Penn Orthopaedics

Penn Orthopaedics

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Friday, March 4, 2016

4 Ways Workout Apps and Wearables Can Make You Fit

You know the saying “knowledge is power," but it turns out that knowledge can also lead to fitness. That’s the idea behind the surge in workout apps and wearables that promise to help people stay fit by sharing real-time data about their activity levels, calories, heart rate—pretty much anything.

According to a February 2016 report from information technology research firm Gartner, Inc. 232 million wearable devices—watches, chest straps, and wristbands—were purchased worldwide in 2015. That number is expected to jump to about 275 million by the end of 2016. A similar surge is happening with workout apps for smartphones. The apps can track activities like how many steps you’ve taken, your running route, or how many calories you just ate.

Even though more people are using technology to track their health, here’s the real question: What have been the results?

“I think wearable technology and workout apps are an excellent motivator to get active and stay fit,”says Arsh S. Dhanota, MD, CAQSM, a sports medicine physician at Penn Medicine. “They are making people more conscious about putting in the effort to stay healthy.”

Research supports Dr. Dhanota’s observation: These fitness gadgets and apps are great for motivating and educating people. To be effective, they should be incorporated within your overall plan for health and wellness.

Here are four key ways fitness technology can be used to help you get a step closer to your fitness goals.

1. Keeping It Steady

Runners gearing up for the spring race season know endurance is a key part of crossing the finish line. Dr. Dhanota says fitness technology can help you keep a steady pace.

“I have a good friend who is training for a half marathon. He wants to run a certain pace,” he explains. “A device can monitor his pace during a run and tell him exactly how close he is to his goal.”

So, for example, if you want to run a steady 8-minute mile, your training could include an app or wearable that lets you know at what points on the course you tend to slow down and whether or not you should slow down or speed up during your run in order to reach your goal.

2. Tracking Progress

If your fitness goal is to challenge yourself to meet new goals—whether that means increasing your distance by a mile or improving your mile speed by 30 seconds—Dr. Dhanota says fitness technology can help you monitor your progress week-by-week.

If you notice a decrease in performance, you can use the data available through your app or wearable to pinpoint the cause by thinking about what may have happened around the time you notice your progress start to peter off. This could also be key information to share with your physician.

“Perhaps you can speak with your physician to discuss any injury or health issue that’s preventing you from improving your performance,” he says. “If you can show your physician how your progress has changed, that data can help him or her help you in the future.”

The good news is many of the wearables are about 80 to 99 percent accurate, according to an October 2015 review of 17 popular wearables, published in the journal Healthcare Informatics Research.

3. Boosting Motivation

Staying motivated can be tough sometimes. Thankfully, there are a number of ways to use apps and wearables to help boost your drive to get out there.

Setting small achievable goals is one of the most effective means of keeping yourself motivated to be active and stay fit. Because apps and wearables can accurately track a variety of important fitness metrics like number of steps walked, miles ran, or calories burned, they are excellent tools to assist in goal setting.

Many wearables and apps are connected to social media as well, providing an opportunity to connect with friends and family who are also working towards their fitness goals. Seeing others post their progress as well as the gratification of sharing your own fitness achievement can keep you motivated not to skip that next workout and also to push a bit harder during it.

4. Telling it Like It Is

It’s one thing to think you’re healthy, but it’s quite a reality check to see that maybe you don’t get as much physical activity, or sleep, or water as you thought. Wearable devices and fitness apps can be like little coaches.

That was Dr. Dhanota’s goal when he purchased fitness devices for his parents. Their wearables tell them how much time they’ve spent sitting, how many calories they’ve eaten, and how many steps they’ve taken. And as with many fitness gadget users, it’s become a friendly competition. “They ask each other, ‘How many steps did you take today?’” Dr. Dhanota says.

“Knowing the reality of your activity level is a great way to self-motivate.”

Penn Sports Medicine

From weekend warriors to professional athletes, the specialists at Penn Sports Medicine and the Penn Musculoskeletal Center provide comprehensive care for athletes of all ages and abilities. Our team of experts from orthopaedics and physical medicine and rehabilitation understands your drive and desire to get back in the game. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.

*Source: Pew Research Center (January 2014)

Wednesday, March 2, 2016

Runners: Should You See a Sports Medicine Doctor for Your Pain?

You've been training for weeks - maybe even months. You're finally in the groove with your running and feeling great when it happens. You start to feel pain. Maybe it's something abrupt that stops you in your tracks, or maybe it's a nagging pain that won't go away. You are disappointed and wonder, what's going on with your body?  When will it get better so you can return to your training plan? Will you have to stop running all together?

And,  you need to figure out where to go for help.

Perhaps the only thing more frustrating than sustaining an injury during race season is trying to figure out what type of doctor to see. At Penn Medicine, our sports medicine physicians understand you want to get back to your active lifestyle to meet your goals, and they want to help.

What is Sports Medicine?

Sports medicine is a type of practice that focuses on helping people improve their athletic performance (regardless of level), recover from injury and help to prevent future injuries. Knee, leg, back, shoulder and hand injuries are a few of the common disorders treated.

What makes sports medicine physicians unique is that they are experts in physical activity, with specialized training in musculoskeletal conditions and the medical concerns of active individuals.

A sports medicine doctor should understand your goals of staying active. In fact, the goal of a sports medicine doctor is to help you get active or stay active, particularly when you’re sidelined by injury.

Penn Orthopaedics has a team of physicians that are specially trained in this specific field. The Penn Sports Medicine team works with patients to develop individualized care plans to help them return to normal activities as quickly as possible.

“We use the same technologies at Penn Sports Medicine to treat runners as we do to take care of patients that are not active in sports,” said Brian J. Sennett, MD. “The overall goal is to work with every patient to establish their diagnosis, explain what's wrong, how we are going to get them better and lead them through that process.”

When Should You See a Sports Medicine Physician?

Still a bit unsure as to when to seek a consultation with a Penn Sports Medicine physician? If any of the statements below apply to you, it may be time to do so.
  • Acute injury: After sustaining a sudden injury - say, a "pop" in your knee, or strain in your hip -  we can help you determine exactly what is injured and what type of treatment you'll benefit from the most.
  • Chronic injury: Long-lasting injuries and areas of discomfort will often improve or resolve with appropriate rehabilitation. We can identify and correct the training errors or biomechanical abnormalities that hinder your performance.
  • Injury prevention: By helping you understand why you sustained an injury – and not just what was injured – we will help keep you injury-free for future races and events.
  • Performance enhancement: Whether you are just starting a new running program or want to improve your performance to better your time or distance goals, we can connect you to a team of professionals – physical therapists, registered dietitians, podiatrists, and more – to provide a comprehensive and well-rounded approach and maximize your athletic potential.

Penn Sports Medicine

From weekend warriors to professional athletes, the specialists at Penn Sports Medicine and the Penn Musculoskeletal Center provide comprehensive care for athletes of all ages and abilities. Our team of experts from orthopaedics and physical medicine and rehabilitation understands your drive and desire to get back in the game. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.

Tuesday, March 1, 2016

Save the Date - Penn Flap Course for Hand and Microsurgery Fellows and Residents

Human Tissue Lab
This 2-day course will include cadaver in sections for local, regional, and free tissue transfer procedures that are tailored for the upper extremity as well as microneural surgery that includes common nerve transfers and brachial plexus approaches.

Date: July 9 and 10, 2016
Location: Human Tissue Laboratory University of Pennsylvania Philadelphia, PA

Course Chairperson:
L. Scott Levin, MD, FACS

Course Faculty: 
Ben Chang, MD
Steve Kovach, MD David Steinberg, MD
David Bozentka, MD Ines Lin, MD
Eric Zager, MD
Ben Gray, MD Lee Osterman, MD
Detlev Erdmann, MD, PhD, MHSc
Scott Hollenbeck, MD
Martin Boyer, MD, FRCS
Geoffrey Hallock, MD
Milan Stevanovic, MD, PhD
Neil Jones, MD
Timothy Shane Johnson, MD
E. G. Melissinos, MD
Nicholas Haddock, MD

Additional details and registration information will be available soon. For inquiries, please contact Lorianne Kish at or Lorna Muramoto at

Thursday, February 25, 2016

How to Fix Shoulder Pain Without Surgery

You go to return a serve at your weekly volleyball game and you feel it - excruciating pain in your shoulder.

That pain has been happening more often lately, and icing it just doesn’t seem to be doing the trick any more. But you’re afraid to see a physician for fear you’ll need surgery.

The good news is that surgery isn’t the only option. Nonsurgical treatments are effective in nearly 70% of sports injury cases and can be an appropriate treatment for many patients.

“Most younger people—younger than 45—probably end up getting surgery because their lifestyle is so demanding,” explains John D. Kelly, IV, MD, Director of Shoulder Sports Medicine at Penn Orthopaedics.

“For the older folks over 70, we do whatever we can to avoid the knife,” he adds.

Dr. Kelly explains four ways to fix shoulder pain without surgery:

1. Do physical therapy.

Certain types of shoulder pain are actually better suited to physical therapy than surgery.

“If someone has had a dislocated shoulder—more than once—surgery is the best option,” Dr. Kelly cautions. “But most of the time, if the shoulder is showing just a little looseness and is a little less stable than it should be, rehab is likely the better option.”

Rehabilitation over the course of about six weeks often helps improve the muscles around the shoulder, which restores mobility.

“We work on strengthening the rotator cuff muscles, subscapularis muscles, posture, and we stretch muscles that are tight that could be causing the pain to be worse,” Dr. Kelly explains. “For patients with overuse injuries, success is at about 90%.”

2. Maintain your weight.

What does weight management have to do with shoulder pain? The answer might surprise you.
“Research suggests that shoulder stiffness is a precursor to metabolic syndrome due to caloric excess,” says Dr. Kelly.

Metabolic syndrome is an umbrella term for a set of risk factors that spike your chance of heart disease, diabetes, and stroke, reports the National Heart, Lung, and Blood Institute (NHLBI).
Five conditions make up metabolic syndrome. However, if you have three out of five, more than likely you’ll be diagnosed with it.

The conditions include:
  • Excess fat around the abdomen
  • High triglycerides (high fat levels in blood)
  • Low HDL or “good” cholesterol
  • High blood pressure
  • Elevated fasting blood sugar levels
To keep weight-related shoulder pain at bay, Dr. Kelly advocates a healthy diet and exercise.
“It’s one of the premises of our research: Lose weight and shoulder stiffness gets better,” he says.

3. Take medication.

No one should suffer in pain. In fact, Dr. Kelly says medication helps many patients manage the pain, but he’s selective about what he recommends.

“We prescribe anti-inflammatories, but we try not to use narcotics,” he says.

Steroid injections can also help treat shoulder pain. Cortisone is an anti-inflammatory that can help reduce swelling and discomfort, and is recommended after other noninvasive methods fail. Although steroid injections are an option for some patients, they are not a long-term treatment solution. If the pain persists, it’s time to speak with your doctor.

4. Control inflammation.

Inflammation in the body causes pain, but it can also set you up for chronic diseases.
“We’ve noticed that some of the degenerative diseases like heart disease, Alzheimer’s disease, diabetes and hypertension have an inflammatory component,” says Dr. Kelly.
The good news: Inflammation can often be managed.

“Hyperglycemia or high glucose increases your body’s inflammation, and high sugar is pro-inflammatory,” Dr. Kelly cautions. “So, if your blood sugar is even a little high, you are set up for an inflammatory condition, including shoulder stiffness.”

If you have shoulder pain, definitely address it. “Don’t ignore it,” Dr. Kelly warns. “It could be a partial rotator cuff tear that could become a full tear.”

“Also, if you have an unstable shoulder, and it dislocates more than once, that is a very high predictor that you’ll have arthritis as you get older,” he adds. “Both of those problems should receive immediate attention by a shoulder specialist.”

Penn Sports Medicine

From weekend warriors to professional athletes, the specialists at Penn Sports Medicine and the Penn Musculoskeletal Center provide comprehensive care for athletes of all ages and abilities. Our team of experts from orthopaedics and physical medicine and rehabilitation understands your drive and desire to get back in the game. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.

Wednesday, February 17, 2016

Nutrition For Runners

When you’re training to run a race, you’ve probably got your brand new running shoes, your amped-up playlist, and your training schedule all ready to go. But there’s another element that’s just as important: your grocery list.

“I view nutrition as the foundation of a lot of the training that runners do,” says Kayli Hrdlicka RD, LDN, CSSD, sports nutritionist at the University of Pennsylvania. “It can allow your body to handle more miles and recover better.”

Kayli knows all about what it takes for runners to eat properly. She’s a competitive runner and half-marathoner. She develops nutrition plans for all of the University’s 33 athletic teams, including the football players, gymnasts, swimmers, and wrestlers. Here, she separates myth from fact about nutrition and hydration for runners. 

1. True or False: Runners can eat whatever they want. 

Answer: Both 

Running is an excellent way to stay fit. A 150-pound person running a 9-minute mile can burn nearly 750 calories an hour, according to MyFitnessPal. But that doesn’t always mean they can eat whatever they want.

“Think about food as fuel for training, competition, and recovery,” Kayli says. “Focus on how food makes you feel.” “It’s not that anything is off limits,” she adds. “But in viewing food as fuel, ask if this versus that is going to provide you with better or worse fuel.” Kayli advises having an 85/15 rule - meaning 85 percent of your food is for nutrition and fueling your training. The remaining 15 percent is reserved for treat foods.

2. True or False: Runners can eat whenever they want. 

Answer: False

Timing is important. Runners should eat before a run, but if it’s an hour or two before hitting the pavement, the meal shouldn’t be too heavy. “You don’t want to eat fettuccine alfredo and go and run long,” Kayli says. Heavy meals can take longer to digest, and can lead to cramping or indigestion during your run. “I ask athletes, ‘What would you eat if you were nauseous?’” she explains. “That’s probably the lightest thing you can think of and the easiest to digest.”

This goes for early morning runners as well. If you’re heading out at 5 am for a training run, grab foods like a banana and granola bar. They’re filling enough to stop the hunger and get you through a run, but are also quick and light.

3. True or False: Your appetite might change during your training. 

Answer: True 

As you ramp up your training, you might notice several changes in your appetite:
  • You crave different foods. 
  • You get hungry at different times, like mid-afternoon or evening. 
  • You’re hungry more often. 
  • Your hunger pangs are more aggressive than before. 

Because you’re increasing the physical demand on your body, your needs might change, and your meals might not sustain you for as long as they did before.

“When you’re training, your body is telling you what it wants,” Kayli says. You might also notice that after your long runs, you’re not as hungry. But just wait. “That day, you might have a low appetite,” Kayli says. “But it may occur a few days later because the couple days afterward, your body needs to repair itself from that run.”

4. True or False: Sports drinks are like any other drink. 

Answer: False 

Sports drinks are not like water or natural juices. They are packed with sugar and electrolytes, and they should only be consumed before, during, or after a training session, Kayli advises. That’s because of the sugar. “It’s designed to give you quick fuel,” she says. “But if you’re drinking one at dinner, you’re already getting fuel.”

5. True or False: Runners can drink whatever they want. 

Answer: Both 

Some drinks will benefit you more during training than others. Water is the best source of hydration, and sports drinks are good sources of fuel. Kayli says the best way to figure out how much hydration you need throughout the day is to divide your body weight in half. That’s how many ounces you should be drinking each day—if not more—since you may be sweating out a lot of fluids during your runs.

But there’s a catch: Soda doesn’t count. “An occasional can of soda is okay. I like a Diet Coke every now and then,” she says, “But just remember, soda doesn't replace water.”


6. True or False: Too much water during a training run can cause cramps. 

Answer: True 

“Drinking large quantities of water immediately before running can cause cramps,” Kayli says. “This is because it takes a little time for the water to leave your stomach. Until then, you may feel it slosh around, causing an upset stomach or cramping.”

During training runs, Kayli says another good rule to try is to drink about a glass of water (8 oz) for every 20 minutes that you’re training.

Another way to tell if you’re getting the right amount of water is by the color of your urine. Too yellow means you’re not getting enough water and need to drink more. Too clear could mean you’re not getting enough electrolytes.

Penn Sports Medicine

From weekend warriors to professional athletes, the specialists at Penn Sports Medicine and the Penn Musculoskeletal Center provide comprehensive care for athletes of all ages and abilities. Our team of experts from orthopaedics and physical medicine and rehabilitation understands your drive and desire to get back in the game. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.

Monday, February 15, 2016

When to Seek a Spinal Evaluation

The spine is an interesting and unique structure, one of the most important parts of your body. It is instrumental to the support, strength, flexibility and range of motion our bodies have. The spine also protects the spinal cord, which carries signals from the brain to other parts of the body.

Harvey E. Smith, MD
Arthritis and degenerative wear-and-tear problems can significantly affect the spine and can lead to back or neck pain, numbness and weakness. Issues with your spine can also impact your hands, arms legs and feet.

So, how do we know when that pain in the back or neck is something that needs to be checked out?

Warning Signs

Trauma. If you’ve had any type of traumatic injury, such as a fall or were involved in a motor vehicle accident, you want to have your back or neck pain checked out by a doctor.

Fever. If you are dealing with back or neck pain, it is important to keep an eye on any type of fever you have. When a fever doesn’t break and is accompanied by pain in the back or neck area, it may be a sign of an infection.

Numbness or Tingling. If you’ve dealt with numbness or tingling for some time and traditional over-the-counter medication has not worked, you could have nerve irritation or damage caused by a herniated disc, spinal stenosis or other disc diseases.

What Type of Doctor Should I See?

When dealing with chronic pain of the spine or the aftermath of an injury, many types of physicians can help you manage pain, repair damage and, in many cases, regain a comfortable range of motion.

The Penn Spine Center treats patients suffering from arthritis, degenerative wear and tear problems affecting an individual’s joints and disks, as well as abnormalities that cause pain, numbness and weakness in the back or neck area.

Harvey E. Smith, MD, Assistant Professor of Orthopaedic Surgery, sees patients with a range of spine and back conditions. When asked about his philosophy of care, Dr. Smith offered the following: “Our role is to help patients understand their diagnosis and the treatment options available, which usually include – both - operative and nonoperative. We will never push patients one way or another. We simply try to educate them as much as possible and work with them to decide which option is best for them. The patient really needs to comfortable and confident with their decision.”

The Penn Spine Center

The Center brings together clinicians from numerous specialties, including orthopaedics, neurosurgery, physical medicine and rehabilitation, and pain medicine. This team-based model of care creates a seamless, integrated patient experience and the most efficient process of diagnosis and appropriate treatment for patients experiencing back and neck pain.

“I truly believe that Penn Medicine provides the highest level of care for those suffering from spine and neck injuries or disorders,” said Dr. Smith.

Why Pitchers Have Tommy John Surgery

When it comes to throwing a ball, most think the magic is in the arm or the shoulder. It’s not.

The secret sauce is body mechanics.

G. Russell Huffman, MD
“In reality, about seventy percent of the velocity of say, a fastball pitch, actually comes from the pitcher’s leg and torso,” explains G. Russell Huffman, MD, Director of the Shoulder and Elbow Fellowship Program at the Penn Musculoskeletal Center.

“The shoulder, elbow and hand are really for ball control more so than velocity,” he adds.

When a pitcher develops poor mechanics during prolonged use, Dr. Huffman says, “it can ultimately lead to shoulder or elbow injuries.”

The Surgical Solution

Elbow injuries are a common problem for pitchers, whether they play professionally or at an amateur level.

A common fix is Tommy John surgery.

The surgery, named after the Los Angeles Dodgers player who first had the procedure in 1974, fixes tears in the ulnar collateral ligament (UCL) of the elbow. This ligament connects the forearm bone (ulna) and the upper arm bone (humerus).

Where Pitching Problems Start

At the root of elbow injuries is poor mechanics. But that’s not the only problem.

Dr. Huffman cites overuse as another key factor. And when you’re good at what you do, the problem gets compounded.

ulnar collateral ligament (UCL) reconstructionAlso, younger athletes who participate in multiple leagues may end up pitching year-round. This prevents their bodies from fully resting and recovering.

Ensuring that the body recovers is critical, considering the severe nature of pitching.

“When you release the ball, it’s a pretty violent act,” explains Dr. Huffman. “Just the act of throwing and using all that stored energy in your body to transmit that into a moving object creates some damage that your body can handle.”

But if you don’t take time to rest during and after games, stretch, and let the muscles recuperate, “then the damage keeps building up,” he adds. “You start to lose motion through your shoulder, and then that translates down the arm into the elbow.”

Tommy John: The Repair Job

In Tommy John surgery, a tendon from another part of the body—usually the wrist—is used to reconstruct the damaged UCL in the elbow. The fairly quick procedure takes about 90 minutes.

Traditional Tommy John surgery requires the surgeon to drill a hole in the ulna and humerus bones, and thread the ligament through the bone.

The surgeons at Penn refined their surgical technique, which allows athletes to perform on a higher level.

“We’ve developed a very reliable technique for doing both Tommy John and first-time revision surgery. It’s a little bit of a smaller incision and preserves a little more bone than the traditional fix,” says Dr. Huffman.

Recovery, no matter which technique is used, usually takes up to 18 months.

Why Pitchers Feel They’re Better Than Before

Dr. Huffman says there’s a perception among players that the surgery makes pitchers better.

That’s because it does.

Players understand good mechanics. So, they shift their focus to prevent re-injury.

“The first step is building up leg and core strength,” says Dr. Huffman. "Then, it’s about consistent shoulder stretching and helping athletes become better advocates for themselves by letting coaches know when they need rest.”

When pitchers prepare to go back for their first full season, Dr. Huffman applies the rehab approach for golfers: short, quality outings.

“They have high-quality outings with a lot of strikes, so no one gets discouraged, and they’re not overutilized,” Dr. Huffman says. “I think that’s a smarter way to go back, rather than trying for a complete game the first day out.”

Penn Sports Medicine

From weekend warriors to professional athletes, the specialists at Penn Sports Medicine and the Penn Musculoskeletal Center provide comprehensive care for athletes of all ages and abilities. Our team of experts from orthopaedics and physical medicine and rehabilitation understands your drive and desire to get back in the game. These experts work together as a seamless unit to provide a wide range of treatments, not just surgery, and help you return to an active, pain-free lifestyle.