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.
Arthroscopy is essentially a bloodless procedure and generally has few
complications. The underlying health of the patient is considered when determining who is a candidate for arthroscopy. Most
importantly, the patient should be able tolerate the anesthetic that is
used during the procedure. A person's heart and lung function should be
adequate. If there are existing problems such as heart failure or emphysema,
these should be optimized as possible prior to surgery. Patients
who are on anticoagulants (blood thinners) should have these medications
carefully adjusted prior to surgery. Other medical problems should also be
controlled prior to surgery, such as diabetes and high blood pressure.
Preoperative evaluation of a patient's health will generally include a
physical examination, blood tests, and a urinalysis. Patients who have a
history of heart or lung problems and generally anyone over the age of 50
will usually be asked to obtain an electrocardiogram (EKG) and a chest
X-ray. Any signs of ongoing infection in the body usually postpones
arthroscopy, unless it is being done for possible infection of the joint
in question.
How is arthroscopy performed?
Arthroscopy is most often performed as an outpatient procedure. The patient will
check into the facility where the procedure is being performed and an
intravenous line (IV) established in order to administer fluids and
medication. The type of anesthesia used varies depending on the joint
being examined and the medical health of the patient. Arthroscopy can be
performed under a general anesthetic, a spinal or epidural anesthetic, a
regional block (where only the extremity being examined is numbed), or
even a local anesthetic. After adequate anesthesia is achieved, the
procedure can begin. An incision is made on the side of the joint to be
examined and the arthroscope is inserted into the incision. Other
instruments are sometimes placed in another incision to help maneuver
certain structures into the view of the arthroscope. In arthroscopic
surgery, additional instruments for surgical repairs are inserted into the
joint through the arthroscope. These instruments can be used to cut,
remove, and sew damaged tissues. Once the procedure is completed, the
arthroscope in removed and the incisions are sutured (sewn) closed. A
sterile dressing is placed over the incision and a brace or ACE wrap may
be placed around the joint.
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.
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