Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
History: Even in today's world of technology, physicians rely on a detailed history and examination more than any single test.
The doctor will typically want to know the exact nature of the pain.
Where in the knee is your pain?
What does the pain feel like?
Has it happened before?
What makes it better or worse?
How long have you had pain in the knee?
The doctor will also want to know a bit about you.
Do you have any major medical problems?
How active is your lifestyle?
What are the names of the medications you are taking?
The doctor will want to know about any related symptoms.
Do you still have normal sensation in your foot and lower leg?
Have you been having fevers?
Physical examination
The doctor will likely have you disrobe to completely expose the knee.
The doctor will then inspect the knee and press around the knee to see exactly where it is tender.
In addition, the doctor may perform a number of maneuvers to stress the ligaments, tendons, and menisci of the knee and evaluate the integrity of each of these. An experienced health care professional will be able to make a preliminary diagnosis based on this examination.
These maneuvers can establish potential tendon, ligament, or meniscus injuries.
Depending on your particular history and examination, the doctor may suggest
X-rays of the knee. X-rays show fractures (broken bones) and dislocations of bones in the knee as well as arthritic changes and abnormally large or small joint spaces.
Rarely, the doctor may order a CT scan (a
three-dimensional X-ray) of the knee to precisely define a fracture or deformity.
Both X-rays and CT scans are excellent for diagnosing fractures. They both are also poor, however, at evaluating soft-tissue structures of the knee such as ligaments, tendons, and the menisci.
In contrast to CT scans, MRIs do not image bones and fractures well.
Also in contrast to CT scans, MRIs are excellent for evaluating ligaments and tendons for injuries.
Fluid removal
The knee and all bursae of the knee are filled with fluid.
If your symptoms suggest infection, inflammation, or certain types of arthritis, your physician may
use a needle to remove fluid from the knee.
The removal of the fluid will sometimes decrease the pain you have been experiencing and make it possible for you to bend your knee.
This fluid will then be analyzed to better clarify the diagnosis and detect
infection.
Crystals, which suggest crystalline arthritis, often can be seen under the microscope.
Blood tests: The doctor may also elect to perform certain blood tests to evaluate for signs of infection or diseases such as rheumatoid arthritis and diabetes.
Arthroscopy
The orthopedic surgeon may elect to perform arthroscopy if you have chronic knee pain.
This is a surgical procedure where the doctor will
place a fiberoptic camera within the knee joint itself.
By doing so, the surgeon may be able to see small particles in the knee or to look more closely at damaged menisci or cartilage.
The doctor may also be able to repair damage by shaving down torn cartilage or removing particles from the knee while the camera shows the inside of your knee.
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Chronic PainChronic pain is pain that persists for a period of six months or longer, and is the result of a long-standing medical condition(s) or damage to the body. Common...learn more >>
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