoenix, Arizona, and showed an early talent for things scientific and mechanical.
He enjoyed building things and fixing cars, mini-bikes and motorcycles.
“If I hadn’t become a doctor,” he ventured, “I would have liked to have been an engineer, but I’m not sure I’m smart enough.” Fortunately, he said, orthopaedics has a mechanical element to it. “Orthopaedics has the ability of fixing things. If somebody comes in with a problem, you can mechanically repair what’s wrong and that’s very gratifying.”
He earned his undergraduate degree from the University of Arizona, Tucson, 1979; his M.D. from the University of Arizona, 1983; his internship in general surgery (1983-84) and residency in orthopaedic surgery (1984-88), also from the University of Arizona; and his sports medicine fellowship at the Steadman/Hawkin Sports Medicine Clinic in Vail, Colorado, 1990-91.
After working in private practice for several years in San Diego, Hoenecke joined Scripps Clinic in 1997.
“A lot of my [early] shoulder research has been in … shoulder replacements, artificial shoulders,” he said. ‘That’s how I got into the research initially because I was seeing in the operating room that some of the shoulder prostheses weren’t fitting exactly right.”
At the time, most joint replacement surgeries were performed on lower, weight-bearing extremities such as knees and hips. The medical community believed the strategy for replacing lower extremity joints, using the shape and position of the bones to assess mechanics, would also apply to upper extremities such as the shoulder.
“We felt these traditional beliefs were off base,” he said, “because in the shoulder, muscles are more important than bones in transmitting mechanical forces.”
But he had to prove it.
Working with Scripps Clinic’s biomechanics orthopaedic research lab, he and his colleagues, using the same type of software used for testing stress points in bridges and buildings, developed a sophisticated computer-animated shoulder simulator that could look at cat scans in 3-D.
Hoenecke credits Dr. Darryl D’Lima, the M.D., Ph.D. director of the Scripps Clinic orthopaedic research laboratories, with being “the brain behind everything I tell you that has the word ‘computer’ in it.”
The computerized program measures how much stress is put on muscles during various motions.
“That made us realize that the muscles are the major factor for proper alignment [of a prosthesis] in the shoulder, whereas in the knees and hips, it’s the bones.”
They found that there was a problem in determining the best way to align the prosthesis in the body.
The breakthrough came when they were able prove that the traditional methods of assessing the alignment for knee and hip replacements doesn’t work the same in the shoulder.
Knowledge gained from the research has enabled Scripps to develop an expertise in positioning and refining the alignment of shoulder prostheses.
The 3-D shoulder simulator model also allows doctors to perform “virtual surgeries” on a laptop computer the night before performing a surgery.
Hoenecke performs about 60 shoulder replacements each year. Arthritis and injuries are the major causes requiring shoulder implants.
Hoenecke is now in his third season as head physician with the Padres.
In pitchers, he said, it’s very rare to see arthritis in the shoulder, he said. “They do wear out their tendons, but rarely do they develop arthritis in their shoulders.” Most of the energy for pitching a baseball comes from the hips and the shoulder acts more like a funnel, if the pitcher is doing it right.”
One of the most important things to monitor in a pitcher, he said, is his range of motion, how much rotation he has in the shoulder.
Recording each pitcher’s range of motion manually with someone moving the pitcher’s arm and another person recording the data was labor-intensive and time-consuming, Hoenecke indicated.
“So I thought there must be an easier way to collect more range of motion data more frequently so I could detect their changes over time,” he said. “So I got with my dad who lives a few blocks away and in his workshop, got some stainless steel, and built a device to measure internal and external range of motion in a shoulder.”
The device was constructed so a pitcher could rest his arm in it and rotate his arm. Hoenecke velcroed a digital woodworking inclinometer onto it to automatically measure the range of motion.
Then with the help of an engineer who enjoys baseball, he improved the device even further to make it lighter and more mobile, and then with his researchers as Scripps hooked the device up to a computer to produce a read-out on the range of motion data.
He hasn’t come up with a name for it yet, he said. “If you can think of good name for it,” he laughed, “it’ll make my life easier.”
A further development came when he and his partner, Dr. Jan Fronek, former Padres’ head physician for many years, figured out that a Nintendo Wii gaming device could be modified to make measuring range of motion even easier.
“So I paid a college kid $1,000 to write a program on this open-platform software so this little game device can send the information to my computer instead of to the Nintendo device so that we can put it up against someone’s arm and we can measure their range of motion wirelessly.”
Why is it so important to be able to measure a pitchers’ range of motion?
Because, Hoenecke said, the most common complaint with pitchers is a soreness in the shoulder. “And when it gets sore, it gets a little tight and loses a little bit of what we call internal rotation. And because of that tightness, when they go to throw, it pushes the [shoulder] ball up against the socket and pinches the rotator cup muscle.
“When they get tight, it also predicts the possibility that they can develop an injury and even end up needing surgery. So if we detect the tightness early and treat it with stretching or rest or both, then we can potentially prevent injuries.
“So we measure range of motion of all the pitchers at the beginning, middle and end of the season and in between whenever we need to.”
His other inventions include a surgical instrument that does the job of two instruments used in arthroscopic (camera-assisted) shoulder operations and a positioning pillow and technique that shortens surgery time.
Earlier this year, Hoenecke’s body of research was honored with the Thornburg Award given annually to a Scripps Clinic surgeon for significant research achievements.
And last year, he and his wife, who is an anesthesiologist, assembled a four-person team to teach orthopaedic surgeons in the northeastern African country of Eritrea how to perform arthroscopic surgery.
Name: Heinz R. Hoenecke Jr., M.D.
Distinction: Scripps Clinic orthopaedic surgeon, sports medicine specialist, and inventor Dr.Heinz Hoenecke is head team physician for the San Diego Padres and team physician for the U.S. Ski Team. He is renowned for his breakthrough research into the treatment of shoulder injuries.
Resident of: Del Mar
Born: Kittery, Maine, 54 years ago
Education: B.A. (Highest Distinction), University of Arizona, Tucson, 1979; M.D., University of Arizona, 1983; internship in general surgery (1983-84) and residency in orthopaedic surgery (1984-88), also at the University of Arizona; fellowship at the Steadman/Hawkin Sports Medicine Clinic, Vail, Colorado, 1990-91.
Family: He and his wife, anesthesiologist Dr. Barbara Strawn, have been married 24 years. They have two sons, Karl, 18, a senior at Torrey Pines High School, and Matthew, 21, who is studying business and finance at the University of Colorado, Bolder.
Pets: “Ciba,” a six-year-old Brittany Spaniel, and “Four,” a black and white cat.
Interests: Flying. Both he and his wife are instrument-rated pilots. Snow skiing and water sports.
Current reading: “Outliers: The Story of Success, an examination of the factors that contribute of high levels of success,” by Malcolm Gladwell.
Favorite film: “Across the Universe,” a 2007 musical told mainly through numerous Beatles songs.
Favorite vacation spot: Crested Butte, Colorado
Philosophy: “Find a problem, fix a problem and make a difference. That’s what I am trying to accomplish with the research and inventions.”
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