The REHAB DEPARTMENT => General rehab issues and pain problems => Topic started by: Buzby on June 22, 2009, 07:04:33 AM

Title: Some questions post patella dislocation.
Post by: Buzby on June 22, 2009, 07:04:33 AM
3 and a half weeks ago my patella was dislocated after I was butted in the leg by a ram.  He hit it on the outside of my leg and the patella popped out (and straight in again) to the inside.

Hospital put me in a cricket bat splint and I've done r.i.c.e. Still some swelling but tiny compared to how it was the day after impact!

I've just started to try regaining some movement and muscle.  I can bend slightly, the amount of bend improves a little each day, and I am now walking with just one crutch and can do a few steps without any crutches.

The main concern I have is that I cannot lift my leg straight up. I can swing it sideways from the hip, but to lift it up for anything, I have to grap the ankle and physically lift it.  Is this a worry or could it just be where things have shut down a little from the trauma and the enforced mobility?  My thigh muscles have withered to nothing and I'm not sure of the best way to build them back up without being able to do leg lifts?

Any thoughts, opinions or advice, gratefully received.

Title: Re: Some questions post patella dislocation.
Post by: John42 on June 22, 2009, 08:50:29 AM
Hi Buzz

You have not made any mention if the knee was x-rayed or not - My view is to go back to the hospital and get an Orthopaedic Consultant to give your knee a proper inspection with a possible MRI scan - this should give you a better picture of what is going on. 

Important - DONT LEAVE IT.

Best wishes

JohnK/ Manchester UK
Title: Re: Some questions post patella dislocation.
Post by: Buzby on June 22, 2009, 09:38:54 AM
Hi John,

Yes they did xray it and said all looked fine there.  They didn't give me any follow up appointments which at the time I was quite pleased about - have had enough injuries in the past to know it's usually a 2 hour wait just to be told to keep doing what you're already doing and come back next week. But now I feel a bit lost as to exactly how much or how little I should be doing with it.
It seems to be responding well to the movements I'm starting to do, it's just the lifting thing that has me a little concerned, but then again, the muscle is so wasted it's like there's nothing to lift it with!

Going to make an appointment with my GP, start from there, but just wondering if anyone else has had this after a dislocation, maybe its just a normal part of the healing?

This is actually the 2nd time this has happened to me. 12 years ago a dog ran into me and dislocated my patella - same leg but that time it came out to the outside.  I couldn't lift the leg then either, but thought that was because I also had a tear in the quad. I don't think that's the case this time, although it's not been scanned, with the tear there was a LOT more pain than I've had this time and no way could I have been walking on it after just 3 weeks.

Title: Re: Some questions post patella dislocation.
Post by: John42 on June 22, 2009, 09:55:31 AM
Hi Buzz

Noted your comments - but noted the fact that you cannot lift your leg - could be a Patella TENDON problem which would not show up on an ordinary X-Ray - therefore suggest once again, have it rechecked or seek a second opinion  - the problem will not go away on it`s own.

Best wishes

Title: Re: Some questions post patella dislocation.
Post by: Buzby on June 22, 2009, 10:43:47 AM
Thanks again John, I do intend to have it rechecked.

I'm not an anatomy expert so might be totally wrong here, but doesn't the patella tendon have to do with bending and straightening from the knee? I can do that, (well, within the confines of how much I can bend it so far, which isn't a lot, but certainly there is movement there.) it's straight leg lifts I cant do.

Last time the ability to lift it did just come back on its own, but as i said, I thought that was to do with the tear in the quad, and I'm reasonably sure I don't have that this time.

Will see what further investigation brings...

kind regards

Title: Re: Some questions post patella dislocation.
Post by: Catrin on June 26, 2009, 07:56:34 AM
Hi there!
Well, regarding my rather vast experience of dislocations (4 severe, several mini-subluxations, 3 arthroscopic sugeries), my piece of advice will be this:
1. your question about lifting your leg - yes, the muscles do shut down after dislocation (or any trauma/surgery) - that's partly the kinda "sprain" your tendons/ligaments have during one as muscles themselves don't work without them.   3 weeks is pretty much to not be able to lift your leg at all - the muscles start building up strength by that time UNLESS you don't work on strenthening them like physiotherapy, post-traumatic rehab exercises - if you don't, then what do you ask from your them?  ;)    You need to start exercising to switch the muscles on - start with lifting your leg bent and while seated, when you do that - try do the same but with your leg straight.  That'll give your quads a workout.   Then - while seated with you leg bent lift your lower leg - i.e. straighten it - as much as you can.  that'll work out the lower leg muscles that help lift your leg straight.

Soon you'll be able to lift it - when you can (even a little bit) just lift and hold it + do some "pulsing" raises from the point you hold and up a little (the same technique as with abdominal muscles, btw  :) )

2. as for the consequences of the dislocation - an X-ray is by far not enouph as it doesn't show cartilage surface, ligaments etc.  You've got to have MRI done, perhaps also ultra-sonic to double-check about the soft tissue in your knee (the not-bone, i.e.).   A dislocation leads to patella-femoral ligaments (medial if it discolocates to the outside, or lateral - to the inside) tear - a complete or a partial one.  The question is - will you need to have them reconstructed to prevent patella maltracking or future dislocations. 
   You may have had partial meniscus tear - an x-ray doesn't show that.   
To cut it short - a good patella OS will tell you what damage's been done and how to deal it.
I totally agree that you shouldn't leave it - to prevent arthritis and knee instability.

A tendon tear would have shown in major pain - perhaps some micro-tear, but your story is v. unlikely you had that.
Title: Re: Some questions post patella dislocation.
Post by: Buzby on June 26, 2009, 09:37:55 AM
Thanks Catrin,
I've been working on the muscles all week and after just 24 hours of tensing them to 're-awake' them, had some lift. Can now lift high as I want, tho not without some pain to the knee itself.

Trying to work on increasing the bend now - that's the toughy, everything is soooooooo tight! I gain a tiny bit more bend each day but it never seems to feel any looser.  :(

You've raised another qestion for me tho- you seemed to think I should be able to do a lot more after 3 weeks than I can. (and it's 4 weeks now.) You talk about lifting it bended and bending and straightening from the knee, but I have very limited bend and at 3 weeks was still in my splint so had no bend at all.

When I had my first dislocation, they put me in a full leg cast for 6 weeks, so there was no chance of me bending it.  This time they put it in a cricket bat splint which they told me to leave on for 6 weeks - it's only because I decided to remove it and start getting it working again that I'm bending it at all. 

Given that the 2 dislocations were 12 years and 85 miles apart (i've moved house!) I assumed the immobility was standard procedure after a dislocation to allow all the stretched/torn ligaments/tendons to heal.  Is this not your experience then? And do you think it makes any difference if the dislocation in the result of an inherent problem in the knee as opposed to being physically whacked out by a forceful blow?

best wishes

Title: Re: Some questions post patella dislocation.
Post by: Smurf on June 26, 2009, 11:57:56 PM
You really need to get into some regular rehab with a trained physical therapist. I dislocated my patella three weeks ago, where I had to go to the ER and have it re-set and I walked myself out of the hospital, in a straight leg brace. I was in physical therapy, per OS orders, 2 days later, and had an MRI done just a few days after that. You need to get an expert in there to help you bend your knee and do leg raises without pain before it becomes too stiff. That's just my opinion.
Title: Re: Some questions post patella dislocation.
Post by: subail on June 27, 2009, 01:05:59 AM
I have to agree with John....sounds like a patellar tendon problem. We both have experience in that department. I went 10 months with a ruptured patellar tendon before they decided to do something about it. Don't leave it....get it checked out.....Sue
Title: Re: Some questions post patella dislocation.
Post by: Buzby on June 27, 2009, 07:52:26 AM
Smurf, mind if I ask how you dislocated yours? I'm still trying to understand how some people can even conceive of weight bearing or moving so soon and if it's to do with the nature of the injury.
I have a pretty high pain threshold but there is just physically NO WAY on either ocassion I could have even considered moving the knee after a few days!

With the first one this may have been because I had a tear in the quad muscle, there was a lot more pain and a lot of bleeding into the joint.
This one was less painful but still I couldn't possibly have taken weight on it or begun moving it in the first week.

Like I said, I'm not a wimp with pain, nor am I a stranger to injury and recovery, have had a total of 3 knee injuries and an arthroscopy, not to mention various pulls, tears, breaks and strains around my body (I'm kinda clumsy - when I had my last dislocation, I managed to break my toe on the crutches  ;D)   So I'm trying to figure out if the amount of trauma causing the injury makes a difference to the recovery?

Also still curious why my doctors want to immobolise to allow the over stretched ligaments and things to heal and other people's seem not to?

subail, thanks for your input, I'm sorry you and John have had tendon problems, but I really don't think that's the problem with mine. Actually, I don't think I still have a problem with mine, all seems to be going well now I've got the muscles going again. Just a case of ongoing physio to get it properly strong and regain full ROM.  Now I'm just curious as to why such huge differences between dislocation treatments and recovery...

Any thoughts most welcome  :)

Title: Re: Some questions post patella dislocation.
Post by: Smurf on June 27, 2009, 02:43:02 PM
Buzz, I hope you're feeling better today.

I first dislocated my knee about 15 years ago in college, when I jumped off a bunk bed and one leg was asleep. My leg couldn't support me from the jump so I fell and somehow my right knee hit the ground and it pushed it out place and right back in again. After that injury, they said I had bone fragments in my knee and had stretched and torn my medial retinaculum. I was put in a big straight leg brace for 8 weeks but was walking without crutches after a few days. I had no choice but to be off crutches b/c my college was on some really steep hills with lots of stairs. It was more dangerous to be on the crutches. After that fall, I did physical therapy (PT) for a long time, lost weight, and got back to full activity plus lots of new activities. Since then, I've run 7 marathons, learned to scuba dive, and just been really active. I also had a few subluxations throughout that time, mainly when I wasn't keeping my knee active, like if I took a week off running and then did some weird twisting motion. However, I admittedly didn't do any strength training specifically targeting my knee, which is what led me to my most recent injury, I think.

All was good until 3.5 weeks ago when I was running in Washington, DC, next to the White House. One second I was running, the next thing I knew, I was on the ground and my kneecap was on the side of my leg. Secret Service had to come help me (no joke!) and I have no idea what happened. I don't remember tripping, twisting, or any other movement that would have triggered the dislocation. It wasn't painful, just very scary and strange. They EMTs came and said they couldn't reset my knee in the field and it would have to be done at the hospital. They brought me to the ER, where they took x-rays of my still dislocated kneecap, and then my muscles started to spasm in my leg. That was the only painful moment, and it was really bad. They had to rush in and give me a shot of valium and painkillers b/c i was screaming. I could see my kneecap moving up and down b/c the muscles were spasming so hard. After those shots though, I felt good, and they were able to reset my knee. They they put me in a full-length brace, and told me to see an OS. I saw an OS the next day, and he put me in a much shorter straight leg brace, and told me to start PT as soon as possible. I've been in PT since two days after my accident. I now go three times a week.

About 2 weeks after my injury, I had an MRI that showed my medial retinaculum is basically stretched and shredded and some swelling, but everything else looked good. My knee is tracking a bit laterally, but I think when the swelling reduces, it will be sit in the grove much better. Neither my OS, my PT, or his boss recommend surgery yet. With intensive PT, they are saying I should be able to keep it strong and go back to my normal activities, although I may need surgery at some point if I still feel it's unstable. I really want to go back to running, and I'm afraid with surgery, I'll never do that, based on the stories I read here and what I've heard from others. With PT and no surgery, my therapist says he has no doubt I'll be back to running but I may need to wear a knee brace or tape my knee.

In terms of my knee movement and pain, like I said, I have had no pain except just some discomfort but mainly from the brace, I think, and a few times in PT as I've been working on getting my ROM back. My lack of pain may be due to the fact that I've injured myself before and I have a high pain threshold too. Even when they re-set my knee it wasn't painful. Just really weird. However, I can't bend my knee when I walk without the brace (at PT). The trauma of the injury has shut down the quad and VMO. In PT and when I do my exercises, I can bend it to 100+ degrees and ride a bike for up to 5-7 minutes. During PT, he also has me walking without the brace and with some taping to keep my kneecap in place, but it's a frankenstein walk with no knee bend b/c of the shot muscles and the swelling. But, I'm getting there. My OS said to keep wearing the shorter straight leg brace, except when I sleep, and then wean myself off of it when I'm ready as my PT sees fit.

that's my story. I'm happy to share any other advice I have or answer questions. Hope you're feeling better.
Title: Re: Some questions post patella dislocation.
Post by: Smurf on June 27, 2009, 03:12:38 PM
Wow, sorry that was so long.
Title: Re: Some questions post patella dislocation.
Post by: Catrin on June 27, 2009, 09:56:55 PM
1. I had different experience with the immobility issue - guess that depends on your knee's condition but more still on the doc's beliefs  ::)  Once I had a full-length semi-cast for 6 weeks (4 weeks initially and left for 2 more by the doc - the total of 6 weeks - later commented on by another OS as too long) BUT weight bearing from Day 1.   Another occasion - no cast, soft padded patella brace with plastic "ribs" at sides for 4 weeks, again weight bearing, bending a bit as i could and as the swelling was down.  Another - a dislocation along with patella fracture (so they said), had arthroscopy to remove the piece - the next day was out of the hospital, in a soft prace, weight bearing (actually, went for 3 hours' shopping 3 days after).   Once - with lots of blood in the knee - had 3-4 punctures to remove it (the MRI showed sth that the OS said no surgery was needed) - again, a soft brace but NO weightbearing for 4 weeks! - my guess in the latter case the doc's desicion was based on the blood in the knee - meaning sth was torn in the knee, he wanted it to heal.  In total, each leg had 2 severe dislocations BUT every time the patellas went back in the track by themselves (as in your case, right?) - the docs said I had (hopefully, have) strong tendons and collateral ligaments that returned the patellas in place. 
I beleive you simply owe it to your knee -  first, before you start this self-PTing, have an MRI and get a good patella OS's advice.  Then you should follow it  OR you'll only have yourself to blame if sth goes wrong (knock on wood) - and it sucks if you have to blame yourself, not smb else!  ;D  Seriously - I wouldn't risk doing anything with the knee before I knew what was going on inside it. 

2. The minor pain in the knee while lifting is totally OK - that's the stretched ligaments/tendons and some damaged cartilage perhaps.

3.  The 3 weeks that I said a long time - I  meant for lifting - not bending as the latter depends on what's going on with (in) knee.  The rest was the PT strategy for you to build up your musces - I didn't say "in a day start bending".
Plus "bent leg"  isn't necessarily 30-45 deg. - a tiny bent you can do even IN a 3-weeks old cast will be already good.

4.  Bending goes smoother after you work out a bit (like walking for 10 min) - a usual warm up, that is.
Title: Re: Some questions post patella dislocation.
Post by: Buzby on June 28, 2009, 09:42:55 AM
Thanks both of you - feel a lot better now, it sounds like your recovery's weren't too different from mine in terms of movement, you just could weight bear quicker than me. That probably is due to the trauma attached to mine - having a solid ram's skull driven into your kneecap by 90kg of ram causes a fair amount of bruising and general shock & trauma to the area.  I really couldn't weight bear until it was less painful to the touch (even puttin a cold gel pack on it was agony in the first few days) and it took over a week for the bulk of the swelling to subside at all ...

I am going to make an appointment to have it re-checked this week, but I honestly think it's on the road to a nice straight forward recovery this time round. (last time i had the complication of the tear, alot of bleeding into the area and needed the arthroscopy to remove loose chips of cartilidge & bone.)

It's getting stronger everyday, I now only wear a brace for sleeping in - which to be honest is more for my own peice of mind cos I worry my boyfriend might accidentally kick it in the night - or for going out walking, I don't use crutches around the house at all other than up and down stairs, and only have one for a little extra support out walking. 

Hoping to get back to work in 2 weeks, so just need to feel comfortable and safe enough to drive - then I'm gonna go kick the ram in his man parts  ;D ;D ;D

Thanks again for all your help and advice.
Title: Re: Some questions post patella dislocation.
Post by: Sokuntry40 on February 02, 2018, 10:10:00 AM
How long before u can bend your knee without pain after knee dislocation?
Title: Re: Some questions post patella dislocation.
Post by: Vickster on February 02, 2018, 10:43:00 AM
I would assume it varies very much by individual (in terms of able) and your doctor’s protocol (in terms of allowed)
Talk to your doctor/Physio