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Paradigm Shift

Shin, Alexander Y. MD

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Techniques in Hand & Upper Extremity Surgery: June 2020 - Volume 24 - Issue 2 - p 53-54
doi: 10.1097/BTH.0000000000000285
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A few years ago, I was at a meeting, and the term “paradigm shift” was being repeated in multiple presentations. Wondering what the origin and meaning of “paradigm shift” was, I quickly GFGI’ed (Go Freaking Google It) it. I initially thought it would take a few minutes to get a summary and etymology of the term so I could put another useless fact in my brain for future use. However, the GFGI impulse led to my ordering a book on Amazon, followed by a fundamental change in the way I understood the history of scientific discovery, as well as how I changed my views of advances in the field of hand surgery.

The term “paradigm shift” was introduced in 1962 by Kuhn,1 a physicist, historian, and philosopher who described it in his book, “Structure of Scientific Revolutions.” This textbook has become one of the most cited academic books of all time. A Google search of this textbook performed while writing this editorial returned 122 million hits.

Before Kuhn’s book, scientific discovery was based on Whig theory of the history of science. Whig theory purports that scientific advances occur because of the addition of new truths to old truths with an increasing approximation of the theories to the truths and, in the odd case, correction of past errors. Essentially, in this theory, scientific advances occur secondary to the continual advancement of the “truth,” and occur because of a greater and greater understanding of the problem.2

Kuhn challenged Whig theory because he interestingly did not see scientific advancement as a steady, forward-moving, cumulative process, but saw it as having alternating phases of “normal” and “revolutionary” periods. Kuhn defined a paradigm shift as “a fundamental change in the basic concepts and experimental practices of a scientific discipline.” A paradigm designates what the members of a specific scientific community have in common, and their “normal science” is characterized by a set of theories and ideas that give a clear set of tools to approach a problem. However, Kuhn keenly points out that, even under the best of “normal science” conditions, anomalies will occur, and the current paradigm cannot universally explain these anomalies. When enough anomalies accrue within a current paradigm, the “normal science” cannot explain the variations and is thrown into a crisis, resulting in the need for extraordinary research or innovation to address these anomalies. The aftermath of the crisis resolution or scientific revolution is that a new paradigm is born. The new paradigm gains new followers in the scientific community until it becomes the current paradigm, and the old paradigm becomes historic and irrelevant. This process is in contradistinction to Whig theory, where new truths are added to old truths to advance the field. A paradigm shift results in the abandonment of old paradigms and the adoption of new paradigms to reconcile the anomalies.

One example of a paradigm shift is the transition of Ptolemaic to Copernican cosmology. Ptolemaic cosmology theorized that the earth was stationary, and all planets and the sun revolved around the earth. When observing the movements of the planets, Copernicus noted the anomalous paths of the planets that could not be rationally reconciled. After years of astronomical observations and mathematic calculations, he proved the sun was the center, and the planets revolved around the sun and forever changed the way astronomy was studied.

Even within the field of hand surgery, we have seen and experienced paradigm shifts. In distal radius fracture care, we have shifted from the Arbeitsgemeinschaft für Osteosynthesefrage philosophy of dorsal plating for extra-articular dorsal angulated distal radius fractures to volar locked plating in the 1990s. In peripheral nerve reconstruction, we have seen the shift from nerve grafting to nerve transfers.3 In soft tissue reconstruction, we have shifted from the reconstructive ladder (moving up one rung at a time) to the reconstructive elevator, often performing more complex surgeries to obtain improved outcomes.

Interestingly, it took decades for Kuhn’s concepts to be read and become impactful. When first published in 1962, it sold 919 copies. By mid-1987, it had sold 650,000 copies and, to date, has sold >1.4 million copies and has been a driving force for understanding the history of science.2 Kuhn’s concepts spawned the term “paradigm shift,” as well as an entire way of thinking of how scientific advances occur, and have been applied to almost every aspect of life.

My quick Google search to understand the etymology of “paradigm shift” lead to an enjoyably serendipitous read of Thomas Kuhn’s “Structure of Scientific Revolutions.” It provided a way for me to understand how scientific advances occur. So, the next time there is an outcome (good or bad) that cannot be explained or does not fall into the prevailing paradigm of hand surgery (ie, an anomaly), you may be at the inception of a new paradigm shift!


1. Kuhn TS. The Structure of Scientific Revolutions. Chicago, London: University of Chicago Press; 1962.
2. Naughton J. Thomas Kuhn: the Man Who changed the Way the World Looked at Science. The Guardian, Guardian News and Media; 2012. Available at:
3. Domeshek LF, Novack CB, Patterson JMM, et al. Nerve transfers— a paradigm shift in the reconstructive ladder. Plast Reconstr Surg Glob Open. 2019;7:e2290.
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