Matt+Gustafson

=Arthroscopic Surgery= toc

** __Goals__ **
The goal of this project was to learn as much as I could about arthroscopic surgery and how it could positively help athletes. I also wished to find out more about what it meant to be an arthroscopic surgeon (salary,work time,enjoyment,etc). Along with learning about arthroscopic surgery, I wanted to find out more about how the entire process of surgery is done to ensure the safety of the patients.

**Discoveries**
The most common signs of needing shoulder surgery are pain, swelling, numbness of the shoulder, weakness of rotation, color change or limited range of motion. Some of the most common shoulder injuries are: torn rotator cuffs, torn labrums and fractures in the shoulder bones. All of these injuries can occur during athletics. (1)  Another shoulder injury that is common in athletes and people who lift weights is injury to the AC joint. The AC joint is at the top of the scapula, directly above the shoulder socket. The joint is between where the collarbone connects to the scapula, forming a small bump. The joint is made up of a meniscus in the middle and cartilage surrounding it. The clavicle is held together in the joint by the coracoclavicular ligaments. The most common way of injuring the AC joint is by falling directly onto the joint area. A dislocation of the AC joint is when the clavicle breaks away from the collarbone and this is extremely painful. A sprain is when the ligaments holding the two bones together are stretched. There are three grades to an AC joint sprain. Grade 1 is when the ligaments are only stretched out; grade II is when then ligaments are slightly torn and grade III is when the ligaments are completely torn from one another. An AC joint injury is the most severe when one can see an irregular bump near the joint which is formed when the clavicle breaks apart and can stick up under the skin. The AC joint is used in such lifts as the military bench press.(2) For an AC joint to need surgery the patient’s joint must be severely painful and the joint must be either sprained to the point where the joint needs to be altered for it to work correctly, or if it has been torn. One condition that is common in weightlifters is the “weightlifter’s Shoulder”. The scientific name is Distal Clavicle Osteolysis. Lifting heavy weights in a movement over one’s shoulder can give you pain in the AC joint. One way to fix the AC joint through surgery is using the Mumford procedure. This procedure uses arthroscopic tools to remove the end of the clavicle so that the end of the bone can be re-attached to the collarbone. The Mumford procedure is typical for patients with “Weightlifter’s Shoulder”. In other cases where the injury causes more severe dislocation of the bones or tearing of the ligaments, the surgery procedure will have to be changed. One alternative to the Mumford Procedure for patients with more serious problems can be then Weaver-Dunn procedure. The surgeon would make a small incision above the AC joint, remove the end of the clavicle and then move the ligament form the bottom of the collarbone to the clavicle.(2) The ligaments being moved over will replace the torn ligaments. The downside to this procedure however is that it can only be done in open surgery, not orthopedic surgery. For the rehabilitation process, the patient will be in a sling and certain shoulder exercises will help to add more mobility for the shoulder as it heals. The Weaver-Dunn procedure will take a few weeks longer before the shoulder exercises can begin. (3) The labrum is located inside the shoulder socket. It is where the humerus meets the shoulder blade. In the joint, there is one kind of cartilage called the articular cartilage and there is another type of cartilage that makes up the labrum. The labrum cartilage is more fibrous which helps the socket to stay intact. The job of the labrum is to deepen the socket and allow the “ball” to stay in place. This is why when a labrum is torn it can force the ball to slide out of the socket and cause extreme pain and limited mobility. The labrum is also where the bicep muscle connects to the arm through a tiny tendon. If the area of the labrum that connects to the bicep is torn or stretched, the patient can have trouble with the mobility of their inner arm. (3) There are a few forms of labrum tears. One is when the ligament is completely torn off the bone. This usually occurs when the bone is dislocated and the movement forces the ligament to tear completely off the bone. Another form is when the labrum is slightly torn and rubs up against the bone to the point where it is not smooth and no longer works to hold the socket in place correctly. Another form is the SLAP lesion. This stands for Superior Labrum Anterior and Posterior. This is when the tendon connecting the labrum and bicep muscle is torn. (4) For an ACL tear, it is when the Anterior Cruciate ligament is torn. The ACL joint’s job is to limit the mobility of the knee. ACL tears are seen in sports often, and about 80% of the injuries are non-contact injuries. Most patients complain of hearing a “pop” when their ACL tore. Before surgery, the doctor checks the knee ligaments through an MRI and tests the mobility and stability. Surgery is not always needed for a torn ACL if one does not participate in athletics that demand the ACL. An example would be an elderly man who does not do much physical activity, he may not need surgery because one can operate normally without the ACL. If one does need surgery, the repairing of the ACL is called ACL reconstruction. The patient will need a donor graph to replace the torn ACL. This means that the surgeon must take the torn ACL out of the knee of the patient and insert a healthy ACL and connect it to the bones. After surgery, a brace should be worn to hold the graph in place in order for it to grow and connect to the bone. (4) Reference 1. “The AC (Acromioclavicular) Joint.” www.scoi.com. HealthPresences,Inc., n.d. Web. 18 Apr. 2011. . 2. Alden, Anton. “AC Joint Injuries: Weightlifting Exercises to Avoid .” Livestrong.com. Livestrong, n.d. Web. 18 Apr. 2011. . 3. Jonathan, Cluett. “Shoulder Pain.” orthopedics.about.com. Medical Review Board, n.d. Web. 18 Apr. 2011. . 4. Mcfarland, Edward. “What is a Labrum/‌Labral Tear?” Hopkinsortho.org. John Hopkins Medicine, n.d. Web. 10 Apr. 2011. .

Challenges
Some of the challenges that arose during this project were, the hours that I was able to watch surgeries, no camera rule in the operating room, and procrastination. It was difficult to find a time when both the doctor and I were able to work together. The busy schedule at school and the fact that the doctor only worked in the operating room on wednesdays, was a difficult thing to overcome. The hospital had a "no camera rule" in the operating room which made it increasingly difficult to remember the exact situation that had occurred and a useful way that I could reiterate the information I had gained to the class without the exact pictures. With most students, waiting to the last minute for this project definitely heightened the level of challenge on this project.

Solution
One solution that made my project possible was that Mrs. Sweeney and the school allowed me to miss a day of classes and go to observe a surgery at Winchester Hospital. Without the ability to miss school, it would have been impossible to get a chunk of time where I could have observed surgeries like I had. At the end of the day of surgery, I asked the doctor if I could have a copy of the pictures he had taken during the surgery, he had the patient sign a waiver allowing the transaction and I was lucky enough to be able to present the pictures to the class.

Looking back
**5 Things you wish you knew before you started the project**
 * 1) Not to wait until the last minute, start early.
 * 2) Ask Mrs. Sweeney for help often, It will help to keep you on track and to make sure you are doing the correct format.
 * 3) Take the checkpoints along the way very seriously, they will help to avoid procrastination.
 * 4) Pick a subject that you will be very interested in. This will make the hours spent working on the project much easier and more enjoyable.
 * 5) Begin planning times for working on the project (such as weekends) because if you leave it for the last week, it will interfere greatly with other class work.