University of Pennsylvania Department of Orthopaedic Surgery

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University of PennsylvaniaDepartment of
Orthopaedic Surgery
Shoulder and Elbow Service
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UPHS Hospitals

• Presbyterian Hospital
• Hospital of the University of Pennsylvania
• Pennsylvania Hospital
• Veterans Affairs Hospital
• Assoc. with Childrens Hospital of Philadelphia

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Presbyterian Medical Center

• www.pennhealth.com/presby

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Tradition of Orthopaedic Excellence

• 1889 First free-standing Department of
  Orthopaedic Surgery in the US
  
• 273 trained residents
• 48 residents with academic rank
• 8 chairmen

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Orthopaedic Services
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University of Pennsylvania Residency Program

• 42 Residents
• 8 per year
• 2 in McKay Labs
• 24 Full-time clinical faculty
• Five hospitals
• University of Pennsylvania (HUP)
• Presbyterian (Presby)
• Childrens Hospital of Philadelphia (CHOP)
• Veteran's Affairs (VA)
• Pennsylvania Hospital (PAH)

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Residents Medical Schools

• Penn
• U of Virginia
• Georgetown
• Utah
• U of Florida
• Wayne State
• Northwestern
• Pitt
• Harvard
• Medical College of Ohio
• SUNY Brooklyn
• Albany
• Boston U

• Finch U of Health Sci
• UT-Southwestern
• LSU
• Yale
• Temple
• UMDNJ
• Vanderbilt
• Drexel
• Jefferson
• Mt. Sinai
• USC
• Cornell

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Shoulder and Elbow Service

• 27 trained fellows to present date

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Shoulder and Elbow Faculty

• Joseph Iannotti MD, PhD
• Past Director

• Dr. Gerald Williams MD
• Current Director

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Joseph Iannotti, MD, PhD

• Current chairman of the Orthopaedic Department at
  the Cleveland Clinic Foundation

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Shoulder and Elbow Faculty

• Gerald Williams, MD

• Matthew Ramsey, MD

• David Glaser, MD

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Shoulder and Elbow Faculty

• Gerald Williams
• Director of Shoulder and Elbow Service
• AAOS Board of Directors (02-04)
• Matthew Ramsey, MD
• Director of Elbow service
• Only fellowship trained elbow program associated
  with a fellowship trained shoulder program
  
• David Glaser, MD
• Clinician Scientist
• Louis Soslowsky, PhD
• Director of McKay Research Laboratory

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Upper Extremity Service

• Dr. Williams
• Shoulder
• Dr. Ramsey
• Shoulder and Elbow
• Dr. Glaser
• Shoulder and Elbow
• Dr. Bozentka
• Hand and Elbow
• Dr. Beredjiklian
• Hand, Elbow
• Dr. Steinberg
• Hand and Elbow

• Dr. Stein
• PMR
• Dr. Chou
• PMR
• Dr. Sennnett
• Sports Medicine
• Dr. Hoffman
• Sports Medicine
• Dr. Webner
• Family Med, Sports Med, Shoulder
• Dr. Gentchos
• General

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History of the Shoulder and Elbow Service

• 1986 Shoulder and Elbow Service started by
• Joseph Ianotti, MD, PhD
• 1987 Shoulder and Elbow Fellowship program
• started by Joseph Ianotti, MD, PhD
• 1991 Gerald Williams, MD joined the service
• Completed fellowship with Charles Rockwood, MD

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History of the Shoulder and Elbow Service

• 1991 Gerald Williams, MD joined the service
• Completed fellowship with Charles Rockwood, MD
• 1998 Louis Soslowsky, PhD
• started as the director of the McKay Basic
  Science Research Laboratory
  
• 1998 Matthew Ramsey, MD joined service
• Completed shoulder and elbow fellowship at Penn
• Completed elbow training at the Mayo Clinic

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History of the Shoulder and Elbow Service

• 2001 David Glaser, MD joined service
• Completed shoulder and elbow fellowship at Penn
• 2003 Kenneth Rogers, PhD, ATC joined service
• Director of clinical research and outcomes

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Awards to Shoulder and Elbow Faculty

• Neer Award 1996 (Williams and Iannotti) and
  2001 (Williams and Ramsey)
  
• ASES European Exchange Fellow
• ORS New Investigator
• OREF Clinician-Scientist Award
• North American Traveling Fellowship

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Grants

• NIH Grants
• Aircast
• OREF
• Whitaker Foundation
• Selective Genetics
• Cali Foundation
• McCabe Foundation

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Upper Extremity Service

• Integration of Services / Departments
• Orthopaedics
• Shoulder and Elbow
• Hand
• Sports Medicine
• Physical Medicine and Rehabilitation
• Electrodiagnostic
• Physical Therapy
• Occupational Therapy
• Family Medicine

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Upper Extremity Service

• Vision
• Prevention
• Diagnosis
• Treatment
• Rehabilitation
• Outcomes

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Shoulder and ElbowResearch Staff

• Clinical Research
• Dr. Kenneth Rogers, PhD, ATC
• Alexis Greenhut, BS
• Basic Science
• Louis Soslowsky, PhD
• Director of McKay Orthopaedic Laboratory
• Vice Chair of Research Orthopaedic Department

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Current Research Projects

• Nerve conduction monitoring during elbow
  contracture release surgery
  
• Nerve conduction monitoring during shoulder
  replacement surgery
  
• Cellular Examination of Healing Musculoskeletal
  Tissue Following BMT
  
• Humeral fracture nonunion - biomechanics study
• Functional Outcome Following the Repair of the
  Distal Biceps Tendon
  
• Frozen Shoulder - efficacy of treatment
  injection and therapy with injection
  

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Current Research Projects

• Proximal Humerus 4 part valgus fractures
• Proximal Humerus Percutaneous Pinning
• Scapula Fracture - Operative and Non-operative
  treatment
  
• The Tension Required at Repair To Re-Appose the
  Supraspinatus Tendon to Bone Rapidly Increases
  Following Injury
  
• Post-Operative Immobilization Improves Tendon to
  Bone Healing of the Rotator Cuff
  

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Clinical and Basic Science Research Efforts

• Coordinated with the Physical Medicine and
  Rehabilitation department, Family Medicine
  department, Hand, and Sports Medicine services of
  the Orthopaedic department
• McKay Orthopaedic Lab
• Musculoskeletal Research Core
• Radiology Department
• Genomics Department
• Biomechanics Department
• Engineering Department

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Publication Record

• Journal of Bone and Joint Service
• American Journal of Sports Medicine
• American Society of Shoulder and Elbow Surgery
• Clinical Orthopaedics and Related Research
• Sports Medicine and Arthroscopic Review
• Physical Therapy
• Journal of Orthopaedic and Sports Physical Therapy

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Publication Record

• Books
• Chapters
• Abstracts and Posters
• AAOS
• AANA
• AAOSM
• ICSS
• ASES
• APTA
• NATA

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Area of Research

• Basic Science
• Soft Tissue Healing
• Fracture Healing
• Fracture Treatment
• Clinical Science
• Surgical Clinical Outcomes
• Treatment Clinical Outcomes
• Evidence Based Medicine

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Faculty Presentations

• International
• International Congress for Shoulder Surgery
• National
• AAOS
• National Meeting and Instructional
• Course Lectures
• ASES
• AANA
• Local
• Pennsylvania Orthopaedic Society
• Philadelphia Orthopaedic Society

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Faculty Service

• National
• AAOS
• ASES
• Local
• Pennsylvania Orthopaedic Society
• Philadelphia Orthopaedic Society

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Shoulder and Elbow Fellowship Application
Process

• Between 15 25 applicants per year
• 10 - 20 applicants interviewed
• 1-2 sessions
• 3 attendings, 2 fellows, 1 resident
• 4 rooms
• Positions available
• Two 1-year slots

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Fellowship Paperwork

• Match Program
• Cover Letter
• ASES Shoulder Fellowship Application
• Transcripts
• Curriculum Vita
• 3 Letters of Recommendation
• Scores
• Jpeg photo at interview
• All information is sent to Barb OConnor

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Fellowship Offer

• ASES Fellowship Match Program

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Fellowship Acceptance

• Formal letter of agreement
• Provided with contact names to clear hurdles
• UPHS system requirements
• State requirements

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Shoulder and Elbow FellowResidency Programs

• Mount Sinai
• Royal College of Surgeons
• Rush - Presbyterian St. Lukes
• Summa Health System
• Thomas Jefferson
• Univ. of Miami
• University of Colorado
• Univ. of Pennsylvania
• Washington University

• Akron City Hospital
• Brown University
• Carolinas Medical Center
• Case Western Reserve
• Cleveland Clinic Foundation
• George Washington
• Kingston General
• Long Island Jewish
• Loyola University

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Shoulder and Elbow Fellowship Placement

• Academic Institutions
• Community Based Hospitals
• Private Practice

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Shoulder and Elbow Post Fellowship Placement

• Las Vegas Orthopaedics
• Loyola University Medical Center
• Mount Sinai Hospital
• St. Anthonys, CO
• St. Marys, TN
• Stevens Orthopedic Group, WA
• University of Arkansas
• University of Penn
• Washington University

• Aurora Health Care, CO
• Blue Ridge Orthopaedics, VA
• Carolinas Medical Center
• Coral Gables Hospital, FL
• Fallon Community Health, MA
• Good Samaritan, PA
• Grand River Med. Ctr, CO
• Kelsey Seybold Clinic, TX
• Larkin Community, FL

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Fellowship Benefits

• Health
• Dental
• Disability
• Malpractice
• On-call meals
• Parking on-site
• White coats
• UPHS E-mail
• Access to Penn Libraries

• Vacations
• three non-consecutive weeks (21 days)
• Salary
• 45,000
• Minor adjustments for inflation

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Conferences

• 1 meeting per year approved by Fellowship
  Director
  

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The Alumni Retreat

• Combined University of Pennsylvania and Cleveland
  Clinic Fellowship Programs
  

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Fellowship Rotation

• Three month rotation per surgeon
• Williams
• Ramsey
• Glaser surgery coverage with increase in
• clinical office demand
• Three office locations
• Presbyterian 1x per week per surgeon
• Cherry Hill 2 x per month with Dr. Ramsey
• Radnor 1x week with Dr. Williams
• 2 x per month with Dr. Ramsey

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Resident PGY 2 Coverage

• Upper extremity
• 6 weeks _at_ Presby
• Drs. Williams, Ramsey Glaser

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Resident PGY 5 Coverage

• Upper Extremity
• 6 weeks _at_ Presby
• Drs. Williams, Ramsey, Glaser

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Call Schedule

• No call schedule

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Surgery Coverage

• Dr. Glaser 1 day per week
• Dr. Ramsey 2 days per week
• Dr. Williams 2 days per week

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Source Case Volume

• Level I Trauma Center
• Tertiary referral center
• Wide range of cases
• Total cases ? 1200 / year
• 65 - Shoulder
• 35 - Elbow

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Operative Cases

• Shoulder
• Rotator Cuff
• 150 per fellow per year
• 80 Arthroscopic
• 20 Open
• Arthroplasty
• 100 per fellow per year
• Instability
• 70 per fellow per year
• 80 Arthroscopic
• 20 Open
• Fractures
• 30 per fellow per year
• Open and percutaneous
• Tendon Transfers
• 5-10 per fellow per year

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Operative Cases

• Elbow
• Ligament Reconstruction
• 20 per fellow per year
• Arthroplasty
• 10 per fellow per year
• Fractures
• 50 per fellow per year
• Open
• Stiffness/Contracture
• 30 per fellow per year
• 50 Arthroscopic
• 50 Open

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Weekly Didactic Conferences

• Upper Extremity Conference
• Wednesday, 530 PM at Presby
• One to Two presentations per year
• Attendings, Fellows, Residents, Allied Health
  staff, and other staff are present

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Monthly Research Conferences

• Meet every Second Tuesday of every month
• New research project proposal
• Review research projects
• Discuss research issues

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Grand Rounds

• Thursday, 730 AM at HUP
• Speakers
• Dr. Rockwood
• Dr. Boden
• Dr. Mankin
• Dr. Beatty
• Dr. Morrey
• UPHS Faculty
• Fellows invited to dinner with faculty and Grand
  Rounds speaker

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Grand Rounds

• Ernest Gentchos Lecture
• Prominent speaker on Shoulder and Elbow topic

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Physical Therapy

• Outpatient
• Located on the same floor as the clinic offices
• Home program
• Formalized Program
• Research Collaboration
• Works closely with physician during clinic hours

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Occupational Therapy

• Outpatient
• Located on the same floor as clinic offices
• Home program
• Formalized Program
• Research Collaboration
• Works closely with physician during clinic hours

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Physician Assistant

• One PA for each Dr. Williams and Dr. Ramsey
• Work closely with the fellow during rotations
  with each physician
  
• Patient management
• Clinical management
• Post-op management
• Calls from patient

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McKay Orthopaedic Labs

• 3rd largest NIH funded Orthopaedic Research Lab
• Annual budget 4 million
• 15 out of 15 abstracts accepted to 2003 ORS
  meeting
  
• Over 50 staff and trainees

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McKay Orthopaedic Labs

• Faculty
• Dr. Soslowsky, Director
• Dr. Kaplan, Director
• Dr. Elliot
• Dr. Shore
• Dr. Clark
• Dr. Nicoll
• Dr. Friedenberg
• Dr. Brighton
• Dr. Glaser

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McKay Orthopaedic Labs

• Research areas
• Biomechanics
• Biomaterials
• Tissue engineering
• Tissue culture
• Biochemistry
• Cell Molecular Bio
• Histology
• Microscopy
• Animal Studies

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McKay Orthopaedic Labs

• Current projects
• Rotator Cuff Injury Model
• SIS
• Overuse
• BMP signaling
• FOP
• Tendon Healing
• Genetic mice
• Fetal tissue
• Degenerative Disc Disease
• http//www.uphs.upenn.edu/orl/

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McKay Orthopaedic Labs

• Clinical faculty involvement
• Two orthopaedic surgery residents / year enter
  lab after PGY-2
  
• Basic science research opportunities available

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Philadelphia Ortho Society

• Excellent Speakers (2002-2003)
• Dr. Poka
• Dr. Salvati
• Dr. Iannotti
• Dr. Torg
• Dr. Goldberg
• Resident Bowl
• Meet attendings and residents from the area in a
  social setting
  
• Free for residents

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UPOJ

• University of Pennsylvania Orthopaedic Journal
• Entirely resident organized
• Peer-reviewed
• Distribution of 1500
• Penn Tradition

http//www.uphs.upenn.edu/ortho/oj/
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Fitness (clear your head)

• Gyms
• Penn Campus
• Gimbel
• Hutchinson
• Sweat
• Worlds
• 12th Street

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Philadelphia
http//www.gophila.com
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Philadelphia History

• Independence Hall
• Liberty Bell
• Carpenters Hall
• 1st Federal Reserve Bank
• Betsy Ross House
• Reading Terminal
• Italian Market
• Constitution Center
• Home of the Cheesesteak

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Philadelphia Neighborhoods

• Rittenhouse Square
• Manayunk
• Society Hill
• China Town
• Center City
• University City
• Washington Square
• South Philly
• The Northeast

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Philadelphia Museums

• Rodin Museum
• Philadelphia Museum of Art
• Franklin Institute
• Academy of Natural Sciences
• Mütter Museum

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Philadelphia Sports
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Philadelphia Sights Sounds
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Additional Information

• Barbara OConnor
• 215.349.8851
• penn.ortho.shoulderelbow_at_uphs.upenn.edu
• Department of Orthopaedic Surgery
• Presbyterian Medical Center UPHS
• 39th and Market Streets
• 1 Cupp Pavilion
• Philadelphia, PA 19104

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University of PennsylvaniaDepartment of
Orthopaedic Surgery Shoulder and Elbow Service
Training Tomorrows Leaders Today
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