Shoulder Service

The Shoulder Service, under the direction of Dr. Jon J.P. Warner, has continued to advance care through clinical quality initiatives, research and teaching. Last year, Dr. Warner served as the 28th President of the American Shoulder and Elbow Society (www.ases-assn.org) and the 2nd President of the New England Shoulder and Elbow Society (www.neses.com), of which he was the founder. These are the premier national and regional organizations for treatment of shoulder problems. Under Dr. Warner’s leadership, both organizations have moved to value-based initiatives for care of the shoulder.

At the MGH, much of Dr. Warner’s strategic agenda has focused on patient-centric care delivery initiatives. This includes web-based initiatives in shared decision-making to assist patients in selecting the best treatment option for their problem. A value-based shoulder care initiative has been ongoing with the Harvard Business School and Michael Porter’s group. This has included “Time-Based Cost Accounting” (TDABC) for shoulder care, and a planned pilot of bundled payments for rotator cuff repair with a local insurer.

Central to the value-based initiatives in shoulder care is outcome measurement and transparent reporting of patient satisfaction, readmission rates, and infection rates, which are posted on the website (www.bosshin.com). This year Dr. Warner and his colleague Dr. Laurence Higgins (at BWH) began implementing a novel Internet-based outcomes tool called the Surgical Outcomes Study (S.O.S.). This promises to allow us the ability to analyze each patient’s recovery curve compared with his/her peers for the same surgical procedure. This pilot database study will be offered to all other shoulder care providers once it has been trialed for several years.

We are very pleased to welcome Dr. Matt Provencher to the Shoulder Service. His main responsibility at MGH will be as the Chief of the Sports Medicine Service, but he will also be the Director of a combined Sports Medicine and Shoulder Laboratory.

Dr. Luke Oh continues to serve a dual role on the Shoulder (and Elbow) Service and the Sports Medicine Service. His clinical practice has grown and he has started a monthly Elbow Indications Conference for Sports and Shoulder fellows. A collaborative conference with the Upper Extremity Service will begin this year as well.

Dr. Thomas Holovacs continues to manage a busy practice and teach the residents and fellows. He has initiated a project in the Technology and Implementation Research Center to examine focal cartilage defects in the glenoid.

The Shoulder Biomechanics Lab, under the leadership of Dr. Daniel Massimini, completed several innovate dynamic anatomy studies. The first of these, which was published in the Journal of Shoulder and Elbow Surgery, analyzed the dynamic anatomy of the suprascapular nerve and provided insight into neurogenic pain with rotator cuff tendon tears. The second study analyzed the dynamic motion of the long thoracic nerve and has provided insight into the etiology of scapular winging. Daniel continues to work toward completion of his PhD this fall. His studies of 3-Dimensional Kinematics of the normal and abnormal shoulder have given unique insight into the dynamic forces across the glenohumeral joint.

This year four fellows graduated from our postgraduate program. Josef Eichinger, M.D., took a position as Chief of Shoulder and Elbow Service at the Army Medical Center in Tacoma, Washington; Timothy Hartshorn, M.D., took a position at Ventura County Medical Center; Xinning (Tiger) Li, M.D., took a position as an Assistant Professor at Boston University School of Medicine and Team Physician; and, Mena Mesiha, M.D., is in private practice in Fall River, MA.

This year’s fellowship match selected four fellows from a competitive applicant pool of over 40 individuals. The fellowship program continues to be one of the most sought-after in the United States.

In conclusion, we have great expectations of continued growth and contribution, especially since the arrival of Dr. Matt Provencher. This promises to bring the Sports Medicine and Shoulder Services closer, which will certainly lead to innovative collaboration, higher quality research and improved patient care.