Dr. Austin: Welcome to an MUSC Health Podcast. I'm Dr. Linda Austin. I'm interviewing Dr. David Geier, who is an orthopedist, and Director of MUSC Sports Medicine. Dr. Geier, lots of patients with injuries I guess especially of the shoulder and knee end up with arthroscopic examinations. Just what is arthroscopy?
Dr. Geier: I think that's a fantastic question. It's a scary word, and can be terrifying for a patient because it is surgery. You have physicians I think unfortunately that tell patients “Oh, we'll just scope your knee” or “Oh, we'll just scope your shoulder” and it's really not that simple. It truly is surgery. It may be done through two or three little stab incisions, really big enough to get an ink pen through, so very minimal incisions and doing very large surgeries through that. But it is truly a large surgery, albeit through little tiny poke holes
Dr. Austin: So let's take shoulder. Tell us what a typical arthroscopic procedure of the shoulder might entail, what kinds of injuries or problems do you do that for?
Dr. Geier: Sure. Many, many procedures can be done through an arthroscopic procedure of the shoulder, namely work on it to fix a rotator cuff tear, work on it to repair tears of the labrum, such as in shoulder dislocations. There's procedures you can do to the biceps' tendon, and some other type of work in the shoulder. But the main two you really see are for rotator cuff surgery and for shoulder instability or dislocations.
Dr. Austin: And what are you actually doing?
Dr. Geier: It's a great question, and I think many people are amazed at how these complicated surgeries can be done through three or four little stab incisions But through the little poke holes, one of which you're looking with a camera into the shoulder. Then through the other small little stab incisions you're maneuvering instruments, suture passers, grasping devices to pass stitches through the tissue, and then using various forms of suture anchors, little plastic anchors to tighten up or tack down whatever the repair, the structure that needs to be fixed is. But it's all done, essentially it kind of looks like a video game through very small incisions and long instruments that go into the shoulder to repair whatever the tissue is.
Dr. Austin: Now, you mentioned sutures I'm having a hard time sort of visualizing sort of a needle with long thread. It can't be quite like that.
Dr. Geier: Sure. Yes, and no. They're stitches. Typically they're passed with a variety of different devices, but they're stitches just like you see under the skin made of different materials. But they're passed with long instruments that have needles or have hooks on the end to pass something through the tissue, and then you manage to shuttle the stitch through. It's fairly complicated compared to the old, big open procedures that accomplish a lot of the same result, but clearly has a lot of advantages.
Dr. Austin: Such as?
Dr. Geier: Well, I think namely recovery time. You're trying to get two to three small little one centimeter incisions to heal versus a long ten centimeters of a three to four inch incision to heal. I think in terms of getting your range of motion back it's much quicker. I think people are having less pain so they rehab a lot quicker. And there's a cosmetic appearance to it. I mean, I think in this day and age people want incisions where you can barely see the scars.
Dr. Austin: Let's take the knee. What are some of the common injuries or problems that use arthroscopy on the knee for it?
Dr. Geier: There's really just a tremendous number of procedures with the kn