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.
Other Causes, Symptoms, Signs, Treatment, Prognosis, and Types of Acute Knee Pain
Description: Both the quadriceps and patellar tendons may rupture partially or completely. Quadriceps tendon rupture typically occurs in recreational athletes older than 40 years (this is the injury President Clinton suffered while jogging), and patellar tendon rupture typically occurs in younger people who have had previous tendonitis or steroid injections to the knee.
Symptoms and signs: Rupture of either the quadriceps or patellar tendon causes pain (especially when trying to kick or extend the knee). Those people with complete ruptures are unable to extend the knee. The patella is also often out of place either upward (with patellar tendon rupture) or downward (with quadriceps tendon rupture). The patient can usually notice a difference in appearance when comparing his/her knees.
Treatment: Tendon ruptures should be evaluated urgently. Tendon ruptures generally require surgical repair. A partial rupture may be treated with splinting alone.
Description: Injuries to the meniscus are typically traumatic injuries but can also be due to overuse. Often, a piece of the meniscus will tear off and float in the knee joint.
Symptoms and signs: Meniscal injuries may cause the knee to lock in a particular position or either click or grind through its range of motion. Meniscal injuries may also cause the knee to give way. Swelling typically accompanies these symptoms although the swelling is much less severe than with an ACL injury.
Treatment: Meniscal injuries often require arthroscopic surgical repair. A locking knee or a knee that "gives" should be evaluated for arthroscopic repair.
Description: Dislocation of the knee is a true limb-threatening emergency. This is also a rare injury. Dislocation of the knee is caused by a particularly powerful blow to the knee. The lower leg becomes completely displaced with relation to the upper leg. This displacement stretches and frequently tears not only the ligaments of the knee but also arteries and nerves. Untreated arterial injuries leave the lower leg without a blood supply. In this case, amputation may be required. Nerve injuries, on the other hand, may leave the lower leg viable but without strength or sensation.
This injury can be due to a motor vehicle accident where the patient's knee or leg hits the dashboard.
Symptoms and signs: Knee dislocations are severely painful and produce an obvious deformity of the knee. Many dislocations are reduced or put back into anatomic alignment spontaneously. As this occurs, many will report feeling a dull clunk.
Treatment: If the knee dislocation has not been put back into place (reduced), the doctor will immediately reduce the dislocation. Medical treatment, however, does not stop here. Whether a dislocation reduces by itself or is put back into place in the hospital, it requires further evaluation and care. After reduction, people with these injuries are observed in the hospital, where they usually do a number of tests to ensure that no arterial or nerve injury has occurred. If such an injury is found, it must be repaired immediately in the operating room.
Dislocated kneecap (patella)
Description: A common injury caused by direct trauma or forceful straightening of the leg, such as an injury that happens when serving in volleyball or tennis. Patellar dislocation is more common in women, the obese, knock-kneed people, and in those with high-riding kneecaps.
Symptoms and signs: If you have this injury, you will notice the patella being out of place and may have difficulty flexing or extending your knee.
Treatment: The doctor will pop the patella back into place (reduce the dislocation). Even if the patella goes back into place by itself, however, it needs to be
X-rayed for a fracture. After reducing the patella and ensuring the absence of a fracture, the doctors will treat these injuries by splinting the knee for
three weeks to allow the soft tissues around the patella to heal followed by strengthening exercises to keep the patella in line.