Shadowing! Get ready to learn :)

I just got back from shadowing an ortho PA. I spent two hours with her today and I loved it. I'll do a brief rundown of the patients we saw today:

#1: An older lady who had undergone an Achilles tendon debridement, because she had tendonitis that didn't get better with anti-inflammatories, a CAM walker (walking boot), or PT. Some links on the procedure here and here. The PA also showed me how to do a Thompson Test to determine if there has been a rupture of the Achilles tendon.

#2: A middle aged lady who had a wrist fracture at the distal end of the radius (one of two arm bones in your forearm, the one on your thumb side), and just came in for some x-rays and a new cast. Believe it or not, I've never seen a cast made, and I had no idea it was that easy. Here's a video of it. She whipped out a saw and cut the old cast off, and although I didn't understand how you could do that and not cut the person, I finally understood why it is possible (the teeth on the saw aren't very big, and there's a lot of bandaging and padding under the cast itself. I can't believe a cast is just a fancy roll of "bandage" that you wet and wrap. How cool is that!

#3: A lady who had a tib-fib fracture while ice skating. Ouch! I won't post a video of what that looks like, haha. She was in a CAM walker and was just granted full weight bearing status.

#4: A boy around 10 years old, I'm guessing, who broke the growth plate in his wrist while on his dirt bike. I learned about the Salter-Harris rankings, which are a way of classifying the severity of the break. Here is a good picture explaining the different classifications.

#5: A woman about to have a carpal tunnel release. The PA did an H&P (history and physical). Here is a video of carpal tunnel release surgery, which is minor and minimally invasive. I am assuming everyone reading this has heard of carpal tunnel. You have two nerves that innervate your hand, the median and the ulnar nerve. The median nerve innervates (stimulates) your thumb, pointer, and middle fingers, as well as the inside half of your ring finger that is closest to your middle finger. Here is a great picture explaining that better. The purple is where the median nerve innervates. The tunnel part of carpal tunnel is made up of three bones and a ligament. When the tunnel gets "too small," the median nerve is impinged upon, causing weakness, numbness, and tingling in the fingers. I learned two tests to detect carpal tunnel, Phalen's and Tinel's. In the Phalen's test, you flex the wrist as much as possible and see how long it takes for symptoms to arise. In Tinel's, you tap the wrist right over the tunnel, and if positive, the patient will experience a sharp shooting sensation into their fingers.

So those are the patients we saw in the two hours I was there. If I were to specialize as PA, orthopedics would probably be what I would do. Those of you who know me can imagine how happy I was to be in that environment and learning! Here are some positive and negatives of Ortho that I have come up with so far:

POSITIVE

• I really like the subject matter...I think it's because of my background as an athlete
• Using cool tools
• Surgery would be awesome!
  
• You see patients get better, as opposed to doing chronic pain management or diabetes/hypertension management
  
• I can relate to the patients, having had an ACL reconstruction and arthroscopic meniscul repair myself
• Pretty focused on one aspect of the body, only have to really know about bones, muscles, nerves, and some soft tissue. You'd get to be really knowledgable about that area.
• Still get to see patients of all ages
  

NEGATIVE

• Sometimes in ortho you can have a busier schedule with call and long days (not so at this practice however)
• Dealing with people looking for pain pills and lying about their injury
• Life might get a little monotonous doing the same things over and over again (just a guess, I mean I have only seen two hours of ortho life)
• It'd be harder recertifying for the PANRE, because you wouldn't be using some of that primary care knowledge
• You might not get to build up long lasting relationships with patients, kind of like what I would be looking for by doing family practice in a small town.

There's that...I'm sure I'll have more to add once I've spent more time at the office!