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Author Topic: Ultrasound to break up arthrofibrosis?  (Read 8019 times)

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Offline AzJohn

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Ultrasound to break up arthrofibrosis?
« on: August 17, 2011, 07:59:34 PM »
My pt said he'd try ultrasound around my patella if I want him to. Could this be beneficial to break up scar and help regain Rom? It's been 9 weeks since my patellar dislocation and I might let him try it as it may not yet be matured scar. What's your thoughts? Is it something that is frequently tried with arthrofibrosis( which I don't know if I have yet) will it aggravate it if it is? My rom is 120 Ty.

Offline Decruz

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Re: Ultrasound to break up arthrofibrosis?
« Reply #1 on: August 17, 2011, 08:15:09 PM »
See my reply to this question in the other your thread
Decruz

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Offline WAD

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Re: Ultrasound to break up arthrofibrosis?
« Reply #2 on: August 17, 2011, 09:01:14 PM »
If you have insurance covered PT, I would try almost any and everything to see if something helps!

I currently receive ultrasound in PT. I have no idea if it helps or not.

In the research for arthrofibrosis thread, there is a link about how ultrasound is beneficial.

When my insurance runs out due to too many visits, I will not pay for it at PT. I bought an at home kit off ebay (from China).

Best of luck,
Wayne

Offline Rennschnecke

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Re: Ultrasound to break up arthrofibrosis?
« Reply #3 on: August 17, 2011, 11:10:31 PM »
Try this link for info on ultrasound http://www.electrotherapy.org/modalities/ultrasound.htm.  Ultrasound can be used as part of the treatment of scar tissue in the early stages in conjunction with massage or other treatments.  Whether or not it is beneficial depends on the skill of your therapist in selecting the appropriate intensity and duration of treatment along with how it is combined with other types of therapy that may be used.

If your flexion is 120 degrees then you may not be regarded as having arthrofibrosis.  This term is usually reserved for significant loss of function owing to scar tissue.  That said, you can still improve your flexion through dedicated stretching and ultrasound before stretching can be helpful.

Sadly, it's a case of try it and see; we're all walking (or limping) experiments!

Good luck!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope – debridement, trochlear cartilage lesion (Gr4); 12/08 Scope – chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope – LOA, IPCS & patella infera; 9/10 Scope – AIR & LR.

Offline AzJohn

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Re: Ultrasound to break up arthrofibrosis?
« Reply #4 on: August 18, 2011, 01:15:53 AM »
Hey thanks for the replys. I've been massaging firmly and that might be helping too. I'm still gaining ROM not very fast but then again I don't know what fast would be either. Maybe I'm being impatient as I've only been working on Rom the past 2 weeks after not bending all the way for 7 weeks. I've gained about 25 degrees.  I wish I would have sooner dang it. Now I'm working hard, hopefully not too late.  Still gaining a little but going to send reports to AF specialist to be looked over just in case.

Offline Decruz

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Re: Ultrasound to break up arthrofibrosis?
« Reply #5 on: August 18, 2011, 01:54:37 AM »
If your flexion is 120 degrees then you may not be regarded as having arthrofibrosis.  This term is usually reserved for significant loss of function owing to scar tissue. 

Oh, this is so wrong...more than one AF specialist told me in person I had AF when flexion was near to 140° as my full flexion measured with the controlateral leg was much more.
Don't want to open a discussion about it, it's just wrong - see Shelbourne AF's classification here: http://ajs.sagepub.com/content/24/6/857.short and note there're other type of AF in which extension is missing few degress, anyway bad problem (like the whole hyperextesion plus few 2-3 positive degrees) and flexion is missing 10°-15° (like 135° if your original flexion was 150°m or even 140° if your original one was 155°), plus Type 1 doesn't necesseray mean it's less painful or damaging your knee than Type 2.
I'm not going to add anything else as I posted a lot in the very same direction in this 2 threads about AzJohn case, I hope it's not AF but it's a suicide not going to a visit in person with an AF specialist, IMHO.
Goodbye
Decruz

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Offline AzJohn

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Re: Ultrasound to break up arthrofibrosis?
« Reply #6 on: August 18, 2011, 03:08:16 AM »
Gotcha Decruz thank you. 

Offline kcknee

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Re: Ultrasound to break up arthrofibrosis?
« Reply #7 on: August 18, 2011, 03:49:04 AM »
Ultrasound has not "broken up" any scar tissue around my knee, but having ultrasound at the start of each PT appointment followed by a lot of deep tissue work and patella mobs with the suction cup device has helped me to keep my knee moving fairly normally in between PT sessions and I believe prevented more permanent damage so far. There is a huge difference in how my knee feels between my PT sessions if he does not do the ultrasound before the rest of the treatment. I do go to PT 2-3 times a week for the past few years. The results for me are not permanent, as the scar tissue constricts again and especially above my knee will tighten up to the point I can't do stairs or stand with my leg straight if I miss too many PT sessions. (My PT used to be able to stretch my torn ACL stump, which became caught in the notch in my knee blocking extension, out enough that I could live normally and even sit back on my heels and stand straight for a few days in between appointment before it would constrict back again, so I think he is very aggressive and strong in his stretching out of my knee.)

I'm having more urgent problems with scar tissue in my leg for the past year so have not been able to have my knee released again. I am totally dependent on my PT and ultrasound to keep my knee moving until I am able to focus on that scar tissue again. Last August I had sheets of scar tissue removed by my patellar and quad tendons.

Kristin
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline starpolisher

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Re: Ultrasound to break up arthrofibrosis?
« Reply #8 on: August 24, 2011, 04:24:16 AM »
I would urge anyone with arthrofibrosis (I have it in both knees) to PLEASE try to find a physical therapist certified to do Astym treatments.  I lived with terrible pain and therefore extremely disabled for 6 years.  I had knee replacements done which began the nightmare.  I had a 2nd operation when I went for a 2nd opinion and found one spacer in one knee was too large (felt as if I had a boulder in there!).  They removed scar tissue during that surgery and did an MUA on the other knee.  Finally, because I was doing so poorly in spite of so much pt, I was tested for allergies to any components and a test (controversial) showed I was very sensitive to the cement.  It was hoped that revisions done would fix the problem.  I had one done at a time and lots of pt, and while I seemed to be somewhat better, it was obvious I had arthrofibrosis....both knees never reached 120 degrees.  I tried Dr. Shelbourne's clinic in Indianapolis and used his elite seat which did help to straighten my legs, but whenever we'd try to get them to bend, I'd lose degrees of them being straight and was told nothing further could be done.  I never attained 100 degrees....90 was the best I did (in one leg).  A new friend I made told me about Astym and there is a physical therapist in the town where I live that does it.  It was developed in Indiana and is common at PT places here.  You can go to their website: www.astym.com and read a lot about it and find a therapist closest to you who is certified in Astym.  While it cannot break down the scar tissue in the joint itself, those of us who have a lot of scar tissue around the knee (both of mine bulged) can obtain enormous pain relief and far less stiffness.  I was able to cut back quite a bit on my pain meds and able to get around much better.  I'm not done with treatments yet....one knee especially needs more work.  One treatment a week is recommended by the doctor who developed Astym when it comes to AF.  There are NO cases of anyone with AF having their AF come back or aggravated by Astym.  It's a gentle type of therapy and amazingly effective.  I hope this is of help to someone!!!!!!!

Offline Shaky

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Re: Ultrasound to break up arthrofibrosis?
« Reply #9 on: August 26, 2011, 02:01:50 AM »
If you know, how is Astym different from the Graston technique?

Offline captainruss

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Re: Ultrasound to break up arthrofibrosis?
« Reply #10 on: September 02, 2011, 07:58:02 PM »
What is the Graston technique?  I asked my PT therapist to look up ASTYM today, but I guess I will do it myself with he web site listed above.  I also asked her today about this question, ultrasound.  She indicated that her clinic had ultrasound, but she did not give it because there was no medical proof it provided any benefit in reducing or breaking up scar tissue.  Please understand I have worked with her between all of my problems over the last 15 months.  She works on my from 90 minutes to 120 minutes every day.  The normal appointment at this clinic is 45 minutes. 

I would kill for 120 degrees of flexion.  I have 60 degrees after she stretches it for 120 minutes.  I have 40 degrees on my own after she works on it.  After icing it, I have about 30 degees.  It tightens up that much.  I am working so hard to be able to walk normally as swinging my leg hurts my lower back and hip.  I have been using the CPM with a Polar Ice device which is a cooler with hoses and  pad that you can fill with ice and attach to your knee with an ace bandage.  It is the best way to keep ice on your knee. 

I am trying to find out about accupuncture?  I would also like to know if the Elite Seat works on flexion?  Blue Cross does not cover the EMPI Flexinator which is a chair that hydraulicly stretches your knee.  The rep told my PT today that I would have to pay $595.00 for 6 weeks.  I cannot afford as I have not worked for 15 months.  My first OS said I would be off 6 wks.  Any ideas you folks have would be appreciated. 

I had a TKR 15 months ago.  Because it was purple, swollen, hot I was told it was infected.  All 3 OS did tests to find infection.  All came back negative, yet 3 infectious disease docs say I am infected.  My TKR was removed by OS #2, but I now think it was AF.  OS #3 put it back in and I am the best I have been, but I am still frustrated at a lack of progress.  The only think progressing is the scar tissue in my knee. 

I hope to have arthroscopic relief of scar tissue in 3 wks and then a MUA.  I hope to flex more then.  Thanks to all of you for the great info!

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline skibum9

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Re: Ultrasound to break up arthrofibrosis?
« Reply #11 on: September 04, 2011, 03:24:07 AM »
Russ

You need to find a new PT. The one you have may be spending a lot of time with you, but is she doing the right things in all that time is the question. I have fired many PTs in my day and finding one that understands AF can be a challenge.  Ultrasound can be beneficial to "warm" up the tissues before doing patella mobes and other slow stretching to achieve flexion.

What did OS#2 say when he removed the TKR? He should have seen your knee filled with scar tissue. If he didn't say anything, request your surgical report. Also ask OS#3, he should have seen the scar tissue too. Ask for written records, they say a lot more than doc's say in office visits.

$595 for 6 weeks of the flexinator is good. I wood beg, borrow or steal to have one of these following your next surgery. This was key for my ultra stubborn knee getting to 110 flexion. Not great, but I will take it in a heart beat.

Sharon
11/06 - ORIF left patella
1/07 - wire removal with MUA
2/07 - LOA with MUA
3/07 - diagnosed with AF, patella baja
5/07 - scar tissue removal
7/07 - z-plasty patella tendon lengthening & reconstruction
1/08 - hardware/scar tissue removal
3/09 - scheduled for TKR

Offline starpolisher

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Re: Ultrasound to break up arthrofibrosis?
« Reply #12 on: September 05, 2011, 11:25:33 PM »
Graston is an older form of Astym.....the same people worked on both, initially.....but Astym is a milder form and if you google Astym vs Graston, you'll be able to see the difference.  There are articles on this very subject.  From what I have been able to tell, it seems that Astym is more popular.  Graston is more aggressive and you can bleed (and more pain) from it.  Since I have severe AF, I don't want the scar tissue to come back and haunt me....though from what I understand, neither has caused AF to come back.  But I have now had 16 treatments (one per week) of Astym and have taken 3 weeks off at one point just to see how I'm doing and I must have had a load of scar tissue around my knees.  These procedures cannot go into the knee joint itself and break down the scar tissue so don't expect great ROM......but my ROM has really improved and my pain is FAR LESS.  I have been able to really cut down on my pain meds.  I was in really severe pain and astym seems miraculous in how much better I feel.  You have to be patient and disciplined: do your daily exercises they give you!  Drink plenty of fluids.  They are breaking down scar tissue (I had a lot surrounding my knees) and my knees are far more normal in size.  The skin used to be stretched across the knees....now it's looser.  It's given me back so much more of my life.  You must go to someone certified in Astym.  I was living in severe pain for 6 years and my pain if so much less.  I am so grateful for that.