Meniscus :

Muscle atropphy and swelling in Bangkok - - Posted by JerC (JerC), 18 December 2004


I'm living abroad in Bangkok, Thailand and even though My OS was very highly recomended( graduated from Washington medical school St. Louis) he has given me little or no reason to trust his post operative diagnosis.  I also don't feel that I have the luxury of getting a second opinion here in BKK because this OS is the top gun....Doctor to the royal family, sports stars ect.  I'm at the point of trying to determine whether to catch the next flight back to the US or not.  

I'm 31 years old and I had a medial bucket-handle tear repaired nearly 8 weeks ago.  1) My knee is still extremely swollen, 2) the muscle in my thigh is extremely atrophied,  3) the pain in my knee still keeps me up @ night, 4) the OS has prescibed no PT to this date 5) My range of motion is a pultry 45 degerees. 6) I'm walking without crutches but it's still quite painful.

Am I over reacting  I would sincerely appreciate any thoughts or advise what so ever.  

Thank you,
The Bangkok Gimp



Posted by andrewc (AndrewC), 18 December 2004

Hi there JerC

Just to get a bit more info...


Are you very active / sporty or not??
Was it a sporting injury?

Also, is the OS you are seeing a specialist knee OS?? (ie/ he does only KNEES?) as you say he is doctor to the Royal Family out there...do you mean general doctor or general orthopaedic doctor?

From the condition you say you are in....this is NOT where you should be 2 months after a meniscus repair.
Granted it is quite a major procedure in terms of recovery, certainly for bucket handle tears as they are large by their very nature.
I had a repair to a huge bucket handle tear to my lateral meniscus seven months ago and I am still recovering!  

The extreme swelling (depends on HOW xtreme) might be ok as my knee was really swollen for 2-3 weeks after but still a bit swollen for 3 months (not much tho)

You SHOULD be doing some form of Physio. The quadraceps that you say are atrophied are vital in the stability of the knee joint and you should be doing SLR's (straight leg raises), quad contractions as a safe Minimum.

Your ROM of 45 degs is really poor and again physio may help to address this...but you REALLY NEED to get a second opinion, if it were me I would probably go back to the US to get it if need be.... Is there No one else you can see in that region??

This address is taken from this websites "knee surgeons" link....I do not know ANYTHING about them tho but maybe you could try there if no other options?

Dr Panya Wongpatimachai,
Bumrungrad Hospital,
33 Sukhumvit 3 (Soi Nana Nua),
Wattana,
Bangkok 10110,
Thailand.
tel +66 2667 1000
fax +66 2667 2525

Anyway, the best thing you can do is RICE the knee (rest,ice,compression,elevation). Look up some gentle exercises for your legs to get them stronger until you start pt.
The fact you are walking is really good but you should be further on than you are now and you should be doing physio no doubt. Will this OS not organise any for you or what?

Post back if you can

All the best

Posted by JerC (JerC), 19 December 2004

Hey AndrewC

Thanks for the info!

I am indeed an active individual, and my knee injury was the result of a sports injury.  That’s why I opted for the repair, if the OS deemed possible, instead of a menisciotomy.  I hoping I won’t regret it.

My OS serves as a member of a medical council that handles the medical affairs of the Royal Family, but he is trained as a knee and shoulder specialist.  

When I mentioned that my knee was still swollen …..I mean it is SWOLLEN.  There’s been minimal swelling reduction since I’ve left the hospital.  And this swelling is the ‘reason’ my OS has restricted my ROM to 45deg and no PT.   Actually I don’t know if swelling is the correct word, because I think it’s full of blood and senovial fluid.

One of the reasons I don’t have much faith, in said OS, is because he didn’t prescribe RICE for post-op.   He made no mention of elevating my leg, didn’t stress icing, and told me I could load my knee as long as I wore my crappy knee brace.  As you can probably tell, I wasn’t real happy with the knee brace he gave me either.  It was an archaic design out of Taiwan, which had only one neoprene strap for the thigh and one neoprene strap for the calf.  This allowed quite a bit of sloppy movement and neoprene is not the material an individual wants to be sporting in balmy BKK……so I found a better brace online and had it shipped over.  

Anyways, I just received a referral this morning for another OS here in BKK.  This OS is out of Harvard med school with all the necessary certs, so hopefully he’ll say something that makes sense:
Dr. Wichan   Karnchanatawan
Bangkok Hospital
My current OS is from the hospital you mentioned below (Bumrungrad Hospital), so I’m a bit relieved to find another qualified OS outside Bumrungrad.  Bumrungrad Hospital is a class A organization and I’ve had nothing but great care until this situation, but I fear the OS below, Dr Panya Wongpatimachai, might be tentative to step on his colleagues proverbial toes.    Does my logic make any sense to you?

My appointment is in 2 days time so I’ll post the outcome.

Thanks again and Happy Holidays

Posted by sienna (sienna), 21 December 2004

Hi there,
As Andrew mentioned, you should be in pt particularly since that you have such poor rom.  You may even find that once you get the knee moving, some of the fluid can move away on its own.  I had a repair last year and even now I find that if I don't keep it moving it feels like it is swelling on the inside (nothing appears on the outside).  I find hydro and swimming very helpful in this.
The pain you are in could well be a result of the atrophied muscles.  You need to do the quad contractions and slr every hr to start to build up some strength.  I found that once I started to do this my pain eased and I was finally able to stand up.  It's great that you are walking around so this shows that you have some token strength.

If you feel that the 2nd os might not want to step on the first one's toes, then don't mention who did your op.  Tell them that you just want to get an objective opinion on what is happening so that you can get better and move on with your life.  If he doesn't recommend pt then find one yourself.  I don't know how the system works over there but here in Aust, you don't need a referral for pt.  You jsut turn up.

good luck with your appt.  I'll be interested to see how it goes.
Take care.

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