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Author Topic: still cant bent knee  (Read 923 times)

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Offline grumpy_lady

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still cant bent knee
« on: December 01, 2004, 08:55:09 AM »
hello, i hope there is someone who can help!  
i am a 32 yr old female, and i fell and dislocated my right kneecap, excruciating pain!!!! the back of my knee turned purple-black in color. as did the front of my shin . the ortho doctor put it in a straight leg knee imobolizer, after the swelling went down an mri was done and i was told i had a lateral meniscus tear.  i had orthocopic surgery 8 days ago. i still cannot bend my knee .. my dr. says there is nothing in there preventing it from moving any more. no matter how hard i try it just wont , im in throbbing pain , and extreme discomfort. im using crutches to assist in walking, my knee wont support me yet,  im supposed to start phys. therapy in 5 more days.
will therapy help me bend it again at this point? or do you think that i should have my dr. check anything else? 2nd opinion ? or will i ever walk normaly or drive again  ???? i am terrified scared at this point i hope that some one can help me relax a bit about this or bend it . thank you !!! ???

Offline Heather M.

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Re: still cant bent knee
« Reply #1 on: December 01, 2004, 09:33:43 AM »
It's always a good idea to give therapy a chance--some people are able to work wonders.  But it would also be good to keep an eye on things and make sure you aren't developing a lot of scar tissue.  I presume if you had this from the dislocation that your doctor would have seen it and removed it...but it's not always a good idea to assume.  Anyway, I had two surgeries in a three week period following a post-op infection, and I knew within 3 days that my knee was frozen.  With the help of therapy, I was able to go from 30 degrees of flexion (that's barely anything) to just under 90 degrees (what you need to sit in a chair).  So I know it's possible to achieve many gains in therapy.  Sometimes the knee is traumatized and you need to be patient, do a lot of supportive and anti-inflammatory therapy, and give it some time.  But if you plateau in therapy or can't get past 90 degrees within a month or so, then it may be time to have as serious discussion.  Your PT should be able to tell you if there is an actual mechanical blockage preventing you from bending--if you do have this, it takes a lot of painkillers and hard work to get through it, but it can be done.

Read on this page about people after dislocations and patellar fractures where they were immobilized having a lot of trouble bending--with patience, persistence, and GENTLE but persistent PT you should be able to advance a little bit each day, and a little more each week. If you can't make any progress, it's worth talking about with your doctor to see if he feels you might have excessive scar tissue in the joint.  If the doctor refuses to even entertain the possibility, you may need to find a scar tissue specialist.  But don't borrow trouble yet!  Find a good PT, one who understands that while you need to work the knee you also can't have unrelieved pain and constant swelling--that will get in the way of bending.  It's a little early to say whether your knee is frozen yet, because you haven't even started therapy.  I'm willing to bet that after a week or two of doing the exercises you will begin to see some serious progress.  

You may also want to talk to the doctor about effective pain management during therapy--working with scar tissue is pretty painful, yet you have to move the knee...also, it might well be worth it to discuss getting a CPM or continuous passive motion machine.  Your surgeon writes a script for it and then usually someone in his/her office contacts a medical supply company.  They go to your home and set it up for you.  It's a big machine that cradles your leg from the top of the thigh all the way to the toes--you settle in it and strap your leg with sheepskin and velcro, and the machine very slowly bends and straightens your leg for you.  You don't have to do anything--actually, it's best to relax and let the machine do its job.  I was in one about 18 hours a day for close to 5 weeks after my surgery (thank GOD for sleeping pills!) and it helped enormously.

Hope this information helps.  If you continue to have problems, you might want to read about excessive scar tissue (a condition called arthrofibrosis) in the "soft tissue healing problems" section below this one.  But try not to borrow trouble, see how therapy goes before hitting the panic button.  If possible, monitor your knee closely but be positive about the progress you will make.  It's hard to stay upbeat, especially when you are in serious pain.  But you should try.  And don't let anyone tell you the pain is in your head!  If your doctor can't or won't take your problems seriously, it's time to find a new one.  Many doctors have never seen serious scar tissue problems.  But again, there's no way of knowing if this is what you have yet.  I'm hoping that you just have a very unhappy, traumatized knee due to a lot of insults to it in a short period of time.  Things will get better.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline grumpy_lady

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Re: still cant bent knee
« Reply #2 on: December 01, 2004, 08:02:45 PM »
thank you heather,

your reply helped alot!  i have never hurt my knee this bad before.  :( im just scared of the unnknown and grumpy because of the pain. im so thankful that i found this site! reading others questions has also helped and i dont feel like i am going to be going this alone , like i was feeling earlier. thanks again,   susan :)

Offline Heather M.

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Re: still cant bent knee
« Reply #3 on: December 01, 2004, 09:07:53 PM »
Susan,

You are definitely not alone!  I remember when my knee actually was frozen, and there was no one posting on the board with that problem--I thought I was a freak.  My doctor said I wasn't trying hard enough, and my PT started to look like the Marquis de Sade after a few sessions--it was the wrong approach.  Aggressive, bend til you scream therapy wasn't getting me anywhere and should have been stopped.  If your therapist tries to do that, make very clear that you are not going to put up with it--you will work hard, but you will also work smart.  Scar tissue and bending problems often respond very well if the patient bends to the point where pain just starts, backs off a little, then holds it there for prolonged periods of time (1-2 minutes).  If you need some ideas on exercises to talk about with your therapist, read through the soft tissue healing problems section.  Wall slides are great (lying on your back with your bum near the wall and your feet up on it with socks on, using the good leg to support the bad one as you let gravity start to bend the leg and you slide the heel down the wall toward the floorboards).  Another good and gentle method is to sit in a rolling office chair and rock forward until the bad leg just starts to bend a little, hold it, then let go.  Also, a stationary bike with the seat about 6 inches higher than you would normally have it is a great way to help gently get back your flexion--rock the pedals slowly forward with your feet until it gets to the point that you won't be able to go any more forward because the knee pain is starting, hold it there, then gently rock backward and hold it at the point just before it starts to get really painful.  You will find that it's easier to go backward than forward!  Have your PT show you how high the seat should be.  Once you can bend the knee a little better, you can sit on a high stool and just let the legs dangle and let gravity help get the bend back.  Ask your PT to show you how to do patellar mobilizations (as well as patellar tendon) to keep your kneecap mobile--they can be done hourly to help you improve quickly.

As you can see, there are many tips and exercises you can do.  Use the search feature to look for "ROM, flexion, bending problems, scar tissue, etc" and read through the posts dealing with those--you will find a lot of them in the crisis board, the struggling with rehab section, and the soft tissue healing problems section.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell