Week 3 - Daniella Fodera

Just this Friday, I was finally able to obtain OR access and was excited to immediately shadow two of Dr. Rodeo’s surgeries of the day: Knee and Shoulder Arthroscopies. The term arthroscopy simply describes a minimally invasive procedure in which the surgeon inserts a narrow tube affixed with a camera to examine or repair the joint. The knee arthroscopy procedure was a meniscectomy in which a portion of the patient’s torn meniscus in the knee was removed. The second surgery was to repair degenerated supraspinatus and biceps tendons in the rotator cuff of the shoulder. There was certainly a lot to take in but what I found most impressive was not the actual surgery displayed on a small monitor but the number of people that were involved in the surgery who all performed their distinct roles like a dance.

This week I also spent two mornings shadowing Dr. Rodeo’s patient visits; the remainder of my time was spent in the lab processing additional human tendon samples and conducting flow cytometric analysis for inflammatory cells. I have noticed distinct differences in the flow and dynamic of patient visits whether they are there for a follow-up appointment or as a new patient. One of the things I found most interesting was the way in which Dr. Rodeo explained potential procedures to a new patient. On multiple occasions, he sketched out a schematic on the exam table paper right next to where the patient was sitting to better illustrate the anatomical details of a potential procedure. For a patient considering an ACL reconstruction, he detailed the potential allograft (cadaver) and autograft (hamstring tendon, patellar tendon, etc.) options with a quick sketch of the knee. Similarly, he drew a schematic of the shoulder and humeral head for a patient requiring a rotator cuff repair.

While osteoarthritis is generally one of the most common diagnoses, there were many cases on Wednesday related to tendon injuries and healing, which was quite interesting and relevant to my field of work. Across the two days of shadowing, I have realized that most of the cases that present in the clinic are quite common and predictable for the reported location of injury and pain. Already, Dr. Rodeo and his physician assistant are looking ahead at the next twenty steps down the line at the treatment (surgically or non-surgically) and recovery even before they meet with the patient. A lot of information can be taken from MRI and X-ray scans, yet one needs to be careful about prescribing a certain diagnosis and treatment course before listening to the patient’s narrative. It is interesting the dialogue shift that occurs when in the presence and absence of patients. Generally, discussion of patient diagnoses and treatments with the Physician Assistant and Resident use highly technical clinical language which is made more colloquial when speaking directly to the patient.

Some interesting cases include a follow-up visit for staple removal for a surgery involving osteotomy, MACI, and meniscal transplant, steroidal injections for rotator cuff pain, a medical student with an acute on chronic Achilles tendon injury, and NFL player recovering from ACL reconstruction surgery.