The REHAB DEPARTMENT > Soft Tissue Healing Problems - Arthrofibrosis

Scar Tissue Diagnosed -- How?

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eastsidegirl:
I had a second MRI done a few months ago.  The second dr. thinks it may be a scar tissue problem (the MRI report did not indicate in the Impression part that there was any scar tissue).  My question is:Can scar tissue be seen on an MRI or X-ray?  If it can be seen on an MRI is it always noted in the "Impression" part of the report?

Can someone have a scar tissue problem that does not show up anywhere (MRI, etc)?

What other way is scar tissue diagnosed as being the cause of one's pain?  As always, thanks to all of you.

Sheila

P.S. As you can tell I didn't learn much from the "new" doctor because as most doctors I have encountered they double talk you (probably think we wouldn't know what they are talking about anyhow!!)

eastsidegirl:
One more question I forgot to ask :-[:  Does scar tissue supposedly near the fat pad (I think) ever soften or something and go away or at least shrink, perhaps with exercise?? on it own?  Or is the only recourse to have it surgically removed??

Thanks again :-*  

Heather M.:
Sheila,

Sorry your new doctor didn't have a lot of answers.  I'm afraid you'll often find that to be the case when you are dealing with people who don't have a lot of experience with severe arthrofibrosis.

As for your questions:  Yes, it's possible--even probable--that severe cases of scar tissue will not show up on MRI.  Often, you will see the changes that the scar tissue has brought about instead, especially if you have an x-ray.  These changes include decreased joint space, low or high riding patella, extreme lateral tracking or tilt of the patella.  These are just some examples.  The symptoms and signs that show up on diagnostic tests depend on where the scar tissue is in each patient.  I've had three MRI's on my left knee, and only on the last one did scar tissue show up.  And that was only because it was a huge fibrotic chunk of it over my lateral release site--it was over an inch long.  So the radiologist noted it.  If they see something that is not normal, they will note it in their impressions.  

Be sure that you get the full, multi-paragraph version and not just their first thoughts on doing the 'wet read' right after your MRI is done.  The MRI is read twice; once while you are still there, so the radiologist can determine that it was done adequately and to ensure that you don't have a serious or life-threatening issue.  That's the wet read, and it's done in maybe thirty seconds.  The second, full reading is done within 24-48 hours and is much more extensive.

So anyway, it is very possible to have scar tissue and not have it show up.  For me, the best way to show it was to look for the complications in a full x-ray series--my patella baja has always shown up.  Also, a hands on exam by someone who really knows scar tissue should be enough to tell the doctor all he needs to know.  But the surgeon needs to know what he's looking for...unfortunately, a lot of them don't.  On the exam, the doctor will assess patellar mobility, location, tilt, and look for any cracking or grinding.  Grinding on terminal extension (the last few degrees before going straight) is a good sign of scar tissue around the patellar tendon and under the kneecap (and it usually wraps around the fat pad).  Restricted flexion is usually a sign of bands of scar tissue above or below the knee, and often in the lateral or medial gutters.  An inflamed fat pad can be a symptom of a lot of things, but scar tissue is usually top on the list.  In my knee, this hurt right when I was beginning to bend the knee--the patella would actually nip the fat pad, kind of like biting your lip repeatedly.  It really hurt.

I'm sorry to say that I've never had scar tissue go away on its own.  If the scar tissue is blocking your flexion, it may be possible that you can keep stretching it and learn to live with any issues it might cause (I couldn't, though).  But for scar tissue under the kneecap, around the fat pad, and under the patellar tendon I've always had to have it removed after conservative therapy failed.  And you really shouldn't wait around, because the longer scar tissue stays in there, the greater the chance that any changes it causes are permanent.  Most specialists agree that you have six month after onset (original surgery) to get the scar tissue taken care of if you want a full recovery and normal activity levels.  Mine didn't get dealt with for 18 months and now I've got much worse problems than a few adhesions.  My kneecap is completely pulled down out of place and sunk into the joint, leading to bone on bone contact.  I'm now on the TKR express, as my last PT pointed out.

I know I sound like a broken record, but I can't urge you strongly enough to see a real scar tissue specialiast.  There are a few around, but you may very well have to travel.  Cincinatti Sports Med has done some great work, as has my doctor in Vail.  Janet is doing much better after seeing her specialist as well.  When I saw a surgeon who wasn't experienced in scar tissue cases, I only got worse, so it's a good thing that you haven't jumped into treatment.  But if you do have scar tissue, the clock is very much ticking.  I wish I had better news for you.

Heather

eastsidegirl:
Dear Heather:  Wow you sure are knowledgeable.  Thanks for all the info you have given me.  From what you describe about the fat pad being nipped by patella sounds like something I might be having.  In addition I get that rubbery feeling under my patella but sometimes (often) it shifts to the lateral side. Plus my knee is always stiff.

Twomore questions:  does cortisone ever help to relieve scar tissue problems? and seeing what my diagnosis was (underneath) what do you think the scar tissue came from.  According to my doctor my procedures were no big deal!!!

Thanks again.

Sheila

Amanda:
Dear Heather

What about an Ultrasound?  Can you see scar tissue with one of these?  The reason I ask is I have Common Peroneal Nerve Dysfunction and I don't know what has caused it (other than it starting after the operation).  And i was wondering if an Ultrasound would show if it is scar tissue disturbing the nerve?  I just want to know for sure whether it is.  Thanks again.

Amanda

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