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Author Topic: Knee pain and worries  (Read 6397 times)

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Offline Cherokeegal

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Knee pain and worries
« on: August 06, 2012, 03:18:44 AM »
Hello, all. I'm new to the board. On June 19 suffered an injury to my knee at work. I am 42 and work at a hospital as a nurse's aide. I was helping an RN get a patient back to bed who had just had a knee replacement the day before. The woman was in her early 60s and obese, and would not help herself with the walker. She kept grabbing me instead of the walker. The nurse kept telling her to stop pulling on me. When we got her to the bed, she grabbed me by the uniform at the shoulders and then flopped back onto the bed...taking me with her. In the process of trying not to fall on top of her, I ended up twisting my left knee and hip and ended up across the bed, supported by my arms.

There was an immediate "pop" and pain in my knee and it started swelling. My hip hurt, too, but after a few steps and stretches was able to "walk it off" and it hasn't bothered me since. The knee on the other hand is another story. I have been off work since it happened. I can not bear weight on it due to the pain, it catches when I bend it, and feels wobbly and unsteady and gives way when I put a bit of weight on it. It's very difficult to bend it, and if I'm forced to, it's very difficult to straighten it back. I was seen by the Nurse Practicioner in Employee Health twice before being referred to an orthopedic surgeon. On the day I injured it, the NP said that I would be able to come back to work the following morning.  I wasn't, and like I said, haven't been back since.

The regular xrays showed "no broken bones" and the MRI has shown "signs of osteoarthritis... bone spurs, a popliteal cyst, and some osteochondral defect". It says the ACL and MCL are "intact"and nothing with the meniscus shows. I had absolutely no pain or problems with this knee before that old woman pulled me down. The first visit to the ortho doc, he did a cortisone injection that hasn't helped me one bit. If anything, it made it worse.

The ortho doc says it's "only a sprain" and ordered me to physical therapy. But he is very unfriendly and just in and out both times I've seen him and won't specify which ligament is sprained or to what extent. He told me the second visit, as soon as he walked into the room, "I gotta get you back to work, the hospital is mad at me." PT was a nightmare, and I cried through it every day.  Every movement caused a horrible "pulling" sensation in the middle inner area of my knee.  One of the PTs told me that there is no way it's just a sprain and there has to be some MCL damage and probably a meniscal injury.  Each treatment caused a huge increase in pain and swelling.  I applied for a new doctor due to what I felt was a conflict of interest with him, since he seemed to have no interest in my knee and didn't even hardly look at it. I felt like he was more concerned with the hospital where he admit patients and does surgeries than me.

I did get approved for a new doc in the next town who is not affiliated with my employer hospital, and am waiting for an appt with him.

I don't know what the problem is.  I just know something needs to be done.  I have to get around on crutches because I can't bear weight on this leg.  I'm clumsy on crutches, and there are times I have to touch weight on my left leg to steady myself.  At those times, and this is the only way I can describe it, it feels like my knee is hollow and there is a squishy ball inside it that bulges.  I know that's weird.  LOL

Sorry for the length.  I'm just worried and terrified.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline dm

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Re: Knee pain and worries
« Reply #1 on: August 07, 2012, 12:56:48 PM »
If you're "clumsy on crutches" you may need to adjust them. With the tips about 2" in front of your shoes, the armpit parts of the crutches should be about 2 fingers under your pits, not up in them. If they're stuffed up in your pits, they may need to go down a notch, and tweak the handgrips up, so that you can grip them with your arms straight, but without "reaching" for them.

Moving with crutches is a "tripod" effect... move the crutches forward to either side of you about a foot and half, keep the bad leg a little in front and not behind or under you, it makes the balance easier, and swing through where you placed the crutch tips, so you land with your good foot about a foot or so past the crutch tips. Taking short "crutching strides" gives you control. The big swinging moves you see people do is those who're "experienced" and have been on crutches for a while.... I've got 6 knee ops behind me.... so I know the deal. If they didn't give you clear instructions, and watch you practice some before turning you loose on them - that's their bad as a hospital! I hope they're not so neglectful with the paying patients, if that's what they do with employees who get hurt!

Well, I hope my tips help you to get crutching a bit more confidently, so at least you don't feel like you're gonna fall over.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline silverghost

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Re: Knee pain and worries
« Reply #2 on: August 07, 2012, 03:38:35 PM »
Hey cherokee

Sorry to hear your in so much pain! Im surprised you didn't go on the attack with a bedpan after that!

I'm surprised MRI's didn't show anything other than wear and tear as I'm sure your aware the symptoms you have are indicative of a cartilage tear or ligament damage especially if you had had no previous warning signs....

I think you have made a good call in contacting another doc and would get a second opinion especially if the cortisone injection has not touched it.  I had 5 cortisone shots over 2 years and towards the end it didnt touch it so it appears work maybe needed.

Crutches are a pain in the backside! ive been on them for 9 weeks now and don't think i'll ever get used to them... only tip I can give is not to go out when its raining, may as well set fire to yourself and throw yourself off a cliff it would be less dangerous!

you take care  :)
'96 ACL reconstruction
'09 Arthroscopy/cartilage repair
Diagnosed with Grade 4 OA no medial cartilage and significant varus alignment
'11 fitted with off loading knee brace
'12 HTO, meniscus transplant, acl reconstruction & microfracture all in 1 go!

Offline Lottiefox

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Re: Knee pain and worries
« Reply #3 on: August 07, 2012, 06:30:23 PM »
Couple of thoughts:

1. MRI scans do not pick up everything and also the person reading them doesn't always pick up everything!
2. The pop you describe and your feelings of instability *could* indicate an issue with a ligament, perhaps your ACL and again, tears are often hard to see on an MRI and are sometimes only found on a scope.
3. The reports mentions signs of osteoarthritis - it is possible that the action and fall has set off existing damage and caused the pain. I know I had OA changes for many years but they never bothered me until one days I was doing crazy boot camp sprint stuffs and pivoted hard - kind of odd feeling and instant sharp pain. I know from scans I disturbed a big chunk of cartilage but that never created instability and I have been able to work around it...but I've been lucky!

When you say it is hard to bend it, is that because it hurts or because there is a physical block to the motion?

You must be mad at that patient. I hope you get some relief soon!

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 Cherokeegal

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Re: Knee pain and worries
« Reply #4 on: August 08, 2012, 01:49:28 AM »
If they didn't give you clear instructions, and watch you practice some before turning you loose on them - that's their bad as a hospital! I hope they're not so neglectful with the paying patients, if that's what they do with employees who get hurt!

Well, I hope my tips help you to get crutching a bit more confidently, so at least you don't feel like you're gonna fall over.

Thanks, dm.  Actually, the hospital didn't even give me crutches.  The day of injury, Employee Health sent me home, limping and hopping, to do RICE.  I ended up borrowing the crutches from my brother-in-law because I physically could not get to the bathroom here at home. A week and a half later, when I got them to give me an appt to come in to be rechecked, because I couldn't stand the pain or bear weight on it, when I came crutching in, they were like, "Oh, you got crutches.  Good.  Don't put any weight on your knee." 

Thanks for the tips.  That does give me a smoother and steadier gait.  I've never used them before, and was kinda putting my bad leg down then stepping over it while trying to keep my weight on my arms.  Pretty unsteady.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline Cherokeegal

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Re: Knee pain and worries
« Reply #5 on: August 08, 2012, 01:54:25 AM »

I think you have made a good call in contacting another doc and would get a second opinion especially if the cortisone injection has not touched it.  I had 5 cortisone shots over 2 years and towards the end it didnt touch it so it appears work maybe needed.

The cortisone shot hurt like the devil when he did it.  Afterwards, I had a lot of pain at the injection site, where it hadn't hurt before.  But it made my blood sugar go really high with me being diabetic.  And the entire night after it was done, I felt sweaty and hot.  I truly don't want to have to have another one.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline Cherokeegal

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Re: Knee pain and worries
« Reply #6 on: August 08, 2012, 02:04:30 AM »


When you say it is hard to bend it, is that because it hurts or because there is a physical block to the motion?   

Both, actually.  Most of the time it just hurts so bad that I don't want to bend it.  Every now and then, if I'm forced to bend it...like sitting and getting up...it won't bend and feels like something is actually stopping it...like something is in the way. 

Quote
You must be mad at that patient.

I'll admit, I have been dealing with a lot of anger directed at the patient.  I don't like that, and try really hard not to be mad at her. She had just had a TKR the day before, and I know she was in pain.  PT had gotten her up to a chair, and the nurse was trying to help her back to bed.  She wasn't cooperating or using her walker to help herself.  That's when I got called in to help.  She was laughing and saying she couldn't do it, and kept grabbing me.  After it happened, she kept laughing and said,"Where's your bottle?" as if I'd fallen due to being drunk.  By jerking and lunging to the side, in efforts to not fall on top of her, that's what twisted my knee.  I was trying not to hurt her and hurt myself.  That makes me mad a lot.

 
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline dm

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Re: Knee pain and worries
« Reply #7 on: August 08, 2012, 12:33:53 PM »
If the patient was laughing etc, she may have been high on painkillers, then the RN should have noted that and had the PT wait for her session until the patient was more coherent and cooperative, due to her size. Bad on her for not seeing that.

If the knee hurts that much to bend at all, I'd look into getting an immobilizer to stabilize it until you can get it seen again.

glad the crutching instructions helped!
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Cherokeegal

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Re: Knee pain and worries
« Reply #8 on: August 08, 2012, 01:47:41 PM »

If the knee hurts that much to bend at all, I'd look into getting an immobilizer to stabilize it until you can get it seen again.


I will have to ask the new doc about an immobilizer once I get my first appointment and see him.  Like they didn't give me crutches, they didn't give me anything for my knee except a length of Ace wrap to keep it wrapped with.  I've been washing it and reusing it this whole time.  Without it wrapped snugly around, my knee is very loose feeling.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline dm

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Re: Knee pain and worries
« Reply #9 on: August 09, 2012, 03:29:26 AM »
I don't know where you're at, but around here there's a lot of thrift stores. I've found the straight knee immobilizers, often pretty much new, at them for just a few bucks. I found a walking cast boot when I needed one that way - 10 bucks vs 250. If you've got a long wait for your appointment, and your knee feels that bad - you might consider the idea, if you feel it really needs the stabilization now, and not in two more weeks, or whenever they have decided it's convenient to see you.

you can also create a support yourself by taking a bedsheet or towel, folding it about 24" wide longways, and fold it up until its about 12-14" wide. So, you end up with this thick rectangle about 24" x 14". Put it on the bed, lay your leg on it, wrap it up and around the knee and overwrap with the ace bandage. Basic, but gives you a thick, padded "U" wrapped in place with your elastic bandage to give the knee some added support and protection.

If you've got nothing else, and can't afford anything, think up something along these lines using what you have, and see if you can come up with something that adds some support to your knee.

The bad thing about wrapping it too snugly is you can affect circulation to your calf... so a bulkier wrapping that supports more of the leg is probably a good idea. Too bad you can't just call work comp and talk to them, tell them that you're appt is x, but you need a more aggressive support for the knee now, not then, can they authorize you an immobilizer from the hospital or a med supply place, so you can just go pick it up, so you don't make the knee worse....
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Cherokeegal

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Re: Knee pain and worries
« Reply #10 on: August 09, 2012, 06:23:30 PM »
Thanks so much, dm! I hadn't thought of a thrift store for an immobilizer.  I'll definitely have to check that out.

Still no word on the appt with the new doc. So still in a holding pattern here.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline Cherokeegal

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Re: Knee pain and worries
« Reply #11 on: August 09, 2012, 08:14:22 PM »
Just got the call.  I have an appointment with the ortho doc's PA tomorrow afternoon.  Apparently I am to see him to "get my foot in the door" and will see the actual doc on all future appts.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline dm

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Re: Knee pain and worries
« Reply #12 on: August 09, 2012, 11:47:41 PM »
Good! hopefully they'll do something for you sooner rather than later, and put you in an immobilizer or hinged brace for support until they decide what to do.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline Cherokeegal

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Re: Knee pain and worries
« Reply #13 on: August 10, 2012, 04:16:38 PM »
 :(

Well, it doesn't appear as if I am going to get to see the PA at my new ortho's office after all today. 

I have not received a WC benefits check in three weeks. I got an email Monday from the adjuster that said two checks for three weeks' worth of benefits was "in the mail" and I should receive them by Thursday. They didn't come yesterday.

Yesterday evening around 5 I emailed the adjuster and told her there's no way I can make the hour's drive to the doc's office as  my car is on "E" and I have no money since she hasn't paid me for three weeks.  I told her she will have to reschedule the appt.

I also emailed the WC chick at my job.  She replied first thing this morning and said she will "check with" adjuster.

I have not heard anything from either of them, so I called the new Nurse Case Manager they had assigned me.  She had not even been told that I had an appt today, and she is supposed to accompany me to all appts.  She said, "Well they can't expect you to run all over TN if they won't pay you."  She said she is going to call the adjuster.

I freakin' HATE worker's comp!!!!!  I hate my knee.  I hate being broke and useless and beholding to others.  I can barely take a shower by myself, and my I can't even clean my house!  I am just sick and tired of all this.  I give up.
06/12 Twisting injury @ work
07/12 Failed PT & Cortizone Inj
09/12 Arthroscopy w/Chrondroplasty & Debridement
09/12 Back in agonizing PT

Offline dm

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Re: Knee pain and worries
« Reply #14 on: August 10, 2012, 09:36:14 PM »
Hey, hang in there! It's frustrating as can be to not be able to get around like you're used to, to have the dishes piling up, the car out of gas, etc. The thing to do is to figure out what you CAN do about it.

Now... sit and have a good cry... eat a bowl of ice cream with chocolate sauce if it makes you feel better, and have a good wallow in self pity - AND THEN KICK YOURSELF IN THE BUTT and figure out what you CAN do!!!

1. get on the phone and call your local salvation army, church, or other aid agencies and see if you can round up a gas voucher or two so you can get to the doctor.
2. Find a roll around office chair if you don't have one, see if you can borrow one - sit in it and scoot around the house and use it to do some chores in the seated position. You can use it to do the dishes in stages - stand on one foot - do a few - then sit down and take a breather - repeat - if you're the dishwasher. Lay a towel on the counter so you can air-dry the dishes - it doesn't make any sense to stand there and dry them - too much work.
3. things like dusting can wait. Pick your priorities - do what you HAVE to do - like the dishes, the house doesn't have to be spotless.

I've never heard of a case manager having to accompany you to an appointment. What absurdity is this? I've had WC doctor appointments after an injury, and went by myself. If she's to go with you, and they scheduled your appointment, then she can drive and you can use HER gas!! Right?? I'd ask her to come pick you up for your appointment and take you to the doctor, cuz she has to go and since they can't get you your checks!! I'm nasty that way. Then I'd ask when your appointment is, and what time she'll be meet you at your house!!

Get mad, get active, get on the phone, kick some bootys.....squeak loudly so they do something!! Heck... I'm ready to get mad for you!
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.