Week 3: Orren Shachaf

This week, both clinical and research work picked up. During Dr. Moore’s Medicaid clinic—which she holds once a month—I saw some particularly difficult cases, including one 49-year-old woman with bilateral frozen shoulder (also called adhesive capsulitis), which is characterized by joint stiffness and subsequent pain that results in limited motion, either through stiffness or as a pain response.  Another one of these cases was a 21-year-old male who had had acute lymphoblastic leukemia and, as a result of his sustained use of steroids (which decrease immune system activity), developed avascular necrosis in his knee and got a total knee replacement; at the clinic—two years after his knee replacement—his knee was nearly double the width of this calf, and he had about 10-15 degrees of motion, making it extremely difficult for him to walk and perform other normal, daily tasks. He had been referred to Dr. Moore, since she performs arthroscopic knee surgeries for fibrotic tissue cleanup, but the amount of scar tissue in his knee joint would be too time-consuming for her to perform arthroscopically; further, Dr. Moore noted some calcification behind his patella (heterotopic calcification), which was most likely the biggest factor inhibiting his motion. Ultimately, he will likely need to get a fully new total knee replacement, which was a really unfortunate conclusion. In addition to in-clinic patient interactions, I observed three arthroscopic knee surgeries, which were all cleaning up fibrotic tissue formation following prior knee surgeries.