Undergraduate: Orthopaedic surgeons first train as doctors this involves a six year university education. Degrees awarded: MB, BCh, BAO. LRCP & SI (Royal College of Surgeons in Ireland) Internship: Following this one year is spent as an intern in a teaching hospital under the supervision of the Professors of Medicine and Surgery. Basic Surgical Training: All Orthopaedic surgeons must train as General Surgeons and perform basic procedures such as hernia repair, appendectomy and trauma surgery. This can take two or three years. There is a Fellowship examination at the end of the surgical scheme. May doctors also do research and complete a higher degree in Surgery MD or MCh. Degrees awarded: FRCSI (Fellowship of the Royal College of Surgeons in Ireland) MCh (Master’s in Surgery) MD (Doctorate of Medicine) Higher Surgical Training: Admission to higher surgical training in Ireland is by competition and many trainees spend years trying to get onto the ‘training scheme’. This scheme lasts for six years. There is an Intercollegiate exit examination which is held with the College of Surgeons in Ireland, London, Glasgow and Edinburgh. Degrees awarded: FRCSI (Tr & Orth) (Fellowship in Orthopaedics and Trauma) Fellowship Training: Orthopaedic surgeons usually take a year or two following training to pursue research interests or complete sub specialty training in an area of interest. May surgeons go to world renowned centres of excellence. Additional training is sometimes undertaken. DSM (Diploma in Sports Medicine) MMedSci (Masters in Medical Science) MSc (Masters in Sports & Exercise Medicine) PhD (Doctorate of philosophy) Consultancy: Orthopaedic surgeons can decide to work in a public capacity only, private capacity only or can elect to do both. Public consultants have to compete for a position by interview. These jobs are highly sought after and are coordinated by the Public Appointments Service. A persons joints can become angry and inflamed for many different reasons. They find that part of their spine or limbs may become red, hot, painful, swollen and they may lose some function. The term Arthritis is used to cover all of these conditions, although there are many different types that are treated in different ways. There are more than 100 kinds of disease that can cause arthritis. The most common forms of arthritis are: • Osteoarthritis (OA) • Rheumatoid Arthritis (RA) • Gout Less common forms are referred to as psoriatic and septic arthritis. Osteoarthritis is also known as degenerative joint disease. It is caused by injury or years of use. It results when the smooth cartilage between the bone joints wear out or is damaged by injury or disease. Arthritis can become worse over time as cartilage wears away and bones grind against each other during joint movements. One of the most important steps is to arrive at an accurate diagnosis. This requires a full evaluation and appropriate investigations by the Orthopaedic team. This is one of the main reasons that your general practitioner referred you to Mr. O’Grady. Many conditions may be treated conservatively with physiotherapy and injection therapy. Other non operative regimes can be co-ordinated as shared care between Mr. O’Grady and your General Practitioner. Occasionally your condition may require surgical intervention. This is often performed in hospital and may involve a local anaesthetic or a general anaesthetic. Some conditions are extremely rare and require a number of specialists in a multidisciplinary approach. If this is the case Mr. O’Grady will arrange to have you referred to the best available experts in that field. For more detailed information about specific conditions please refer to our patient Education section. Occasionally, Mr O’Grady will perform a joint injection. If this is the case, joint injections may decrease the accumulation of fluid and cells in the joint and may temporarily decrease pain and stiffness. WHAT USUALLY IS INJECTED INTO THE JOINT SPACE? Corticosteroids (such as Adcortyl) are formulated to stay primarily in the joint. They are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation and pain within the joint space WHICH JOINTS ARE COMMONLY INJECTED? Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, base of the thumb and small joints of the hands and feet. Hip joint injection may require the aid of an ultrasound or X-ray called fluoroscopy for guidance. Some small joints may be more easily aspirated or injected with aid of ultrasound. WHAT ARE THE RISKS OF JOINT INJECTIONS AND ASPIRATIONS? Occasional side effects include allergic reactions to the medicines injected into joints. Infections are extremely rare complications of joint injections and occur less than 1 time per 15,000 corticosteroid injections. Another uncommon complication is post-injection flare—joint swelling and pain several hours after the corticosteroid injection. If this happens,apply a cold pack on the affected area, elevate the limb, rest the limb and if necessary, take some oral anti inflammatory medication. ARE THERE SITUATIONS WHERE A JOINT INJECTION SHOULD NOT BE GIVEN? Yes. The most common reasons for not performing a joint injection are the presence of an infection in or around a joint and if someone has a serious allergy to one or more of the medications that are injected into a joint. Epidural injections are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program with a physiotherapist to provide additional benefit. While the effects of an epidural steroid injection tend to be temporary (lasting from a week to up to a year) an epidural steroid injection can deliver substantial benefits for many patients experiencing low back pain. The Epidural is carried out at the Hospital. You will not need to fast for this procedure. It is, however, necessary that you have someone drive you home after. You will have your blood pressure taken frequently following the epidural. Are there side effects? A dural puncture occurs in 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually improves within a few days. Rheumatoid arthritis is caused by inflammation of the lining of the joints. It tends to be present for many years. Rheumatoid arthritis usually affects many joints and can lead to damage of cartilage, tendons, ligaments, and bone. This may cause deformity of the joints. We do not yet understand the cause of rheumatoid arthritis as it varies from person to person. No. Rheumatoid arthritis may affect young and old people. Osteoarthritis can be found in young adults; however it usually becomes more of a problem with age.