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Author Topic: OS exam~ Confused  (Read 1339 times)

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Offline Hiker girl

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OS exam~ Confused
« on: August 09, 2012, 06:50:59 PM »
Hello,

I am 10 weeks out of infrapateller fat pad debriedment.  I have been going to Physical Therapy for 8 weeks.  We finally have a tx that is exhausting without causing my knee to blow up the size of a cantaloupe. This is also the first week of semi-normal gait in mornings until afternoon.

Today I saw my OS.  He said do you really think you are getting anything from PT?  He also informed me that full extension will come eventually on it's own.  I am 10 degrees short.  He also said 130 degree flexion is normal range.  I can achieve 130 if someone else is pushing it back or if I do wall slides. 

He did not check my gait, look at my knee which is purple and red and sensitive to touch.  I don't know what to do he is saying I get 1 more month of PT.  I am frustrated he did not listen.  I think he is frustrated I am slow at recovery.  My hubby who was with me got the feeling he thought I was malingering.  Gosh darn, I have been working at my job since week 3 on top of recovery. 

I guess I am unclear how to communicate to him what is happening.  I focus on how I have improved.  Should I be focusing on what I can't do?  Or what I would like to do? ???

Debbie
Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline crankerchick

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Re: OS exam~ Confused
« Reply #1 on: August 09, 2012, 08:14:10 PM »
I think you have to be more stern with the doctor regarding what your current state is and what your expectations are, rather than him/her telling you what they are. Plenty of OSes say 120 degrees ROM is "functional" but others disagree. I've been told that full extension and flexion means it equal to the opposing leg. Don't let your OS tell you what you should be ok with, but rather stress what you want so you can arrive at how to get there.

Also, I'm not an MD but I don't really believe extension "comes with time" but that is just me.

Does your insurance require the doctor's ok to continue with PT? If not, you can always continue PT even if your surgeon discharges you from his care.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline allyd

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Re: OS exam~ Confused
« Reply #2 on: August 09, 2012, 08:33:47 PM »
Between injuries and surgery I’ve had… I can say the last 10 degrees or so of both Extension and Flexion do simply come with time. Think months, not weeks. It can depend on the individual... but best just to keep plugging away at it.

Outside of ROM and PT being cut off, what are your concerns? Maybe talk to your PT and see if they can help articulate to your Doctor. Sometimes it’s easier for the PT as they work with you more… I know this is the route I took with my OS when I had a hard time communicating my needs/wants well in an appointment. When I had my PT “translate” the light went on for my OS. 
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline Hiker girl

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Re: OS exam~ Confused
« Reply #3 on: August 09, 2012, 08:34:39 PM »
Thank you crankerchik,

My PT said insurance will continue to pay for PT as long as OS continues to prescribe it, so I need to be clear with him. He reluctantly gave me 12 more visits this month. With my good leg I am -5 in active extension and my heel touches my rump passively.  

I would like to walk down a ramp without the aid of crutches, walk at normal speed with proper gait, bend my knee to get into bath and get out of bathtub, driving would be awesome.  Don't think I am asking too much. :P

How does one get full extension?  I sit with heel on coffee table, push on it, leg lifts.  Anything else I can do?  

Debbie

Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline allyd

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Re: OS exam~ Confused
« Reply #4 on: August 09, 2012, 08:42:20 PM »
When I first injured my knee,  I lost full extension. This sounds similar to what you are doing - But, My PT just had me working as such: sit on the floor, legs stretched out, and do quad contractions – to the point where the back of the knee was to push down on the floor (eventually that is… once I got the extension back). Put a pillow underneath for support initially, and remove as you gain ROM.

I'd definitely have your PT give your OS a call regarding the lack of strength in your knee for daily activities. Walking, stairs, etc.
04/09 RK - Dislocated Patella & Grade III MCL Tear
06/10 RK - Re-Dislocation Patella
09/11 RK - MPFLr + Lateral Lengthening

Offline crankerchick

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Re: OS exam~ Confused
« Reply #5 on: August 09, 2012, 08:53:09 PM »
I've had my last few degrees of flexion come back with time, but extension, not so much, but again just my experience. With my plica removal, my PT never pushed my surgical leg past 0 degrees flexion (she said that was bad...), even though it hyperextends quite a bit to I think -15 or so. :o I always had pain extending past zero after that.

When I had my second surgery 2.5 years later, my OS had me locking the leg in extension when elevating, so as not to lose extension. It really helped not to lose the extension and even start get back those last few degrees I never regained from the first surgery with the prior OS. It took over a year of elevating like that, hanging weights from my extended leg, etc to be able to extend the same as the other leg without pain. I just did this on my own since I knew it was residual from the first surgery. I ran it past my current OS and rehab folks and they said what I was doing was fine. So you could check with your PT and/or OS and see if they are ok with using weights if you want to try something on your own. Otherwise, you could wait and see if it comes back on it's own.

After my plica extension, I had to work over the course of 8 weeks or so to get flexion to 120+, and then as allyd said, the last few degrees came over time, but with some work. After my derotational surgery, I maintained flexion to 120 when measured on my back, but I could not actively get my heel to my bum when standing or laying on my stomach. Even with my trainer stretching me I couldn't get it there without pain and mumblings. I bought one of those stretch straps (you could just use a rope or belt too) and worked at it multipe times a day. Somewhere around I guess the 7 month mark I was able to get it there, and then I guess a month later I could accomplish it without cussing anyone out. When standing, to hamstring curl, it still took just a bit more time to eek out those last few degrees to bend my leg to the same as the other.

I'm one who says 120 degrees might be functional, but it's still annoying if you are used to your leg bending more. When I couldn't bend my leg as much as the other, I often found myself not being able to do routine things like bend my knee enough to put my shoes or socks on, or just felt that resistance when walking, etc. That just made me keep doing the stretches to try and force it. No idea if it would have come on it's own in time, but I was too annoyed to wait to find out.

I don't think you are asking for too much. I just think perhaps either some brute force to the doctor, or as allyd suggested, a neutral third party rallying for you, migt be in order. Sometimes doctors get so caught up in "what is enough" that they forget to pay attention to what they patient wants.
« Last Edit: August 09, 2012, 08:55:31 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Hiker girl

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Re: OS exam~ Confused
« Reply #6 on: August 09, 2012, 09:09:28 PM »
Thank you both for replying.

I will definitely get the PT to go to bat for me.  Last week my muscles began to obey me.  It was quite odd for nothing to happen when my mind was expecting the muscles to do something.

I will ask if I can use weights to help extension.  The swelling has been so bad that I have had to really back off my I will do this attitude and settle for slow and easy, listening to my knees.  I have not been measured on my stomach, just sitting position and usually by estimate.  I am sure that they see so many knees that they can do this without measuring....??? 

I appreciate you sharing your experiences as this helps to normalize my reality and expectations.

I have been putting a towel under my knee and activating my quads...nothing happens.  I think my heel is supposed to pop off the table.  If you have any other suggestions I am open and willing to do anything.

Debbie



Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline Lottiefox

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Re: OS exam~ Confused
« Reply #7 on: August 10, 2012, 08:20:06 AM »
What are your general pain levels like?

Definitely push for PT being maintained. I don't think you're expecting too much at all. Ask the OS how he'd feel living with his knee in the current stages of flexion and extension......betcha he'd be keen to keep trying to improve.

Good luck and keep us posted,

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 Hiker girl

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Re: OS exam~ Confused
« Reply #8 on: August 18, 2012, 01:31:33 AM »
Thank you all for the clarification,

Lottie my pain levels range between 2-7.  They seem to spike in the evenings.  I work in the afternoons and evenings so I take ice packs with me and put my leg up on a coffee table.  It is unconventional as a therapist but I have to work. 

I am not using any pillow at night under my leg so I can  keep my extension and it is becoming easier to sleep.  PT is now using ultrasound every session along with ice massage and tens unit.  I am finding on the leg press if I start with 30# and work up I am not distressing the knees as bad.  In the evenings the PT told me to use my crutches to avoid pounding the other knee due to having poor gait when tired.  This whole experience is like discovering a whole new life  :-\ 

I will know in 2 weeks what the OS thinks and will be ready to push back.  Thank you for all of your suggestions and the pep talk.

Debbie

Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage