Who loves shadowing?

I do! But I can't wait until I get to do the real thing.

I just got back from a nice four hour afternoon at the ortho office. The theme of the day was nerve conduction studies. Before I get into those though, I'll go over the other patients we saw.

The first patient had ACL reconstruction yesterday, but the ice pack had leaked and soaked the bandages. We changed the bandages, and got him a new immobilizer, since the one we had was rather uncomfortable.

We also saw a patient for a followup with a broken big toe. We took an x-ray to see how the fracture was healing, and came across something rather interesting. Let me see if I can find a picture of it on Google...

...I couldn't find one, which doesn't surprise me, so I found an x-ray of a foot and doctored it a little to show the unusual thing we found.


Ignore the arrow pointing to the avulsion fracture. Let's have a little contest to see who out there who reads this blog can figure out what is abnormal about this foot. It's definitely something easy to see, even though it might not be something you would look for.


And just because I know my audience, I'm just going to go ahead and give a hint.

exostosis

Also, it has nothing to do with his original complaint, the fracture in his big toe.

Winner gets a box of candy that I was given but can't eat. :)

Ok, onto nerve conduction studies. Nerve conduction studies are used to detect carpal tunnel, among other things. Basically what happens is, we hook up some wires and pads to their wrist, which sends signals down the median nerve into the middle finger. The specific number we are looking for is the DML-delayed median latency. This is basically testing the amount of time it takes for the impulse to travel through the nerve. The numbers we got today were in between 3.3-4.3 (sorry, don't know the unit), which is considered mild carpal tunnel. Any number above 7 or 8 is considered operable. The numbers are all compared to what is normal for that person's age, height, and weight group. Well after seeing one done, I got to do one myself! (With help, of course).

First you had to prep the skin with alcohol to get it all clean. Then you had to locate the special points of interest. For testing the median nerve, we had to mark spot right in between the two tendons you see when you touch your pinky to your thumb and flex your wrist towards you a tiny bit. Then you attach all the pads and whatnot. This is what the setup looks like:

There's a plug that we stick into a handheld diagnostic tool, which sends the impulses into the nerve. I was told it feels like you are hitting your funny bone. The test lasts for about 15 seconds or so. When we tested the median nerve, we also got the ulnar nerve for comparison, as well as the opposite hand's median nerve.

The setup is slightly complicated (for a newbie) because the sensors and pads can't touch anything, other than the skin it is intended for. I didn't mess it up though!

Do you know what that thick pad of muscle is that is located at the base of your thumb on the palm side? The thenar eminence.

We also saw a boy for a followup for a sprain to his ac joint (a space mid-collarbone). I learned that if you hold the arms out to your side then bring them to your midline in front of you and cross them over, he'd have pain if he had a sprain. He was ok though.

The other big thing that we dealt with today was the drug addicts who are looking to sell pills. Some of these people are on vicodin and percoset weeks after surgery. I didn't need anything after I had my knee operated on. We had this one lady call asking for a prescription refill, when she had already been given one five days earlier. Her reason? "The pharmacy wouldn't let me fill it because it was dated three days earlier." We called the pharmacy, who said "Yeah...we don't tell that to our patients..." The patient then called back and admitted she had already filled it. Ha! I guess it is something you just have to deal with in any medical field.