Jump to content

Help with common issues seen in ortho?

Recommended Posts

Just about to get into ortho/sports med , mainly shoulder and knee outpatient stuff with little OR. Wanted to know from other ortho PA's what the most common problems you see come in and any advice you wish someone told you when you first started. Any other tricks/keys to success? I'm just going to review anatomy and all those exam techniques from PA school. I will probably be doing some injections too. How long for someone to get proficient in that starting from scratch?

Thanks a bunch.

Share this post


Link to post
Share on other sites

If you have any knee injuries and shoulder injuries, there is a chance to get knee pain as well as shoulder pain. Some type of therapies also useful to get pain relief. Once try that one.

Share this post


Link to post
Share on other sites

Not Ortho PA, but been around.

 

80% of your clinic will be back and knee, 15 % shoulder feet and hands, 5 % neck

Would recommend strongly,

 

Learn a quick, thorough knee exam, and be able to correlate the exam with pathology.. You should be able, based on exam and PE only, to diagnoses 90 percent of problems.. Djd, OA, meniscus, cruciate, collateral, bursar, etc.( 90-120 sec per knee)

 

... A thorough shoulder exam ( takes maybe 90-120 seconds), and like knee, should lead you to which rotator, which bursa, is affected, versus labrum, impingement, tendon, etc

 

... And a good, correlative neuro back exam(2 minutes)

 

 

You want to be able to fairly accurately predict the pathology by PE, to help direct intervention ( MRI, arthroscopy, myelo gar,. Arthrogram, etc)

 

Know the dif between OA, ra, Ddd, djd, radiculopathic dz, etc.

 

Review basics of cast, splints, etc.

 

Reductions, repairs, injections, etc, will come in time.

 

This should get you started. I do not know what the above poster is talking about.

Share this post


Link to post
Share on other sites
If you have any knee injuries and shoulder injuries, there is a chance to get knee pain as well as shoulder pain. Some type of therapies also useful to get pain relief. Once try that one.

 

Huh???????

Share this post


Link to post
Share on other sites
Huh???????

 

Looks like a troll, trying to bump their post count so they can post links etc. to promote their trash sites urgentcareblahblah.com These guys are popping up all over the site

Share this post


Link to post
Share on other sites

know how to perform a Pivot Shift test for the knee and what it means. Perform a good neck and back exam and neuro exam. Know your shoulder differentials. Start to study and know fractures--what is stable vs unstable and treatment. Learn about post-op care. Learn how to dress a wound. Start to learn suturing. I'm in Ortho Surg doing TKA, THA, ORIF, Rotator Cuffs, etc. So much to know!!!

Share this post


Link to post
Share on other sites

If I may ask, when you say that you're doing TKA, THA, etc., could you tell me a little bit about what your role will be with these things? I ask because I had a rather depressing experience following an Ortho PA in the clinic recently, where the PA's First Assist duties were largely the same for every type of surgery.

Share this post


Link to post
Share on other sites

For TKA and THA, I am the 2nd assist. On a rare occasion, I am the 1st assist if our 1st assist is on vacation. He has 15+ yrs of experience and can suture with the best surgeons in Santa Barbara, like a mirror image. Me, not so much. I'm slower as I've only done this for the past year. However, on other days, I am the first assist on knee lig reconstructions (ACL, LCL), ORIF's, and Rot Cuff Repairs. Then I help position the patient, retract, suction, provide lighting, hold the scope, hold body parts, cut, tap, maintain the sterile field, provide the best field of vision for the surgeon as possible, help with any surgical technique he asks, inject local, help prepare grafts (I haven't done the whip stitch on my own yet) close the wound--suture (subdermal, subcutaneous, staple, simple interrupted, dermabond, etc)--a myriad of closing techniques. And then I dress the wound with our standard dressings (ex--for an LCL reconstruction, the post-op dressing would be: staples, betadyne ointment, adaptec mesh, 4x4s, 8x4 ABDs, 6" ACE wrap (x3) foot to thigh. With an ACL, I would add a cold therapy unit over webril but under the ACE. I'd use a post-op brace locked out at 0 degrees with the yellow tabs point up proximally. I have another list for my rotator cuff repair dressing, and for the total knees. I would ask the surg tech to have these things ready for me (and possibly the surgeon) before the surgeon has to ask for these things. The sharp techs already know what we want. I would usually inform the techs if we are going to do an open vs scope procedure since I usually do the pre-op. There are times when I'm closing and the surgeon has already de-gowned, de-gloved and goes to dictate the OP note while I finish and dress, so that we may move on to the next case. I have to order the tourniquet down at times as well. After dressing the patient, the tech and I clean up the patient for transfer to PACU. And I stand alot on my feet, so wear the best comfy shoes you can buy--for me, it's Nike Lunar Glides! For our Total Joints, I template the cases on the films and measure the femur and tibia. There is so much to learn and it takes time and lots of notes put into my iphone. Then I can run through the dressing prior to the surgery while I'm waiting. There is alot on youtube as well. I am a regular on the AAOS website too. However, I must say that I'm leaving my job in OrthoSurg for a new job closer to home for the Chief of NeuroSurg for Ventura County. If anyone is interested in a tough job but one in which one will definitely learn the ropes of OrthoSurg, there is a job with William Gallivan, Jr., MD, for Santa Barbara Orthopedic Associates at Cottage Hospital. It's a tough demanding job with long hours but without a doubt I have gained valuable experience. Fracture management, wound care and osteomyelitis/septic arthritis are also problems that I've dealt with alot the past year.

Edited by Nakasoner
more to add
  • Upvote 1

Share this post


Link to post
Share on other sites

Also, will need to learn to cast -- short arm, short leg are typical. Learn to do a splint. Achilles ruptures, Cast/cam walker boots. Learn how to inject the knee, the shoulder (GH vs Subacromial), hip bursae, DeQuervains. How to use Ultrasound guidance technique vs w/out US. Get good at reading xrays cuz you will be reading them daily many times over. Also MRI and CT's, Total body bone scans. Know your joint replacement techniques and materials--beware of metal on metal hips. Patellar fractures. Proximal humerus fx, Prox femur fx, distal radius fx. All of these are very common to see. Know what a reverse total shoulder arthroplasty is. Heterotopic ossification, anticoagulation, lovenox bridging, dental prophylaxis for total joints, know your spine differentials, DEXA scans. I could go on and on. My iPhone is filled with pics of fractures, end stage arthritis, wounds, etc that I use to communicate with the surgeon throughout the day/week.

Share this post


Link to post
Share on other sites
Guest JMPA

I recommend learning a thorough neck exam being that shoulder pain can be coming from the neck. Also anticoagulation, brachial plexus injuries, and infections. Patellofemoral syndome / chondromalacia is a common finding. Best of luck!

Share this post


Link to post
Share on other sites

I've spent 2 years in neurosurgical spine, 7 years in Ortho (adult reconstruction-lower extremity), 9 years in EM (4 was part time while I was in Ortho), and a year in PM&R Spine.

 

Ortho and musc. medicine is hard for a lot of providers, because you just don't learn enough about it in school. I functioned as a first assist on everything and would dictate operating order, and which cases the residents would be on. Often, I would give them the more challenging cases to run in a second room with a surgical assistant and the surgeon. The primary room would be used for more straightforward cases, and it got to the point where we could do a TKA or THA without even speaking as we could just fly through the motions. I could also open and close faster than most of the residents by my 6th and 7th years.

 

The hours can be brutal though, and after my own surgery, I was looking for a change, which is why I switched to EM (also, the surgeon attitudes were getting a bit stale).

 

Advice? Know your anatomy....backwards, forwards....get a book on biomechanics so you can start to understand Q angles, and how the body works. Learn your exam techniques and when something is REALLY positive, versus not really......Stinchfield, etc.

 

Also, a good spine exam takes a LOT longer than 2 minutes. A good neuro/spine exam takes at least 10, probably closer to 15. I had to go through the fellowship training and testing in order to work independently in spine, I learned pretty quickly that the exams I had been doing in EM were pretty rudimentary. Learn how to do a good neuro exam, how a myelopathy presents, how to tell a cervical from a thoracic from a central cause, how to distinguish a PN from a radic, learn the 5 lower extremity reflexes, etc.

 

Also, for any part of Ortho....learn how to read images. Don't rely on radiology as they miss things. You should be able to read plain films, bone scans, MRIs, CTs, and US. Get really familiar with US...pretty much all of the injections, even peripheral ones are done with US now. Learn your bone density stuff. Learn injection approaches and how to do them....at least the common ones (knee, subacromial, troch, etc.).....

 

Most of all....Have fun!!

  • Upvote 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More