Mission
Research
Educational and Clinical Experience

Mission
The mission of the Shoulder and Elbow Service is to provide the highest standard of clinical care to patients with shoulder or elbow disorders, and to play a leadership role in the committee of orthopaedic surgeons, and the teaching and discovery of new information which will benefit those who treat shoulder and elbow

disorders.

Shoulder & Elbow faculty members include:

Leesa Galatz, MD
Jay Keener, MD

Ken Yamaguchi, MD (Chief of Service)

Research
Research contributions are an important mission of the Shoulder and Elbow Service. Presently, the service is active in multiple investigative efforts. Past research publications have included studies on avascularity of the elbow and the ulnar nerve, the role of the biceps tendon in shoulder disorders, treatment of total elbow arthroplasty infections, lateral humeral motion in rotator cuff, patients with rotator cuff tears, and the role of ultrasonography in the diagnosis of rotator cuff disorders. Recent research projects include evaluation and natural history of asymptomatic rotator cuff tears, arthroscopic treatment of frozen shoulder syndrome, three dimensional reconstructions of proximal humeral, and elbow anatomy. Future, clinical, and basic research work in progress includes prospective evaluation of MRI versus ultrasound in the evaluation of both rotator cuff muscle and tendon dysfunction, a prospective study on the natural history of rotator cuff disease, recreation of proximal humeral anatomy with generation implants, retrospective analysis of timing of rotator cuff repair: the ultimate outcome and a basic science project on bone to tendon healing.

Educational and Clinical Experience
Education is among the three primary initiatives of this service which is active in education at multiple levels. At the national level, the service is active among orthopaedic surgeons by participation in multiple courses. Locally, the service is active at the postgraduate level with participation in the upper extremity fellowship as well as shoulder and elbow fellowship. 

The Shoulder and Elbow Service is clinically busy. The most commonly performed outpatient procedures included many open arthroscopic rotator cuff repair, complete arthroscopic rotator cuff repair, arthroscopic cervical conical decompressions, arthroscopic elbow procedures, and arthroscopic treatment of biceps disorders. A significant number of open primary and tertiary surgical procedures were also performed. These included AD joint arthroplasty procedures, either seen as primaries or revisions. Also among the commonly performed open procedures were revision rotator cuff surgery, elbow arthroplasty, elbow releases, and post-traumatic disorders of the shoulder and elbow including complex instability of the elbow.

The service is active in the education of residents which have multiple levels including PGY 3 Junior Resident level, PGY 4 Junior Resident level, and PGY 5 Chief Resident level. 

The junior resident PGY 4 rotates on the Shoulder and Elbow Service as its primary resident for a period of eight to ten weeks. During this time, the shoulder and elbow resident is solely responsible for clinic, inpatient, and operating room coverage of shoulder and elbow patients only, with the exception of one-half day of hand clinic coverage per week. During their time on their service, shoulder and elbow residents will scrub on all shoulder and elbow procedures and attend all shoulder and elbow office hours. In the clinic, residents and fellows have the opportunity to see private patients in the attending's office. Residents and fellows generally see all patients initially, performing a history and physical examination, the laboratory data and x-rays as pertinent and then present the patient data to the attending. The attending asks for a diagnosis and a proposed treatment plan and then evaluates the patient demonstrating key points of the history and physical examination. The entire clinical picture is then discussed with the residents or fellows and any treatment plan agreed upon. 

The PGY 3 Junior Resident and PGY 5 Chief Resident rotate on the Shoulder and Elbow Service during their rotation on the Hand/ Upper Extremity service. While on the Hand/Upper Extremity rotation, each PGY2 level resident rotates through the service twice during his/her second year of training. He/she assists with preoperative work-ups, management of in-house patients, and with surgery. 

The PGY 5 resident also rotates through the Shoulder and Elbow Service during the upper extremity rotation. The rotation lasts a period of eight to ten weeks during the Chief Resident year. The Chief Resident assumes a leadership role for residents' responsi-bilities while on the service. The Chief Resident generally spends half of his/her time in the operating room and the other half in the outpatient clinical offices. Experience for both types of clinical service is spread almost evenly among hand, wrist, shoulder and elbow disorders.

Residents and fellows in the clinic are also given the opportunity to dictate new patient visit (office) notes and referral letters for those patients they have seen. The transcribed note is then reviewed by the attending and appropriate changes are made. The attempt here is to instruct the senior residents and fellows on how to dictate office notes and provide appropriate referral letters. Residents will see approximately 80-100 patients on the Shoulder and Elbow Service on a weekly basis here. The Chief Resident and shoulder and elbow resident are often involved with initial pre-op evaluation, operative treatment, and early follow-up during their stay on the service. 

In addition to the four and one half hours of department orthopaedic conferences weekly, the fellows and residents on the Shoulder and Elbow Service participate in additional weekly, service-specific indications conferences as well as bi-monthly shoulder and elbow research meetings.