Author Topic: Knee injury  (Read 993 times)

Knee injury
« on: June 22, 2019, 08:10:57 pm »
A friend, early 40s, has been to the gym and sprained their knee.  They were doing something called 'backward lunges' and the knee got out of line and bent sideways with a cracking noise and she collapsed in agony.  Luckily the gym staff were top-notch, did all the right things and got her off to A&E without delay. 

At A&E she was seen by a doctor then a surgeon, x-rays were taken which showed no fractures but the joint was too swollen and painful for a diagnosis.  Her circulation and nerves are ok however.  Eventually they fitted a knee brace, gave her some crutches and packed her off home with pain-killers.

She went back three days later for a MRI scan but they said the swelling prevented it and that there was blood collected round the joint.  She was told another appointment would be made and it could be at short notice.  We got the impression they weren't a big help. 

Six days on and the knee, still swollen and painful, can't be used. Her concern is she will get another appointment and they will again tell her it can't be diagnosed.

Unfortunately she is a couple of months into a new job that involves driving, walking and lifting after having been out of work following redundancy.  She wants desperately to get back to work and finds the uncertainty is driving her nuts, never mind the inconvenience. She doesn't know if she should just rest up, take mild exercise or what.

Any suggestions as to what more she can do, like trying her GP, would be much appreciated.
Sic transit and all that..

pixieannie

  • Partial to a dash of chainsaw oil
Re: Knee injury
« Reply #1 on: June 22, 2019, 08:44:15 pm »
Relating to my own recent experience with acute knee problems/injuries, I would suggest she speaks to her GP to ask if they can find out and explain what is happening.    I think it very bizarre that the hospital cancelled the MRI due to swelling, not least because, if surgery is necessary, later is not always the best option.  I am not an expert nor a medic but I would not be happy to be left with such uncertainty and in my own case, I've received excellent treatment but sadly, no cure.

Re: Knee injury
« Reply #2 on: June 22, 2019, 09:18:06 pm »
I quite often go and see a (private) physio as a first port of call for injuries now (I've been seeing her for a couple of years for chronic stuff - like to add a bit of variety every now and again...)

Maybe find one that's done a lot of work with footballers!

Re: Knee injury
« Reply #3 on: June 23, 2019, 10:03:23 am »
There's a pretty good set up at the gym and I think they would have given her as much physio help/advice as they could but MRI scans they don't do.  I'd imagine going private is not really an option, especially as she relies on bonuses that she will only get whilst working.

I think you are right pixieannie, her doctor might get things moving. We need a diagnosis asap so she will be knocking on the GP's door tomorrow.

Sic transit and all that..

caerau

  • SR x 3 - PBP fail but 1090 km - hey - not too bad
Re: Knee injury
« Reply #4 on: June 23, 2019, 10:32:52 am »
Having suffered my whole life (well since I was 17) with a major non-fracture ankle injury I would seriously advise just resting it and (unfortunately) putting up with the uncertainty* until it becomes more clear.
Knees are much worse than ankles with regards to soft-tissue injuries - i.e. with problems can ensue long-term -  and they can easily result in permanent damage that cannot ever really be 'fixed' - just mitigated with surgery to ligaments and/or cartilage to limit permanent instability (that's my right ankle).
That's a likely worse case scenario but I'd treat it as if it is - it doesn't sound very good.  If she's done her cruciate ligament in there somewhere then it's going to need surgery.


*Sadly this is the current state of the NHS.  My wife recently got diagnosed with a blocked artery in her leg - (after 2 *years* worth of problems that our GP clearly just though was a weak-woman whinging - he might as well have just said this frankly) - the doctor at the hospital told her they'd be in touch with an 'emergency' appointment in 'a couple of weeks'.  After SEVEN weeks and lots of complaining to the correct department in the hospital - when she finally tracked them down - she has finally been given an appointment next week ... they *had* lost her in the system.  We were just about to complain to PALS when she managed to sort it.


*And that's for a potential life-threating condition - don't expect fast efficient treatment.  I would start complaining to PALS (patient advice and liaison service) if they don't come up with something reasonably soon however.


[edit - reading the post prior to this]  GP *might* be able to help - but ours told my Phil that she'd have to ring the hospital herself -  but he was at least abled to give her their phone number  :facepalm:  - that's how she'd 'tracked them down'
It's a reverse Elvis thing.

Re: Knee injury
« Reply #5 on: June 23, 2019, 10:51:10 am »
problems that our GP clearly just though was a weak-woman whinging

Yeah; I nearly linked to this article in my first post: https://longreads.com/2019/06/21/yentl-syndrome-a-deadly-data-bias-against-women/

Wishing your friend tenacity and good healing, asterix.

pdm

  • Sheffield hills? Nah... Just potholes.
Re: Knee injury
« Reply #6 on: June 23, 2019, 01:08:04 pm »
I think it very bizarre that the hospital cancelled the MRI due to swelling, not least because, if surgery is necessary, later is not always the best option.  I am not an expert nor a medic but I would not be happy to be left with such uncertainty and in my own case, I've received excellent treatment but sadly, no cure.

To perform proper knee imaging with MRI, it is usual practice to use a specialised knee coil. There is limited space in such a coil and the knee may have been too large to get in if it was very swollen. There are other options, e.g. wrap around phased array coils and these are frequently used when scanning a knee is urgent or if the patient is in the immense size category.

2p worth:
Except for fixing fractures (in those cases where fixing is needed) knee surgery is not usually deemed "urgent" - it is usually done, if indicated, once the swelling has settled, disability is assessed and it is determined if such surgery will actually improve symptoms and/or function.
Things may be different in some cases, eg sportspeople, where there is a lot of money involved - eventual outcomes are rarely improved by diving in immediately rather than a week or three later with soft tissue injuries.

caerau

  • SR x 3 - PBP fail but 1090 km - hey - not too bad
Re: Knee injury
« Reply #7 on: June 23, 2019, 04:36:41 pm »

Things may be different in some cases, eg sportspeople, where there is a lot of money involved - eventual outcomes are rarely improved by diving in immediately rather than a week or three later with soft tissue injuries.


Absolutely - the thing is..... the medical profession is ... ummm... often not so good at getting this across.  Just randomly making you feel ignored and valueless tends to be how the system comes across.  It would be nice if they addressed this really.  I'm sure it's not really intentional on a person to person basis in the NHS.
It's a reverse Elvis thing.

Re: Knee injury
« Reply #8 on: June 24, 2019, 03:04:33 pm »
As well as help with diagnosis for certain injuries, physio can help with removing inflamation from around the area (and may be able to give your friend movements or techniques to do that herself). I doubt the GP is going to be able to achieve very much, and NHS physio referral can take ages, but I guess it's worth going and seeing if there's anything they can do.

Even in cases where it's highly paid sportspeople, they often have to wait for swelling to subside before they can MRI knee injuries. The other diagnosis methods rely on movement and or pressure on the joint to work out what is injured, so swelling also stops them from being very effective. RICE and physical manipulation to help with drainage are probably the only treatments available at the moment. :(

Re: Knee injury
« Reply #9 on: June 24, 2019, 08:18:55 pm »
Thanks for the replies and good wishes.  She did go to the GP today and they rang the hospital for her.  Apparently the MRI request is sitting on a radiologist's desk waiting for a radiologist to appear from somewhere.  It could take some time.  Meanwhile she has had to cancel her holiday because flying is too risky because of DVT risk.

Tomorrow she meets her boss to find out how she can have a role that lets her work without driving or lifting stuff.  Her boss sounds like someone who will try to help so that's good.  If she can't work, it'll be tricky, full on mortgage and ageing parent to support. 

I will put her onto PALS and hope they can help her get things moving.  I guess her gym trainer can advise on how to do the physio f.o.c!
Sic transit and all that..

Re: Knee injury
« Reply #10 on: June 26, 2019, 07:32:26 pm »
Some good news, her boss a case-hardened Glaswegian, has fixed it so she can go back to work doing light duties in a week or so and she will continue to be on the bonus scheme.

She got nowhere with the hospital so it's PALS next.
Sic transit and all that..

caerau

  • SR x 3 - PBP fail but 1090 km - hey - not too bad
Re: Knee injury
« Reply #11 on: June 26, 2019, 09:15:17 pm »
That *is* good news.  I hope you get somewhere with the hospital soon.  Could be a long road with a borked knee - very best wishes.  Very unlucky on the holiday but it does sound sensible to cancel.


We found out today (my wife *finally* got her scan) that she does NOT have blocked arteries, that's our good news too :)
It's a reverse Elvis thing.

Re: Knee injury
« Reply #12 on: June 29, 2019, 06:24:24 pm »
Thanks.  Pleased to hear your good news :thumbsup:
Sic transit and all that..

Re: Knee injury
« Reply #13 on: August 09, 2019, 09:12:39 am »
The operation takes place today at long last.  It was scheduled for the end of AUgust!

Last week she was given the results of her MRI scan by a surgeon she met earlier but he was not helpful so we took her to see her GP.  He wasn't available so she spoke to a practice nurse who gave her more information than anyone has so far and said she would try to progress it.

On Weds she was phoned and told her case had been moved to amber i.e. very urgent and she would be operated on today.

She saw the surgeon who will operate this morning who told her he only saw the scan on Weds and that it was kneecap damage on both sides and for it to be a simple operation it should have been done asap after the injury i.e. within seven days not fifty-four days.  He is confident he can fix it if at all possible but otherwise it will be necessary to rebuild the knee.

We will be very annoyed if the delay leads to serious issues.
Sic transit and all that..

Re: Knee injury
« Reply #14 on: August 11, 2019, 09:04:08 am »
It was apparently a re-construction job needed; something called 'ORIF' that involved finding the bits of bone, some from the top of a leg bone and pinning it all back together.  The op took about 150 minutes.  The after effects are a great deal of pain and morphine.  Due to the danger of muscles pulling the repairs apart she can't place any weight on the leg till they are happy it has all knitted together.  Four weeks at least.  It seems strange that the diagnosis was so hard to reach considering the scanning techniques available but what do I know?

Whether the delay has significantly changed the prospects of a complete recovery is too early to say but at least the surgeon was pleased with what he had managed to achieve.   

For the time being she will have to remain in a recovery ward which fortunately is a single patient room with plenty of staff available. 

Despite its shortcomings the NHS is better than the alternative.
Sic transit and all that..

Re: Knee injury
« Reply #15 on: August 11, 2019, 01:53:26 pm »
ORIF simply means open reduction and internal fixation.  It is the short hand for you are broken and we will cut you open and guddle around inside to put you back together again using various things we borrowed from Meccano or B&Q.



I work in the NHS and think the NHS is not bad but I certainly do not think it is world class.  The funding model of Free at Point of delivery is better than the American model, I do agree.  Is the NHS better than the other social insurance models? I do not think so.