I spent another two and a half hours shadowing with the ortho PA yesterday morning. First patient was a medial meniscal tear, which I actually knew something about based on personal experience. Except I didn't realize that just a meniscal tear was such a short recovery. You can essentially start running and being active again after four weeks. I tore my ACL, MCL, and lateral meniscus, and it was four MONTHS until I could start running again, seven before it was even somewhat comfortable. She showed me the McMurray Test, and we talked about how people with meniscal tears can't squat, and have pain over the joint line (which I know from experience).

Second patient was a woman with a proximal humerus fracture. Here's a good picture of it:
Except in the patient we saw, the head (big round part of the arm bone) was actually rotated down and to the right in the x-ray.

At her age, they aren't going to operate, just do PT and monitor the fracture. She won't be able to fully abduct her arm, but the goal is to make it able for her to reach in a cubbard for a dish and whatnot.

The third patient was a followup for a hip surgery for a 100 year old woman whom they just stuck pins into:

Basically her visit was just to check that the pins were in properly.


We had a little bit of spare time, so we went over the Salter fractures again. We also looked at some x-rays that had been taken within the past two days (it's so cool, all the x-rays are on the computer, thanks to electronic medical records). We talked about the three kinds of fractures of the fifth metatarsal (your foot bone going to the pinky toe). They are (and I've added arrows to show you the break):

#1: Avulsion fracture



#2: Jones Fracture



#3: Oblique, or shaft (no real set name):

(Left most foot bone, the fracture is pretty obvious).

[Confidence alert! I Googled "fifth metarsal fractures," did an image search, and was able to read all the x-rays and figure out what kind of fracture was which! Yeah!]

Now from looking at those, which one would you think is the most serious/hard to recover from? You'd think it was #3, the shaft, because it looks like the bone is clear cut in two. In reality, it's #2. There's very little blood supply, which means that it doesn't heal quickly at all. With a Jones fracture, you are not allowed to bear weight (aka crutches) for four weeks. You're in a cast for that long, and many times they won't heal being immobilized, so you have to have surgery. They put a pin up through, I think. I can't imagine having one of those. I was on crutches for a week and that was way more than I wanted to be.

We talked about what trigger finger looks like, which is when the tendons in your pointer finger become inflamed. When you ball up your fist and then unball, the pointer finger is the last to uncurl. In this particular patient's case, it was a result of arthritis, which is a common cause.

Another funny thing that we talked about was the drug Ativan, which I knew was an anxiety drug. What I didn't know was that it is also used to calm contractions or spasms as well. Well later on that night I watched an episode of ER, a patient started having a seizure, and the doc shouted "WE NEED SOME ATIVAN STAT!" I said to myself "Hey I know what they're doing!"

Did you know the reason why you can't have any liquids or food in your stomach before surgery (and I mean none, not even a mouthful)? It's because when you're under anesthesia, a tube gets stuck down your throat, and you could aspirate (suck in) material from the stomach to the lungs. We all know that anything other than air in lungs means big trouble!

Lastly, a takehome lesson from all my shadowing that everyone should take note of is to know your family history and to know what meds you are on. It really helps the doc help you if you know what diseases your parents and siblings had (cancer, stroke, heart disease, high blood pressure, diabetes, etc). Have a record of any surgeries you've had, from your appendix to a root canal to whatever. Lastly, if you are on a lot of meds, write their names and dosages down and keep that with you. It really does make a difference in your care if you can be knowledgeable about all of this stuff with your doc.

Ok, to end on another fun note. Movie trailer time! Who else is SUPER excited about this?!
Where the Wild Things Are