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.
Immediately after arthroscopic surgery, patients may be sleepy,
especially if a general anesthetic has been used. Medications are
administered to control pain if needed. If a local anesthetic has been
used, there may be no pain at all immediately after the
procedure. If a spinal or regional anesthetic has been used, there can be
numbness and weakness of the extremity that gradually resolves before the
patient is sent home.
The surgical incisions from arthroscopy are small. They usually consist
of several 5 mm (1/4 inch) incisions on either side of the joint, which
are bandaged after surgery. The bandage may absorb some of the tissue
drainage from these wound sites. The bandage should only be removed under
the guidance of the treating surgeon or nurse. It should otherwise be kept
as dry as possible during the first few days after surgery. Patients
should notify their physician's office immediately if they develop unusual
joint pain, swelling, redness or warmth, or if they injure the involved joint.
For several days after arthroscopy, patients will generally be asked to
rest and elevate the joint while applying ice packs to minimize pain and
swelling. After surgery, an exercise program is gradually started that
strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues. The goal is to recover
stability and strength of the joint rapidly and safely, while preventing
the build-up of scar tissue. This program is an essential
part of the recovery process for an optimal outcome of this procedure.
Over the years, higher quality fiber-optic equipment has allowed the
development of miniature arthroscopes. This has allowed the examination of
smaller joints with arthroscopy. Arthroscopy has become an integral tool
for orthopedic surgery and its role will continue to expand as further
improvement in arthroscopes and arthroscopic instruments continues.
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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