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Author Topic: Fall and knee problem  (Read 2364 times)

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Offline Closer

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Fall and knee problem
« on: August 07, 2008, 12:32:05 PM »
Hi. Can I begin by just saying that I really respect the many posters here who seem to have gone through very acute difficulties and yet remain willing to contribute to this forum and help others.

I am on here looking for some advice. I had never previously had any problems with my right knee. I fell off my bicycle more than three weeks ago - I cycled into a stationery object (not clever, I know) and was flung over the top of my bike and landed on my knee and elbow. My knee seemed okay - I got up and wheeled the broken bike home. After this I played tennis for two hours, thinking my knee problem was only a bruise.

Unfortunately after the swelling the swelling started to appear and increase and walking became painful. Since that day I've iced the injury only a little and have taken a couple fo painkillers every day. I visitied the GP who told me iniotially to just rest and return in a fortnight if it was not improving. I returned yesterday, and my GP referred me to a physiotherapist (but my appoitnment with the physio may take over a month). I am a very active persona nd need peace fo mind - i need to know what the problem might be and for how long I'm likely to have it, else i find it difficult to concentrate on anything, including work. I'm a bit of a worrywort.

Symptoms

My knee hurts at the kneecap - seemingly around the kneecap and perhaps a little underneath it and slightly on the inside of the knee. When walking on flat surfaces I can walk in a way that isnt particularly painful, but steps, downhill and uphill do cause paina nd the pain then lingers for a while. I certainly cannot run at all. Although after icing and painkillers I did cycle for half an hour without pain about a fortnight ago, now cycling is too difficult. After I cycled that time my knee didn't feel too bad...but I lost my kneestrap that day and a few days walking without my kneestrap was painful too. Initially the swelling was apparent but it has subsided, and the watery stuff that my doctor thought was there the first time is draining away. But the pain remains.

Walking up and down stairs causes the most pain and I have to adjust the way I climb steps, to take pressure off the kneecap. When I've been doing very little with my knee for a while and if I've also been taking painkillers I can go for a long steaily paced walk for almost two hours (10km) with very little significant pain. In the morning after many hours rest it is not painful either (though I know Im putting pressure on the other knee as my body adjusts to the injury).

I have no idea if it's a meiniscus, ligament or bone-bruise type of injury. I dont know if I should be exercising it or not. I don't know the diagnosiss or prognosis. Can anyone give me any helpful tips about any of those things or estimate the severity of the injury. The not-knowing is very frustrating for me.

And can I thank you all for reading.


Closer :)

Offline subail

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Re: Fall and knee problem
« Reply #1 on: August 07, 2008, 02:33:49 PM »
Since you self-admittedly need peace of mind would it not be worth it to have and x-ray and perhaps get a referral to an OS to take a really good look. Your symptoms seem to be all over the map and that would lead me to believe that you should get it looked at. My 2 cents...
Dislocation of left patella and as a result left patellar tendon rupture in the medial section/torn at both ends.
3 Previous surgeries-semitendiosis tenodesis
Reconstruction surgery left knee October 10 '07
TKR right knee May 25 '10.....successful!
Limited ROM/TKR left knee May 25 2015...successful.

Offline tanyap

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Re: Fall and knee problem
« Reply #2 on: August 07, 2008, 03:58:55 PM »
A physiotherapist is not going to be able to diagnose a knee problem.
If you want peace of mind you need to go to an OS, the injury happened 3 weeks ago, youre still experiencing symptoms, a physio will only give you exercises to strengthen the muscles around the knee.
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Closer

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Re: Fall and knee problem
« Reply #3 on: August 14, 2008, 10:16:15 PM »
Hi and thanks for your help.

I'm so worried at the moment I can barely focus on anything else. I cannot yet get a referral to an OS as I already have been referred to a physiotherapist, though I may try and get my GP to get me to an OS as soon as I can. It will probably take months though.

The physio taped up my patella tendon and thinks I may have patella tendinopathy and fat pad impingement or inflammation. I may also have a problem with the bursa. She doesn't think the situation is worth an MRI scan but may do ultrasound next week.


Im so scared since Im getting all sorts of knock-on injuries. My good knee is starting to strain at the kneecap/patella tendon and I can feel it getting slightly tender ont he patella tendon. My injured knee has other wierd symptoms; pain/pins and needles around the kneecap, though this may be as a result of the taping on the skin as opposed to a problem with muscles or ligaments.

The not-knowing what is wrong is just making me a nervous anxious wreck. I can walk with some discomfort; I'm so frightened I won't be able to live an active life again. Maybe I'm just too pessemistic but I don't know what's wrong and I can see the compensation injuries kicking in. I really hope a lot of PT can make a difference because I just don't know what to do.

Offline tanyap

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Re: Fall and knee problem
« Reply #4 on: August 15, 2008, 03:25:38 PM »
Can the physiotherapist refer you to an OS? Or can you go privately - it might be expensive but a one off visit may well put your mind at ease.

I wouldnt worry too much, if the physio doesnt bring improvment then the natural progression will be to refer you to an OS.
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Closer

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Re: Fall and knee problem
« Reply #5 on: August 17, 2008, 04:38:47 PM »
Can the physiotherapist refer you to an OS? Or can you go privately - it might be expensive but a one off visit may well put your mind at ease.

I wouldn't worry too much, if the physiotherapy doest bring improvement then the natural progression will be to refer you to an OS.

That sounds okay - I'm worried though that my knees will somehow degenerate in the intervening period. I can afford a bit of private PT in addition to the NHS treatment but knee specialists might prove to be too expensive. After my 160 consultation, if I need a scan I might just be able to pay for it - and that's a big maybe. If I need any surgery, forgetaboutit. Is it possible for a privately made diagnosis to be referred back to an NHS Doctor for appropriate referral. If I have a private MRI, can I get an NHS OS to look at it?

After a few hours of shopping recently it became too painful to go up and down stairs.
Every day it feels best in the mornings as my legs have been rested all night. Sometimes I feel as though I may be able to run a little too (a few minutes, tentatively). But an hour's gentle walk and my right knee is in pain. The left kneecap becomes tight very easily too probably as a result of over-compensation.

It's difficult to guage how serious the whole thing is and my slight tendency towards anxiety obscures things yet further. I can bend my knee alright when Im not standing on it with only a small amount of pain some of the time. It's the weight-bearing that seems to be destructive. I wonder if I should have had my leg in a brace after the accident. I wonder if it was the fall or the playing tennis on it for hours afterwards did the most damage. Nothing can have popped or snapped since I did play tennis quite well hours after the accident. That's where it must have really become bad.

One question - My tibia on both legs and esepecially on the injured leg is tender and my bone feels like it's under pressure when I've been on my feet too long. Is this a serious problem; am I risking some sort of bone injury by staying on my feet. Does this give an indication as to what my diagnosis may be?

I can feel tenderness on my knee even if its been rested in some places - patella tendon and where it joins onto the tibia. Also under the patella ont he medial side just an inch or two down to the tibia again. There is more tenderness on my knee once Ive walked on it a bit. Im worried that with all the compensation going on the diagnosis will be impossible. It's now 5 weeks since my fall.

Sorry to ask so much. Just really worried. :)

Offline tanyap

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Re: Fall and knee problem
« Reply #6 on: August 18, 2008, 08:55:30 AM »
Hi there,
Im not in the UK so I dont know if you can mix private treatment with the NHS.

You said something interesting, that you feel best in the morning and it hurts worse as the day (or activities) progress. That usually indicates a mechanical problem, you could have something like a foregin body or torn meniscus or something like that floating around in there.

I doubt you are risking any kind of serious bone injury. The tenderness is just linked with the inflammation in the knee - when the knee gets sore, the joint gets inflamed and this puts pressure on surrounding areas.

I really dont think youve done anything terrible here, just some annoying injury that is bothering you. But its worth seeing a specialist. In your initial post your GP said to come back after a fortnight if no improvement - well its almost a fortnight now so perhaps you should go back and express your fears? And as its 5 weeks since your original injury its time to accept something needs investigating - and dont take no from a GP on that. Get referred to an OS.

Its totally understandable to be anxious about any kind of injury, specially when you are hurting but you cant see why. If it helps set your mind at ease I spent 3 years with a badly torn meniscus that caused incredible pain and instability, I subluxed literally hundreds of times, and when it was finally fixed I had no other damage in the joint - so its possible to have what feels like a lot of pain and suffering with an injury but not to be doing any more damage while waiting to have it seen to.



1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Closer

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Re: Fall and knee problem
« Reply #7 on: August 20, 2008, 10:17:07 AM »
Hi there,
Im not in the UK so I dont know if you can mix private treatment with the NHS.

You said something interesting, that you feel best in the morning and it hurts worse as the day (or activities) progress. That usually indicates a mechanical problem, you could have something like a foregin body or torn meniscus or something like that floating around in there.

I doubt you are risking any kind of serious bone injury. The tenderness is just linked with the inflammation in the knee - when the knee gets sore, the joint gets inflamed and this puts pressure on surrounding areas.

I really dont think youve done anything terrible here, just some annoying injury that is bothering you. But its worth seeing a specialist. In your initial post your GP said to come back after a fortnight if no improvement - well its almost a fortnight now so perhaps you should go back and express your fears? And as its 5 weeks since your original injury its time to accept something needs investigating - and dont take no from a GP on that. Get referred to an OS.

Its totally understandable to be anxious about any kind of injury, specially when you are hurting but you cant see why. If it helps set your mind at ease I spent 3 years with a badly torn meniscus that caused incredible pain and instability, I subluxed literally hundreds of times, and when it was finally fixed I had no other damage in the joint - so its possible to have what feels like a lot of pain and suffering with an injury but not to be doing any more damage while waiting to have it seen to.





Hi Tanya. Thanks again for the reply. Im sorry to hear about your troubles but glad to see your joint has immproved.

This is where I am at the moment - my GP reffered me to a physiotherapist. The physio was a lovely person, but didn't to be entirely confident about treatin g the injury. She said she didn't think I had a meniscus injury from testing it my twisting my leg in various ways. Her diagnosis was fatpad impingement or a fat-pad injury of some sort. Since she didn't seem too sure she has referred me to an 'extended scope practioner' who will decide what I should do next in terms of getting treatment. The practitioner may rfer me to a an OS or a scan or reccomend that I persist with physiotherapy. My worry is that the physiotherapist had little in the way of suggestions of treatment if indeed her diagnosis was correct. She mentioned exercising muscles for balance but I assume exercising my quads (which are visibly shrinking on my injured leg) would be near impossible with my knee being injured, and may cause more damage. I wonder if I should strengthen the muscles on my good leg to compensate.

As an update to my symptoms:

I think I am adjusting the way I walk to keep weight off the front of my kneecap. This may or may not be the cause of new types of pain; I get a general burning down the front of my injured leg and sometimes a slight prickly sensation from just about the top of my kneecap to near my tibia. My injured knee may feel slightly warmer than my other one but I can't be sure about that.

Next steps

Next I might see a private physiotherapist to see if he diagnoses the same problem as the NHS phhysiotherapist. if I get a different diagnosis I can make the case for a scan or a referral to an OS> If this physiotherapist also thinks I have a fat-pad problem and nothing much more than that, then I will think about treatment. Does this sound like a good idea or do you think I should be getting scans regardless?

Thnaks again to anyone who might reply.

Offline tanyap

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Re: Fall and knee problem
« Reply #8 on: August 20, 2008, 01:59:11 PM »
Hi,
You can still exercise quads with a problem in the knee, but you may find it difficult/painful and you may well not make a lot of progress - or you may make good progress depending on the underlying problem. Its possible this kind of strengthening will help the problem. Its also possible you will get some benefits but may still need the underlying issue addressed, but time will tell that. One way or the other the best possible course of action is physio anyway as if you do need any kind of surgical intervention you make the best recovery with a stronger leg.
Its unlikely physio will compound the underlying problem or do more damage, but if that was happening it would become obvious to the physiotherapist - so dont worry about making things worse, its a possibility but would only end up speeding things up anyway.

Its not a good idea to strengthen the muscles on the good side to compensate as this will cause a bigger imbalance and may well cause more problems for you in the future.

No physiotherapist is going to be able to give you a solid diagnosis, physios are trained in how to strengthen muscles, stretch tight areas etc....all soft tissue stuff, they are not qualified to diagnosis joint problems. The NHS one who said she didnt think it was menisucs - thats rubbish, even an OS cant diagnosis a torn meniscus without an MRI or other investigation unless its causing severely obvious problems. Mine was badly torn and it was only my 3rd OS who took it seriously and it had already shown up on an MRI.

If I were you Id be cutting the middle men and going straight for the OS referral, an OS will decide whether or not to do scans etc...

Its going on long enough - time to see an OS.

1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline eslteach

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Re: Fall and knee problem
« Reply #9 on: August 22, 2008, 01:56:41 AM »
Well, my doc thought my problem was "just a torn meniscus" and finally sent me for an MRI a week after my fall...but I had a Tibial Plateau Fracture and had been walking on it for 9 days!  I'm fortunate I didn't do further damage during that time.   So I really think you should see the OS just to be on the safe side.  Let us know how it goes.
Ali
5/27/08 - Fall (dog chased cat)
6/4/08 - TPF diagnosed (crutches/NWB)
7/9/08/08 - Surgery L.leg - tendon/meniscus repair
7/14/08 - PT - NWB
7/31/08 - PWB w crutches
8/7/08 - WB w crutch/cane optional
8/28/08-Released by OS
3/2009- R.leg - meniscus tear/fragments/cyst 4x7cm
4/7/09-surgical repair

Offline Closer

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Re: Fall and knee problem
« Reply #10 on: August 24, 2008, 08:36:14 PM »
Hi again,

Ive been referred to an Extended Scope Practitioner who will decide if I am to see an OS - I do not have a choice in this matter and I don't have the 160 that I need to have to see an OS privately and the extra money that would probably be required for subsequent scans and appointments. I'm not sure there's much point to paying 160 for a consultation if I can't afford to follow it up with anything. If I have no luck with the NHS after another month then I might have to resort to finding the money.

I did however go to another physiotherapist who works serving a fairly prominent professional sports team in Birmingham. He also diagnosed me with fat pad inflammation or irritation. He tried acupuncture as he said it has been known to work for the problem, but he insists that if it makes no difference after two sessions (the second being on Tuesday) then he will refer me to an injection specialist who will inject cortisone into the fat pad. So I'm getting somewhere with someone - and if the cortisone shot doesn't work then I can tell the NHS scope practioner that it has been tried and it should strengthen my case to see an OS or get a scan.

It's been six weeks since my fall and I've seen people wait longer to get treatment so Im not going to let that get me down. Yesterday my knee felt great as I walked quite far on it with full weight. However i had to go out late in the day for some shopping and I started feeling the pain again - its been bad since. It was very disheartening since I was sure things were improving slowly. Now I seem to have taken a step back. Perhaps Im being impatient, but I really hope that the next few weeks sees the same sort of gradual improvement with rest and ice.


Offline tanyap

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Re: Fall and knee problem
« Reply #11 on: August 25, 2008, 09:47:43 AM »
Hi,
I dont know what and Extended Scope Practicioner is - is this someone your GP referred you to? Can you make a case to them to see an OS?

Its really only an OS that can make a proper diagnosis for you. (unless an extended scope practicioner is in fact an expert in orthopediacs and specifically knees).

I hope you get some relief from the acupuncture, its great you have physios interested in your case but they just wont have the expertise to make the correct diagnosis for you. Its trial and error - however you might get lucky so fingers crossed!!

Do let us know how you get on in the next while.

1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app















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