Saturday, July 30, 2005

Jeff Ballyns 3rd Week Blog

Monday: Tunde and I met with Dr Potter and observed her go through the wet readings for the day. One of the cases of particular interest to me involved the case about a meniscal tear which could be denoted on the medial side of the knee where one horn was significantly compressed to the side. This compression indicated that the meniscus have been torn and also worn away with significant signs of osteoarthritis present. There was a large list of vocabulary words that were introduced, these include:

Gastricnemia – muscles of the calves composed of lateral, solace and medial.

Onset fracture – a break in the bone due to poor geometry.

euroma – fibrosis tissue (scare tissue) surrounding a nerve (sensory nerve).

Humphry – Secondary stabilizer of the knee (works with the PCL)

Wristberg – other ligament of the PCL that attaches to the meniscus.

Valgus – bent medially (knock kneed)

Varus – bent laterally (bow legged)

Coalition – fusion of a joint (cartilage, bone)

Secimoid – free floating bone (ie. Patella and the bone that is the ball of your foot).

This is an examples of a meniscus with a tear in the posterior horn. You can see that the horn is pushed out posteriorly from the knee signifying that there is a tear. The image was provided by Dove Open MRI

To end the day I met up with Devon and Lilly to observe them dissect the adult knee joints to gather articular cartilage samples. I noticed big differences in the amount of freedom they have with contact with the joints and are still able to avoid contamination problems so I requested a copy of the protocol to see if they are using a different protocol.


Sat in on the medical student meeting where they discussed their projects one that particularly struck my interest was the one about FTIR to diagnose bone composition. The device seemed to have significant similarities to MRI however FTIR gives more quantitative data as opposed to qualitative data.

Wednesday: Attended Dr. Potters MRI physics lecture the first of three.

Thursday: Shadowed Dr. Marx observed an arthroscopy knee surgery and a shoulder cuff repair. One thing of particular interest with the knee surgery was how Dr. Marx had to cut and remove part of the medial meniscus be cause it was unstable and not performing properly. Dr. Marx said that this portion is often removed because it is not securely fastened and could get pinched and cause major discomfort to the patient.

This is what a knee arthroscopy looks like on the outside and then this is what the doctor sees on the camera.

Images are provided by The Haptic Training System

And arthroscopy knee

The shoulder cuff repair was a fairly short operation since the patient seemed to have no major tears but a severely inflamed bursa. The bursa is a sac sandwhiched between the rotator cuff muscles and the outer layer. They serve to lower friction between muscles sliding against one another.

Image provided by Winchester Hospital

Friday: I shadowed Dr. Warren in the ambulatory section of HSS. I watched him perform a shoulder debrisment and a shoulder cuff repair. The shoulder dibrisment was for a patient that had a total shoulder replacement done on him before. Dr. Warren removed surrounding fat and swollen tissue in the area. It was noticed that the Glenoid implanted earlier had become loose, so it was removed and then packed with bone crushed from a femoral head. The glenoid is the articulating surface which the humoral head moves across. This can be seen below along with some images of what an artificial glenoid looks like.

Images provided by and Duke Orthopedics

The final surgery was of a shoulder cuff repair. The patient had torn their shoulder cuff and needed to have the muscle reattached and anchored down. This is a fairly routine procedure the only thing that changes seems to be the technology used for the operation. This was particularly evident when the tools Dr. Warren requested were not present and we had to wait for the nursing staff to bring the equipment Dr. Warren liked using to sow the muscles together.

Here are some images of what shoulder arthroscopy looks like.

What you see on the outside:

What the doctor sees on the screen:

Images provided by by Mr Hamid G. Zadeh


Blogger ehealth city said...

Great information shared here. Thanks for sharing. Shoulder arthroscopy

2:13 AM  

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