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Old 03-09-2011, 05:57 PM   #1
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Question The high cost of diagnosing knee problems.

Before MRIs were used to diagnose knee problems, what method was used and why is it no longer used?

 
Old 03-09-2011, 06:05 PM   #2
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Re: The high cost of diagnosing knee problems.

Since I've battled knee problems since 1966, I can answer that.

What they did was an arthrogram. It was x-rays done with dye injected inside the knee. You had to have them move your knee around with the needle still inside the joint trying to see what was wrong where. And often, it still didn't show.

It was incredibly painful procedure if you weren't allergic to the dye. People died from the dye injections(anaphlactic shock). But mostly, people didn't get the test and just walked on the bad knee. They knew about the pain involved. And they had to use a HUGE needle so it hopefully wouldn't break off inside the knee while they moved it around and if it did, you were looking at immediate surgery just for that.

An MRI may be expensive but it doesn't kill and it doesn't cause you to need emergency surgery.....and it doesn't hurt.

All hail the MRI!

Jenny

 
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Old 03-09-2011, 07:41 PM   #3
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Re: The high cost of diagnosing knee problems.

Thanks Jenny for your answer. I will now quit complaining about the cost.

 
Old 03-11-2011, 12:37 PM   #4
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Re: The high cost of diagnosing knee problems.

Quote:
Originally Posted by SnowBunny2020 View Post
Before MRIs were used to diagnose knee problems, what method was used and why is it no longer used?
Before MRIs were invented the docs examined the knee properly and could be pretty sure what the problem was. The big drawback before MRIs was the knees could not be scoped and large incisions made which led to longer recovery times. I had both knees scoped, no xray MRI and a full and immediate recovery.
MRIs are used almost indiscriminately, patients demand it and get it. What they also get from all of theses tests is too much radiation.
James

 
Old 03-21-2011, 05:25 PM   #5
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Re: The high cost of diagnosing knee problems.

MRI's don't use radiation. They use magnetism. No need to worry about radiation with them...one nice thing.

And proper exams didn't show my problems at all and I had a torn meniscus, a torn ACL and a torn medial collateral ligaments. That was because orthopedists used to be taught that women, unless they were professional athletes, couldn't do such damage to their knees....it was anatomically impossible. Now studies have shown that women actually suffer more of these injuries than men do, due to our anatomy and wide spread hips for child birth.

A good exam can be destroyed by taught prejudice. Thank goodness for MRI's!

 
Old 03-21-2011, 08:08 PM   #6
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Re: The high cost of diagnosing knee problems.

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Originally Posted by jennybyc View Post
MRI's don't use radiation. They use magnetism. No need to worry about radiation with them...one nice thing.

And proper exams didn't show my problems at all and I had a torn meniscus, a torn ACL and a torn medial collateral ligaments. That was because orthopedists used to be taught that women, unless they were professional athletes, couldn't do such damage to their knees....it was anatomically impossible. Now studies have shown that women actually suffer more of these injuries than men do, due to our anatomy and wide spread hips for child birth.

A good exam can be destroyed by taught prejudice. Thank goodness for MRI's!
Well, a damaged meniscus can at times be difficult to diagnose but an ACL is the easiest and should never be missed at a manual exam, it takes seconds to train a person to spot the changes in joint slide. Medial ligament tears are also reasonably able to assess. Orthopeadist have known for ever that young women in particular can easily tear ACLs, in fact many would never have their daughters play soccer. The width of womens hips and the Q angle
cannot predict individuals who will tear knee ligaments. More thought these days is looking at hormonal balance during phases of the Menstrual cycle. There are in females biomechanical differences in the ligaments which stabilise the knee and the dynamic stabilisers, the muscles. One thing we do know is that women with stronger leg muscles, who do plyometrics and agility exercises can bring down the incidence of ligamentous knee tears. If any of the readers here have young women or men who are soccer players, rugby , basketball or even cheerleaders should scan the web for PEP, Prevention injury and Enhansment Performance. In fact females following this program can bring ACLand MCL ligament injuries to be equal or lower that of men. That is why I dont think hip width and the Q angle are relative.
James

 
Old 03-22-2011, 01:33 PM   #7
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Re: The high cost of diagnosing knee problems.

Well James, in 1966 in Canada(yes, I grew up in Montreal) I was told it was almost impossible for a young female, unless she is a professional athlete, to tear the ACL or a medial meniscus. I was young and had been caught in a rock slide while hiking in the Rockies and apparently, that wasn't considered sufficient to cause the injury.

I know you are older than I an maybe even a retired ortho but where you went to train and where my docs did must have been 2 different places because I heard that from more than 1 ortho both in Canada and the US. It took forcing surgery to finally find out I had both and torn MCLs as well.

And my current docs have told me about hearing from other women about that same discrimination against women when it came to knee injuries.

But since they didn't see the rock slide or how it hurt me, they just figured I was exaggerating. If anything, I was making it out to be far less than it was. So if it wasn't a medical discrimination, then it was a psychological one....the perception that women are "hysterical" and their reports of injuries or illness or pain can not be trusted and are exaggerated. My problem was that I had very little pain but my knee kept collapsing on me. Yet they missed it ....repeatedly. Why?????

I've now had 14 knee surgeries and bi-lateral replacements at 47 thanks to them waiting for over 2 years before operating on my bad left knee. I was bone to bone at 24 in the left knee and my dependence on the right knee wore it down fast. Their insistence that I couldn't have been hurt that badly has affected my entire life.

Jen

 
Old 03-22-2011, 04:43 PM   #8
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Re: The high cost of diagnosing knee problems.

Quote:
Originally Posted by jennybyc View Post
Well James, in 1966 in Canada(yes, I grew up in Montreal) I was told it was almost impossible for a young female, unless she is a professional athlete, to tear the ACL or a medial meniscus. I was young and had been caught in a rock slide while hiking in the Rockies and apparently, that wasn't considered sufficient to cause the injury.

I know you are older than I an maybe even a retired ortho but where you went to train and where my docs did must have been 2 different places because I heard that from more than 1 ortho both in Canada and the US. It took forcing surgery to finally find out I had both and torn MCLs as well.

And my current docs have told me about hearing from other women about that same discrimination against women when it came to knee injuries.

But since they didn't see the rock slide or how it hurt me, they just figured I was exaggerating. If anything, I was making it out to be far less than it was. So if it wasn't a medical discrimination, then it was a psychological one....the perception that women are "hysterical" and their reports of injuries or illness or pain can not be trusted and are exaggerated. My problem was that I had very little pain but my knee kept collapsing on me. Yet they missed it ....repeatedly. Why?????

I've now had 14 knee surgeries and bi-lateral replacements at 47 thanks to them waiting for over 2 years before operating on my bad left knee. I was bone to bone at 24 in the left knee and my dependence on the right knee wore it down fast. Their insistence that I couldn't have been hurt that badly has affected my entire life.

Jen
You were certainly not treated well and women should be treated no differently than men, their anatomy is basically the same only some physiological differences. Certainly now women are well looked after by docs and of course sports medicine was in it's infancy at least in Canada in 67. It seems hard to believe that the first ACL repairs were done in 1895 in Leeds England and the patient returned to work and never had another day off.
I myself ruptured an ACL in the mid 50s in the military and of course the MCL is invariably involved. In these days 6 weeks in a cast was the program and then get active, I never had it operated on.. Forty years later both knees gave me trouble, had them scoped and the junk removed. Within a day or so after both were good. In fact just been for a two mile run, my "good" leg is fine and the ACL leg wobbles a little bit but is virtually pain free. It looks awfull on xray, lots of OA changes but full range and good muscles. I am not sure why some folks are lucky and others have endless grief. One great improvement over the years is the quality of orthopaedic surgery and the surgeons. They are no longer as god like as they were, the new ones highly skilled and amenable. The old joke was that when God visited the hospital cafe and went to the front of the line up someone said, who is he, the reply was it's God he thinks hes an orthopaedist!
Bye the way I am not a retire ortho, I began my career as a foot shoulder, a private when drafted in 54 into the medical corps. Trained as a military nursing orderly, then surjical theatre technician, then as PT, then combat medic. From then on for a dozen years worked on rehabing soldiers. Came to Canada as a PT. I have therefore some understanding of injuries.
Spent some time in Montreal, always enjoyed it.
Hope you legs do well, you are certainly too young to have these troubles.
James
PS Looks like a Federal election! How exciting.

 
Old 03-22-2011, 06:41 PM   #9
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Re: The high cost of diagnosing knee problems.

I am a huge fan of physical therapy and feel not enough docs order it and if they do, for not long enough. If can be life changing.

In my case, I suffered a lot of untreated injuries as a child due to severe child abuse so I was a set up for injuries as a teen and adult. Much of my arthritis is from injuries and fractures that were never treated. One of the reasons I developed Cervical Spondylosis at such a young age.

No one believed I had been abused either as my father was the president of an engineering company. Supposedly, child abuse was a problem of the poor and uneducated. The mistake in this logic is that my father, while well educated and making a decent salary, was not the abuser as is usually assumed. It was my under educated and very stressed mother who was severely abused herself, who was the primary abuser. In fact, she had something called Munchausen Syndrome that morphed into Munchausen by Proxy when a child of the appropriate age was available. It's a form of mental illness that kills about 10% of the child victims.

I'm just glad I'm alive.

Jen

 
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