Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Do people appreciate how amazing it is that Philip Rivers (quarterback for
the San Diego Chargers) played on Sun., Jan. 20, 2008, just six days
after having arthroscopic surgery? Aside from the fact that he likely had some
cartilage debris cleaned out and the rehab time is measured in weeks, he still
had a torn anterior cruciate ligament (ACL).
For regular people and pseudo-athletes, the days after arthroscopic knee
surgery are spent reducing knee swelling and starting range-of-motion exercises.
This process is hampered by a couple of physiologic barriers.
When the knee is invaded, the muscles around it tend to shut down
involuntarily. The quadriceps muscle in the front of the thigh tends to get
immediately weaker, and since it is one of the stabilizing muscles of the knee,
it is a big deal when this muscle decides not to work. The next barrier has to
do with hydraulics. The knee joint has its largest volume of fluid when it's
flexed at 15 degrees. When there is even a little fluid, straightening it out
combats the law of physics that says "you can't compress fluids."
Rivers gets out of surgery and presumably hops into the training room and is
attacked by the physical therapists. Appreciate that for mere mortals, physical
therapists can be kind and gentle, but when they want the patient to do
something, they can become relentless therapists. Pushing the body to its limits is
not something regular patients do. Putting it into perspective, a routine course
of rehabilitation in the first week might have a patient trying to get the
pedals on a stationary bicycle to go around without resistance...once.
Arthroscopy is a surgical procedure by which the internal
structure of a joint is examined for diagnosis and/or treatment using a
tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s
and is now commonplace throughout the world. Typically, it is performed by
orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return
home after the procedure.
The technique of arthroscopy involves inserting the arthroscope, a small
tube that contains optical fibers and lenses, through tiny incisions in
the skin into the joint to be examined. The arthroscope is connected to a
video camera and the interior of the joint is seen on a television
monitor. The size of the arthroscope varies with the size of the joint
being examined. For example, the knee is examined with an arthroscope that
is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5
millimeters in diameter to examine small joints such as the wrist.
If procedures are performed in addition to examining the joint
with the arthroscope, this is called arthroscopic surgery. There are a
number of procedures that are done in this fashion. If a procedure can be
done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma,
results in less pain, and may promote a quicker recovery.
For what diseases or conditions is arthroscopy considered?
Arthroscopy can be helpful in the diagnosis and treatment of many
noninflammatory, inflammatory, and infectious types of arthritis as well
as various injuries within the joint.
Noninflammatory degenerative arthritis, or osteoarthritis, can
be seen using the arthroscope as frayed and irregular cartilage. Recently, for
isolated cartilage wear in younger patients, repair of crevasses in the
cartilage, using a "paste" of a patient's own cartilage cells
harvested and grown in the laboratory, has been performed using an
arthroscope.
In inflammatory arthritis, such as rheumatoid arthritis, some patients
with isolated chronic joint swelling can sometimes benefit by arthroscopic removal
of the inflamed joint tissue (synovectomy). The tissue lining the joint
(synovium) can be biopsied and examined under a microscope to determine
the cause of the inflammation and discover infections, such as
tuberculosis. Arthroscopy can provide more information in
situations which cannot be diagnosed by simply aspirating (withdrawing fluid
with a needle) and analyzing the joint fluid.
Common joint injuries for which arthroscopy is considered include
cartilage tears (meniscus tears), ligament strains and tears, and
cartilage deterioration underneath the kneecap (patella).
Arthroscopy is commonly used in the evaluation of knees and
shoulders but can also be used to examine and treat conditions of
the wrist, ankles, and elbows.
Finally, loose tissues, such as chips of bone or cartilage, or foreign
objects, such as plant thorns, that become lodged within the joint can be
removed with arthroscopy.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Elbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. Treatment includes ice, rest, and medication for inflammation. Inflammation, redness, warmth, swelling, tenderness, and decreased range of motion are other symptoms associated with elbow pain. Treatment for elbow pain depends upon the nature of the patient's underlying disease or condition.
A torn meniscus (knee cartilage) may be caused by suddenly stopping, sharply twisting, or deep squatting or kneeling when lifting heavy weight. Symptoms of a meniscal tear include pain with running or walking long distances, popping when climbing stairs, a giving way sensation, locking, or swelling. Treatment depends upon the severity, location, and underlying disease of the knee joint.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Temporomandibular joint disorder, or TMJ, is a disorder of the temporomandibular joint(s) that causes signs and symptoms including ear pain, bite problems, headaches, dizziness, clicking sounds in the jaw, tinnitus and/or locked jaws. Behaviors or conditions that can lead to TMJ include teeth grinding or clenching, fingernail biting, habitual gum chewing, trauma to the jaw, stress, and occupational hazards. Treatment for TMJ may include heat, ice, a soft diet, antiinflammatory medications, physical therapy, stress management, occlusal therapy, correction of bite abnormalities, and surgery.
The anterior cruciate ligament helps to prevent the top and bottom of the knee from sliding back and forth. Symptoms and signs of a torn ACL include knee pain and swelling. Treatment of a torn ACL depends upon the health of the patient and the patient's expectations and willingness to undertake extensive physical therapy. Rehabilitation after surgical repair of an ACL tear may take more than nine months.
Septic arthritis, or infectious arthritis, is infection of one or more joints by bacteria, viruses, or fungi. Symptoms and signs of septic arthritis include fever, joint pain, chills, swelling, redness, warmth, and stiffness. Treatment involves antibiotics and the drainage of the infected joint.
Iliotibial band syndrome is an overuse injury of the thigh and knee. Symptoms include knee pain and possible swelling. Treatment may involve anti-inflammatory medications, physical therapy, ultrasound, and the use of orthotics.
Arthritis is a joint disorder featuring inflammation. A joint is an area of the body where
two different bones meet. A joint functions to move the body parts connected by its bones.
Arthritis literally means inflammation of one or more joints.
Arthritis is frequently accompanied by joint pain. Joint pain is
referred to as arthralgia.
There are many types of arthritis (over 100 identified, and the number is growing). The types range from those related to wear and tear of cartilage (such as osteoarthritis) to those associated with inflammation resulting from an overactive immune system (such as rheumatoid arthritis). Together, the many types of arthritis make up the most common chronic illness in the United States.
The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), metabolic abnormalities (such as gout and pseudogout), hereditary facto...
Do people appreciate how amazing it is that Philip Rivers (quarterback for
the San Diego Chargers) played on Sun., Jan. 20, 2008, just six days
after having arthroscopic surgery? Aside from the fact that he likely had some
cartilage debris cleaned out and the rehab time is measured in weeks, he still
had a 
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