Banner - Hide this banner





Author Topic: Another DR?  (Read 3154 times)

0 Members and 1 Guest are viewing this topic.

Offline Slope

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
Another DR?
« on: February 17, 2012, 09:54:22 AM »
I am Dutch, so no plain language.

Start
Feb 2011 I was climbing. Deep knee bends. “Something” went wrong in right-hand knee.

Result
Pain + rest until Aug 2011. Walking went okay.

Next step
Deep knee bends / squats resulted (still) in a good to hear and tangible “click”.

To the Doctor in Sept
He said it was wise I kept quiet. Checked flexibility.

Advise
Doc said not to worry. I could start running again.

1 Year later
Still that click, loud and clear and I feel that I shouldn’t bend my knee that far. It is like pliers that are locked.

What is it?

Another DR?

Therapy?
Fish oil? (DW 40 or dissolving oil.)
Wait longer?
Ignore it! and don’t complain?
Accept it!
Worst case: operation needed.

Please let me know what you think.

Thanks,

Slope
Started climbing at age 3 any attempt to stop since then has failed.

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Another DR?
« Reply #1 on: February 17, 2012, 02:03:17 PM »
Ever had any form of scans? MRI imaging? Has doctor ever done any tests for ligament damage - instability, loose joint etc.

The locking you mentioned *could* be a meniscal tear, the first step might be to get a scan to see if it shows anything. They don't always pick up everything that is going on though. Do you have pain with the strange sensation you describe? Any swelling?

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Slope

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
Re: Another DR?
« Reply #2 on: February 17, 2012, 09:44:55 PM »
Scans
No, I had never scans made. The family doctor, general practitioner, checked my knee September last year. To describe what he did is difficult. It was pulling and bending.
A physician is not clairvoyant, but …

Specialist
Can ligament testing be done by a non orthopedic?
(I need the general practitioner’s prescription to see a specialist. In Holland we have now a form of health service where every one is obliged to be insured. I have all the options insured)

Swelling
I had swelling which disappeared after a few days, with physiotherapy.
During one week I swallowed inflammatory drugs. Nurofen a.k.a. Alive).

Walking
Knee was sensitive after a long time sitting still. That has gone. But if I go for a walk the knee is still sensitive and there is diminishing tension (in the beginning of the walking it feels like I have light muscle pain).
The day after the skin feels sensitive.
But, no thick knee (no swelling). After a good warming-up knee is not perceptible.

What is that click?
The knee is after a day of exercise locking with tactile “click”.
I fear, it is most likely a meniscus tear.

The big question: Treatment
What treatment methods / strategies are there? Apparently it doesn’t heal by it self. Does it ????
I've learned that surgeons often follow or know only one method (their hobby), while there are often several methods. The one method offered may not be the best solution for my knee (case). How to find that out? Literature, on this site? (I know)
What are the success rates of such operations?

Next step
I will have an MRI scan made.
See a specialist.
But again, what to ask? What pay attention to?

I am scarred to death. Thank you so much for your answer, Lottie.

Bye for now,

Slope
Started climbing at age 3 any attempt to stop since then has failed.

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: Another DR?
« Reply #3 on: February 18, 2012, 04:08:08 AM »
Slope,

Why did the doctor tell you it was good you are quiet?  I would think you would tell an OS immediately.  You need to find an Orthopedic Surgeon (OS) somewhere near you. 

The MRI and/or Xrays will give him an idea what is going on.

First treatment is usually some sort of PT if no structural damage in your knee

PT will strengthen muscles to help you recover.

Anytime surgery is suggested you should have a minimum of one or two further opinions.

Good luck.

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 Slope

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
Re: Another DR?
« Reply #4 on: February 18, 2012, 11:14:00 AM »
Thanks Russ and thanks Lottie,

Monday I will get a prescription to see an orthopedic. Promised.
But once “there”; what to ask the orthopedic? What are failure rates?
As an alpinist I am aware of and used taking calculated risks. I don’t ask for guaranty.
But now I feel like that calf … anyways, first things first.

Thanks a bunch,

Slope
Started climbing at age 3 any attempt to stop since then has failed.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: Another DR?
« Reply #5 on: February 18, 2012, 11:35:48 AM »
As others have said, it is best not to speculate as to what may be wrong without imaging and seeing a specialist - it could be any manner of things, knees are very complex.  IF it is a meniscus tear, depending on where and how big it is, it may heal.  Or you may be able to live happily with the tear.  I had a lateral tear, tried to treat conservatively with physio, but I had locking (unable to straighten leg), buckling, swelling, pain, limping which got worse over time and needed the surgery...all those symptoms went once recovered from the surgery itself.  I had some other damage too which took longer to heal, but the trimming of the meniscus was imo very successful. 

The failure rates vary so much from patient to patient and even more so, surgery to surgery - impossible to give an exact figure, especially not knowing what is wrong!

Also, on the surgery front, yes best not to rush into it unless you are struggling to function due to some sort of mechanical impediment etc

For now, you should avoid doing anything that hurts the knee - clicking in itself isn't always an issue if it isn't painful - I would not run, squat, jump until you know what is up - gentle walking and cycling may be ok - but take the specialist's advice

Regarding getting further opinions, yes if the surgeon seems clueless, you are not happy with the answers, or the imaging is inconclusive.  However, I was perfectly happy for the first surgeon to do my scope (I saw him maybe 6 times over 5 months beforehand) - I had the second op by a second OS but due to insurance issues.  If I need a much larger surgery in the future, I would possibly get a further opinion - but for my own peace of mind, nothing to do wth the doctors per se.

Good luck - no need to be scared :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: Another DR?
« Reply #6 on: February 19, 2012, 01:21:28 AM »
Slope,

Vickster makes great points.  I don't think you have AF (Arthrofibrosis), but that seems to be the worst complication from a surgery.  The OS do not know what causes AF or my latest complication, HO (Heterotropic Ossification).  The people who have knee surgery and end up with the AF complication are I think somewhere around 1 percent.  Anyone unfortunate to have the complication, I have not talked to one person who has been cured.

I did not discover AF until after my 5th TKR.  I trusted my OS (3rd) with my life.  He has done my back, shoulder, and knee multiple times.  I have had excellent recovery with Dr. Holen.  This doctor gives his patients his personal cell number and he writes it right on your chart when he is doing surgery.  It does not get any better than that.....and yet my hero told me two weeks ago he does not think he can do any more for me.

You must become educated.  YOU have to know what to ask....and keep asking.  Any OS that has attitude or does not spend as much time as it takes to make you comfortable, walk away and he is not the one.  I am going to try to post a link on "AF Research"  posted by "missmyknee".  She is the most intelligent knee geek I have met on this site.  The moderator, 'kneeguru" has also pasted on AF.  You probably don't have and will get AF.  If you need any kind of surgery, you need to know what to look for.  If an AF patient gets immediate treatment and correct treatment, AF can be minimized.

Do a search on the bulletin board and I will try to post these links to you.  Missmyknee's blog is out of this world on all aspects...she has a pain management handbook...all kinds of knee knowledge.

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 Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: Another DR?
« Reply #7 on: February 19, 2012, 10:43:59 AM »
Slope - i don't think you have yet had surgery if I understand correctly?  My understanding, as captainruss says, is that AF is a complication of surgery, so I am not sure why he is talking about AF?  ???

There are lots of causes of clicking in knees - can be a tear or strain, can be due to muscle imbalance, can be due to maltracking but it can be none of these or something else.  AF in a non operated knee is surely at the bottom of the list

Good luck when you see the doctor :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: Another DR?
« Reply #8 on: February 19, 2012, 11:42:38 AM »
Slope,

I am a victim of AF.  AF is a condition that has no cure, but is a complication of ALL types of knee surgical remedies from arthroscopic snipping of a little cartilage to my TKR (total knee replacement).  You asked about what questions should you ask.  You will not know what questions to ask unless you know about what complications are possible.  Victster is correct, I am not diagnosing your knee condition.  What I AM trying to say is not matter what I any procedure you have, it can be successfully redone.  If your OS does not understand about this complication, and if you have any kind of procedure, you are subject to having the complication called AF which is NOT curable.  Research is being done and a small number of people suffer from it, but if you have surgery and if you get AF, you will be fighting it for life.

Soooooooo.....my point is educate yourself.  I have had total in my lifetime more than 12 knee surgeries and I don't understand 1/100th of what Missmyknee has forgotten.

A great post by Kneeguru, our world famous moderator, is http://www.kneeguru.co.uk/KNEEnotes/node/2355.  In this thread is 20 different links.  One you should take time reading completely is Missmyknee's blog.  There are 3 blogs and multiple other informational sites.  None of what I am asking you to read applies to you at this minute, but it COULD! 

If you have any type of surgery and post op 5 days you show signs of AF, it is treatable.  It is acutally almost curable.  But, if you let it grow and if it infests your open spaces in your knee, it will be with you for the rest of your life. 

One other point.....the reason why I am so anal about this point.  I had never heard about it even though I had my first knee surgery 31 years ago and a dozen more since.  I had three (3) OS operating on my knee for the past 2 years.  Two of these OS STILL have no idea what OS is!!  My third OS who is cool....he listens to anything I say....is just now learning about AF.  NOT one clinic in all of Florida understand, let alone specialize in AF.

Knowledge is your friend. 

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 captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: Another DR?
« Reply #9 on: February 19, 2012, 12:09:40 PM »
Correction....it is late.  Two of my OS still have no knowledge of AF and I have had the condition for two year.  Each OS removed my TKR because they stated I was infected (knee swollen, hot, no ROM).  All cultures came back negative every single time for infection.  My CED rate and C-reactive Protein levels were very high.  They misdiagnosed this for infection.  It is actually indicators of inflammation.  Inflammation is the indicator for AF, and for infection. 

I spent TOO many weeks on antibiotics for an infection I never had.

My 3rd OS who I very much like and respect only came to know AF because of the material from this site I sent to him.

I am not trying to scare you about your condition which most likely will be very treatable.  One arthroscopic surgery and you will be back running in a month.  But, if you do wake up with a hot, swollen, painful knee you have an option to think about.

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 Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 404
  • Neelie knee!
Re: Another DR?
« Reply #10 on: February 19, 2012, 12:26:44 PM »
You should of course ask the specialist about any potential complications after surgery IF you have it - the anaesthetic, the operation, what to do post op, what rehab/physio will be needed etc - your doctor should discuss all of this with you, if they won't answer any questions, get a second opinion. 

But you don't even know what is wrong and what will be needed - I expect focused physio will be the first course of action, surgery should always be a last resort when conservative measures fail

I had 2 arthoscopies in 2010 - no complications at all - complications are actually rare - probably 99.9% of people who have knee operations never end up on websites like this one, let alone have issues.  I came looking for advice, not because something was wrong after surgery.  My limited understanding of AF is that it is more likely when the knee is immobilised for a long time, there is bleeding into the joint or infection - after arthroscopy, you should be able to get the knee moving very quickly and should follow post op rehab exercises to the letter several times a day  :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline The KNEEguru

  • Administrator
  • SuperKNEEgeek
  • *****
  • Posts: 2617
  • Liked: 111
  • The KNEEguru
    • The KNEEguru
Re: Another DR?
« Reply #11 on: February 19, 2012, 01:25:03 PM »
Hi
I think it would be good to get back to slope's original question, as this thread is going off the tracks. I wonder if that is because Slope used the word 'scarred' instead of what I think was meant, which is 'scared'?

It seems to me as if Slope's main problem is the click, and what might be the cause of it.

Many people have knees that click when they bend. They often describe an uncomfortable feeling just before the click, which then relieves the uncomfortable feeling. This might be from something like a synovial plica, which is a normal structure that can sometimes get damaged and thickened and cause a click. Or it may be from a discoid meniscus, which is again a normal variant. Or it may be, as suggested, from a meniscal tear - but usually in a younger person there is a history of the problem being preceded by an injury - menisci in younger people don't usually tear on their own.

KNEEguru
--
KNEEguru

Offline Slope

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
Re: Another DR?
« Reply #12 on: February 19, 2012, 01:47:46 PM »
TTo Vickster, Russ & the others,

Now I feel really guilty, after reading all your messages. It is a sport climbing injury. Read first post.

I am three *** Michelin star food for psychologists. I am old (63). Started reading yesterday after a year of ignoring “it”. You know or don’t know but I am scared (afraid). Childlike and very unbalanced could one say. Been on the coldest mountain on earth, solo climbed E2 6a. Was partner is a business with 90 people, etc. Anyways, but this … this is apparently my weak spot. Normally I am not a drama queen and I can accept/live with consequences of life.

After reading and seeing some of those pictures: I vomited. Why? Afraid of being dependable of others? That is stuff for other forums. Had a bottle of wine and went to bed. It must be disappointing to all you after you paid so much effort in advice.

I will grab myself together, promised, and start reading about synovial plica, a discoid meniscus, a meniscal tear and make tomorrow that appointment with an OS.

It is strange enough your words are much of help. Vickster, until now: I have buried my head in the sand, I had no operation. You are right first of all I have to make that simple step. Go, have that MRI scan made, see what it is, talk it through, that simple.

I am sane (I think) and will start to behave. Thank you for your kind words and advice.
Stay safe out there! I notify you if there is any real news/progress.

Slope
Started climbing at age 3 any attempt to stop since then has failed.

Offline ElSquinto

  • MINIgeek (20-50 posts)
  • **
  • Posts: 44
  • Liked: 0
Re: Another DR?
« Reply #13 on: February 19, 2012, 10:32:32 PM »
I would also emphasize - do not do any running, jumping, or squatting or heavy-lifting with your knee in this condition.

You should only resume these activities once an orthopedic surgeon who specializes in these cases has advised you that you can resume these activities.

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: Another DR?
« Reply #14 on: February 19, 2012, 11:27:50 PM »
Slope,

I understand you feelings.  My last surgery I am laying there on the gurney waiting to go into the ER.  I have been through a large amount of procedures and thought I was pretty tough.  This last one, I just lost it.  I would have climbed off the bed and slipped out of the hospital except for one little fact....I was buck naked under that blanket!  I think they take your clothes just to make sure you do not make a run for it.

None of us wish to scare you.  I go to sleep every night wishing I knew what I currently know 2 years ago.  No one enjoys surgery especially when the outcome is unsure.  You may have a very simple diagnosis.  Whatever you do, make sure you get every question in your mind answered prior to agreeing to surgery and be totally comfortable with your OS.  My current OS has been so wonderful.  He gives his patients his personal cell and puts the number on our charts.

Case in point, I am laying in the hospital, it is 4 am and I am set to go home.  I never get out of the hospital before noon, but the nurse is disconnecting my i.v. and PCA (patient controlled anesthesia).  I have had so many surgeries and so much pain medication my tolerance is very high requiring large amounts of medication to make me comfortable.  She decided on her own I had enough.  It is all paid for and takes 2 minutes to pull an i.v.  She decides I am going to lay there for 8 hours post op without good pain relief.  I ask her politely twice not to remove my i.v.  She tells me it is in my chart to remove the PCA prior to being released.  I argue that it does not say to do it at 4 am.  I tell her the ride home with having a TKR is very tough for me.  Especially riding in the wife's little PT Cruiser.  She still does not care.  I ask her to call my doctor.  She says no...she is following orders and it is her call.

I felt bad, but I called my OS at home at 4 am.  He was very nice and told me he would call.  He not only called the hospital....but he came into my room before 6 am....told the nurse she needed to apologize and if she ever messed with one of his patients again, she would need another job.  He drove it at 6 am and prescribed extra medication for the ride home and changed all of my bandages himself simply because he is more careful than the nurses.

If you do need any kind of procedure, make sure you trust your OS.

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?















support