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Author Topic: Knee problems - what test should be performed?  (Read 4298 times)

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Offline Maggie

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Knee problems - what test should be performed?
« on: August 05, 2002, 09:42:30 PM »
I was just wondering what test should typically be done in evaluating knee problems? I have seen many orthopedic surgeons over the years and they have never done anything beyond x-rays, and then they immediately start talking surgery. I have been fascinated by all of the post that mention MRIs, bone scans, and all the other tests. Why would these tests be necessary in some cases and not in others? How does the OS determine this? I have had two surgeries with nothing but x-rays and now I have had yet another reccomendation for surgery with only x-rays.
Thank you Maggie.
« Last Edit: September 19, 2002, 12:10:41 PM by admin »
Scope in 1984 torn acl, loose body removal, patellar chondroplasty. 12/01 open VMO advancement, LR, medial meniscectomy, abrasion arthroplasty, patellar chondroplasty.Synvisc, cortisone, celebrex.

Offline Heather M.

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Re: What test should be performed?
« Reply #1 on: August 06, 2002, 01:57:59 AM »
Maggie,

For my last OS consult (persisent pain, swelling, scar tissue formation after four scopes), the surgeon ordered x-rays, MRI, knee aspiration, and nerve tests.
Once he got the x-ray results, he canceled the MRI.  Said he'd found the problem (early arthritic changes)  With things like arthritis, an X-ray combined with a thorough history and hands-on assessment is really the best way to diagnose, except maybe surgery!  And x-rays are also a matter of interpretation, which is why I got a copy of mine and am seeing my original surgeon tomorrow.  He's seen the inside of my knee and will, I think, be better able to interpret the test results.

As for the other tests....I've had 4 MRI's done, two for each knee.  Only once did they pick up the problems.  I had surgery on a knee with a  perfect MRI and my doctor found more scar tissue than he'd ever seen except in a knee replacement patient.  My other knee has had two MRIs showing chondromalacia and nothing else.  But the whole joint is visibly swollen, snaps, pops, grinds, and I even have this hard swelling behind the knee.  NONE of this was picked up or explained by the two MRI's I've had.

Depending on what your problem is, a CT scan might be appropriate, or bone scan for density or whatever--it depends on what your doctor thinks is wrong.  When in doubt, get a second opinion.....

Good luck.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline mj/usa

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Re: What test should be performed?
« Reply #2 on: August 06, 2002, 05:12:27 PM »
Dear Maggie--

Hard to say what tests are needed.  In my case, the x-rays didn't show anythign, yet there was definitely a problem as my os could tell from the physical examination of the knee (pain, popping sounds etc) So I had an MRI done--that MRI was totally useless, showed a meniscal tear where there was none (I had arthroscopy anyway because the os wanted to see where the problem was coming from.)  He found really bad medial plica and a chondral defect. Neither of which were on the MRI or the x-ray.  He removed the former, and left the latter so now I have to have an oats op in September.
BUT the new os also had MRIs done adn they showed the chondral defect very clearly.  
So I guess it comes down to who reads the MRIs and whether you trust them or not.  The person to talk to is your surgeon and if you don't like what he says, how he treats you, then go for a second opinion.
Good Luck!
plica excision 05/01,  followed by OATS 09/02

Offline jathib

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Re: What test should be performed?
« Reply #3 on: August 06, 2002, 08:59:49 PM »
If you have arthritis or some kind of problem with your bones then an x-ray will see it. My x-rays show little space between femur and tibia and it's even obvious to me. If your doctor suspects some kind of tissue damage like meniscus, ligament or cartilage than s/he is more likely to order an MRI because an x-ray won't pick that stuff up. Torn meniscii and ligaments are sometimes obvious just by the tests they do in the office when they yank your leg all around.

Offline The KNEEguru

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Re: What test should be performed?
« Reply #4 on: August 10, 2002, 05:13:45 PM »
In knees, like so many branches of medicine, the doctor should be almost confident of his/her diagnosis before even touching the patient. The story is often so clearly pointing at one or other diagnosis - but one can only ask the right questions, or read the story with understanding if one knows the subject well - and this is at the root of the whole knee problem. Undergraduate training for doctors, not only in knees, but in the whole of orthopaedics, is often extremely limited. Postgraduate training is only minimally better.
Anyway, assuming the doctor understands all about knees and their problems and has taken a flawless history (your story), then the examination is really geared towards confirming or refuting what he/she already strongly suspects.
A good knee doctor will perform a full knee examination even if he/she is sure that the problem is just in one area - it is good sound practice, and often there is actually more than one problem in the knee at any one time - so a good examination will make sure nothing is missed.
What PTs do, which doctors often fail to do, is assess the knee at this stage from a functional point of view - again this is lack of training. A PT will assess muscle function and muscle balance, stiffness, range of motion, etc. This is not diagnostic, but underlines how much the internal disorder is upsetting function.
X-rays etc are actually not as necessary as one might think if the 'history' and examination have been thorough, but most doctors will ask for them anyway as they are a useful fixed record of the knee at a point in time. But again the specific X-ray view has to be ordered with an understanding of what the doctor is looking for. For example, a full-leg standing X-ray will give much more information about joint surface degeneration than an X-ray lying down. MRI is a really tricky one. The book, advertised on the main site, called 'What your doctor may not tell you ...' http://www.kneeguru.co.uk/html/step_10_help/step_10_books.html goes into this in great depth.  The value of an MRI is that it can show the soft structures in the knee as well as the bones.  But interpretation is difficult, and not every radiologist (X-ray/MRI doctor) may not be expert in knees, and small variations of settings can make things look very different - i.e. tweak a knob wrongly and it can make a normal knee seem as if there is a meniscal tear!
CT scans are another similar test - useful for 'seeing' the joint cartilage.
There are tests other than MRI and X-rays, and the one often used at our clinic is 'isokinetics' - where an exercise machine plays a diagnostic role in assessing the balance of muscles, and the positions in the knee cycle where pain inhibits muscle function. There are also machines for measuring ligament laxity etc.
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