University of Pennsylvania Department of Orthopaedic Surgery

1. University of PennsylvaniaDepartment of Orthopaedic Surgery Shoulder and Elbow Service University of Pennsylvania Department of Orthopaedic Surgery

2. UPHS Hospitals • Presbyterian Hospital • Hospital of the University of Pennsylvania • Pennsylvania Hospital • Veteran’s Affairs Hospital • Assoc. with Children’s Hospital of Philadelphia University of Pennsylvania Department of Orthopaedic Surgery

3. Presbyterian Medical Center www.pennhealth.com/presby University of Pennsylvania Department of Orthopaedic Surgery

4. 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 University of Pennsylvania Department of Orthopaedic Surgery

5. Orthopaedic Services University of Pennsylvania Department of Orthopaedic Surgery

6. 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) • Children’s Hospital of Philadelphia (CHOP) • Veteran's Affairs (VA) • Pennsylvania Hospital (PAH) University of Pennsylvania Department of Orthopaedic Surgery

7. 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 Residents’ Medical Schools University of Pennsylvania Department of Orthopaedic Surgery

8. Shoulder and Elbow Service 27 trained fellows to present date University of Pennsylvania Department of Orthopaedic Surgery

9. Shoulder and Elbow Faculty • Joseph Iannotti MD, PhD • Past Director • Dr. GeraldWilliams MD • Current Director University of Pennsylvania Department of Orthopaedic Surgery

10. Joseph Iannotti, MD, PhD • Current chairman of the Orthopaedic Department at the Cleveland Clinic Foundation University of Pennsylvania Department of Orthopaedic Surgery

11. Shoulder and Elbow Faculty • Gerald Williams, MD • Matthew Ramsey, MD • David Glaser, MD University of Pennsylvania Department of Orthopaedic Surgery

12. 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 University of Pennsylvania Department of Orthopaedic Surgery

13. 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 PM&R Dr. Chou PM&R Dr. Sennnett Sports Medicine Dr. Hoffman Sports Medicine Dr. Webner Family Med, Sports Med, Shoulder Dr. Gentchos General Upper Extremity Service University of Pennsylvania Department of Orthopaedic Surgery

14. 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 University of Pennsylvania Department of Orthopaedic Surgery

15. 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 University of Pennsylvania Department of Orthopaedic Surgery

16. 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 University of Pennsylvania Department of Orthopaedic Surgery

17. 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 University of Pennsylvania Department of Orthopaedic Surgery

18. Grants • NIH Grants • Aircast • OREF • Whitaker Foundation • Selective Genetics • Cali Foundation • McCabe Foundation University of Pennsylvania Department of Orthopaedic Surgery

19. 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 University of Pennsylvania Department of Orthopaedic Surgery

20. Upper Extremity Service Vision • Prevention • Diagnosis • Treatment • Rehabilitation • Outcomes University of Pennsylvania Department of Orthopaedic Surgery

21. 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 University of Pennsylvania Department of Orthopaedic Surgery

22. 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 University of Pennsylvania Department of Orthopaedic Surgery

23. 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 University of Pennsylvania Department of Orthopaedic Surgery

24. 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 University of Pennsylvania Department of Orthopaedic Surgery

25. 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 University of Pennsylvania Department of Orthopaedic Surgery

26. Publication Record • Books • Chapters • Abstracts and Posters • AAOS • AANA • AAOSM • ICSS • ASES • APTA • NATA University of Pennsylvania Department of Orthopaedic Surgery

27. Area of Research • Basic Science • Soft Tissue Healing • Fracture Healing • Fracture Treatment • Clinical Science • Surgical Clinical Outcomes • Treatment Clinical Outcomes • Evidence Based Medicine University of Pennsylvania Department of Orthopaedic Surgery

28. 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 University of Pennsylvania Department of Orthopaedic Surgery

29. Faculty Service • National • AAOS • ASES • Local • Pennsylvania Orthopaedic Society • Philadelphia Orthopaedic Society University of Pennsylvania Department of Orthopaedic Surgery

30. 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 University of Pennsylvania Department of Orthopaedic Surgery

31. 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 O’Connor University of Pennsylvania Department of Orthopaedic Surgery

32. Fellowship Offer • ASES Fellowship Match Program University of Pennsylvania Department of Orthopaedic Surgery

33. Fellowship Acceptance • Formal letter of agreement • Provided with contact names to clear hurdles • UPHS system requirements • State requirements University of Pennsylvania Department of Orthopaedic Surgery

34. Akron City Hospital Brown University Carolinas Medical Center Case Western Reserve Cleveland Clinic Foundation George Washington Kingston General Long Island Jewish Loyola University Mount Sinai Royal College of Surgeons Rush - Presbyterian – St. Luke’s Summa Health System Thomas Jefferson Univ. of Miami University of Colorado Univ. of Pennsylvania Washington University Shoulder and Elbow FellowResidency Programs University of Pennsylvania Department of Orthopaedic Surgery

35. Shoulder and Elbow Fellowship Placement • Academic Institutions • Community Based Hospitals • Private Practice University of Pennsylvania Department of Orthopaedic Surgery

36. 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 Las Vegas Orthopaedics Loyola University Medical Center Mount Sinai Hospital St. Anthony’s, CO St. Mary’s, TN Stevens Orthopedic Group, WA University of Arkansas University of Penn Washington University Shoulder and Elbow Post Fellowship Placement University of Pennsylvania Department of Orthopaedic Surgery

37. 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 Fellowship Benefits University of Pennsylvania Department of Orthopaedic Surgery

38. Conferences • 1 meeting per year approved by Fellowship Director University of Pennsylvania Department of Orthopaedic Surgery

39. The Alumni Retreat • Combined University of Pennsylvania and Cleveland Clinic Fellowship Programs University of Pennsylvania Department of Orthopaedic Surgery

40. 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 Fellowship Rotation University of Pennsylvania Department of Orthopaedic Surgery

41. Upper extremity 6 weeks @ Presby Drs. Williams, Ramsey & Glaser Resident PGY – 2 Coverage University of Pennsylvania Department of Orthopaedic Surgery

42. Upper Extremity 6 weeks @ Presby Drs. Williams, Ramsey, & Glaser Resident PGY – 5 Coverage University of Pennsylvania Department of Orthopaedic Surgery

43. Call Schedule • No call schedule University of Pennsylvania Department of Orthopaedic Surgery

44. Dr. Glaser – 1 day per week Dr. Ramsey – 2 days per week Dr. Williams – 2 days per week Surgery Coverage University of Pennsylvania Department of Orthopaedic Surgery

45. Source Case Volume • Level I Trauma Center • Tertiary referral center • Wide range of cases • Total cases  1200 / year • 65 % - Shoulder • 35 % - Elbow University of Pennsylvania Department of Orthopaedic Surgery

46. 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 University of Pennsylvania Department of Orthopaedic Surgery

47. 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 University of Pennsylvania Department of Orthopaedic Surgery

48. Weekly Didactic Conferences • Upper Extremity Conference • Wednesday, 5:30 PM at Presby • One to Two presentations per year • Attendings, Fellows, Residents, Allied Health staff, and other staff are present University of Pennsylvania Department of Orthopaedic Surgery

49. Monthly Research Conferences • Meet every Second Tuesday of every month • New research project proposal • Review research projects • Discuss research issues University of Pennsylvania Department of Orthopaedic Surgery

50. Grand Rounds • Thursday, 7:30 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 University of Pennsylvania Department of Orthopaedic Surgery