I filled him in on what happened, and how my knee cap was out of its groove and how it jumped back in there all by itself.
But since then, I've had swelling and patella slippage.
He is sending me for MRI.
He says he is looking for sprain or tear of the medical retiniculum. He says that it provides stability for the knee cap and the MRI will tell us just how bad it is...and will tell us weather I'll need surgery.
A question...when the doc said your MRI looks excellent, does this mean that it doesn't show any damage or injury? Also, if you're not satisfied with the way this OS is treating you, or you think he is disinterested in your wellbeing, why don't you go to a different OS for a second opinion?
Thanks so much for your replies. They mean the world to me...
Okay...to answer the first question. I had gone in telling him my patella had dislocated and that it was now slipping and there was a lot of pain and swelling.
When I got back to see him after the MRI was taken...he turned and said to me "Unfortunately, your Patella looks excellent" He further clarified saying that the retinaculum didn't even look stretched, nevermind shredded or anything like that.
The attitude struck me as pretty odd...using the word "unfortunately..."
According to him the minor ACL sprain the MRI showed, was old...so that couldn't be a factor in my pain or swelling. Interestingly...I have never injured myself before that I can recall, and you would think that I would have noticed it...so that is just another confusing thing.
The backstory is that I had seen him months back with an injury to the other knee. He is a injury prevention specialist who is the sports doctor director to the women's husky basketball team.
That knee injury was REALLY bad. I was limping terribly, as I couldn't flex the knee or the foot VERY swollen. I saw him twice regarding that injury and he never once explained the danger of opposing limb injury, (which is why this injury occurred), so when I went back to see him with this knee injury I let him know how I felt about that.
Now that this has happened people are quick to tell me that opposing knee injuries are "common." You would think that after all the money you pay out for appointments and doctor appointments...someone would inform you BEFORE it happens.
I've tried to just stay with one doc as the first leg injury was started a year and half ago, which was worsened by two previous doctors...and I'm still very much recovering still from those injuries when this new one came along.
So now, I'm just plain old laid up not able to enjoy the tiniest things in life, and to think that it all started because I went to the doctor over a minor tendinitis near my knee just kills me.
As far as the pain....it seems as though the pain is only if I attempt to walk on it now or if I touch the knee. I did have swelling that caused nerve pain up to my waist, but with icing that seems to be reduced now.
I've kept it braced or wrapped now for about five weeks. I'm using a crutch. I decided to do that because of what I read on line, not because the doctor thought I should. He made no suggestions what so ever...actually.
I have pain in the joint line and sharp pains around the knee cap itself.
Still it looks like I might just see another OS just to for a second opinion since this whole chain of events doesn't look right to me.
Thanks....I just can't help being really, really sad about this.
I've had a bad experience before with a surgeon making BOTH my knees worse. I've had knee pain since i was about 12 years old I'm currently 17, i had complained about it to my doctor and well thought nothing of it, do these stretches to strengthen your muscles and you should be alright. Well that of course did nothing. So after i finally gave up all my favourite things like soccer,roller blading, biking you name it i couldn't do it! The pain took over my life!
I finally got into see a orthopedic surgeon i was told he was the "best you can find in my area". I also got an MRI before i saw him. Well i get there well he didn't pay attention to me or care what pain i had. His residents saw me and spent more time playing around with my knee than he did! They never pulled up my mri to look at it or told me exactly what was on my MRI report! He never treated me like what i said mattered! But anyways, i wasn't to happy after that all i got told was get a brace and physio your knee cap isn't in the groove right. Not real information was given to me on what the heck this man was talking about. I was about to burst into tears sitting on that bed after he left it was maddening!
So i started my 3 months of physio like i was suppose to! Well after a month didn't my knee cap now start to SLIP! The worst pain ever. And not only that it damaged my right knee also. But if it wasn't for my physio therapist then i wouldn't have known what my knee issue was called which is lateral patella tracking. I have it in BOTH my knees.
I finally gave up and said forget it i will go see a surgeon i know is good at what he does and he DOES care! I saw him a week after asking for an appointment. Well my options pretty much were surgery. He wanted to scope it because the fact i had tried physio. I had a lateral release done to move my knee cap back! I've gone to a GREAT physio therapy place this time around, and after a slight relapse my left knee has been amazing! my right knee is up next in the next year!
I had swelling within the back of my knee and it bruised up quite lovely! All the normal symptoms of my issue i didn't really half the time notice. I'd walk with a very bad limp it was like my knee just didn't work normally! Most of my pain was in through the back of my knee! Which is why i had a very hard time believing it was all from my knee cap being out! It was extremely painful, and stairs would kill me, it wasn't the pain it was the fact of just how slow i actually did have to go or else it would just want to give out! I've learned one thing especially is that these doctors can not feel the pain and what your feeling, they can only go by what you say, so if they can't listen or aren't helping you have to find the help yourself because you know yourself the best!
You know it is sad that doctors just dont take their patients seriously.. I have went to my family doctor a few times reguarding my knee cap that slips out.. he would do x-rays & said that everything was fine.. He would always say that my knee cap dislocating was normal.. ha ha.. no.... I didnt even know what a MRI was or anything. I finally went back when I hurt myself & my doctor thought it was patellar tracking.. I went to see my Ortho surgeon and he thinks it is a meniscus tear.. I find out tomarrow what it really is.. my ortho surgeon said that my knee cap is slipping because of my knee being swollen.. that may be true... however, it has done this on & off for the past 3 years.. hard to believe that my knee can swell up for no reason.. I am hoping I get some good news tomarrow.. I would definitly get a second opinion. I didnt get into the doctor I wanted to so I am not sure on how I feel about him yet.. this will be my second time seeing him. The ortho I wanted to see was booked up for a month & I needed to be seen bad. I hope both of you are feeling better & can get some answers.
I know this will probably not win me a popularity contest...but I don't think it's right to lump all docs into a not caring group. I have 3 orth surgeons, all at Duke med center and they're great, I wouldn't trade them for anything. I realize that sometimes you do get docs that don't care, but there are just as many out there that do. Sometimes you just have to keep looking to find one that fits you. Honestly to both of you, if you're that dissatisfied with your doc's, why don't you find a new one? Because you both seem to know that it's not going to get any better.
I do realize that the stress of not knowing what's wrong can make you very sad. I have dealt with degenerative cartiledge disease and osteoarthritis since I was 17 and I am now 39. I have had 10 surgeries, the last one being 3 weeks ago to reconstruct my knee with an tibial tubercle osteotomy. Basically they had to cut my tibia loose raise it 1mm, move it 2mm to the right, do bone grafts on each side and screw it down from the top. So, yeah bad knees do suck and they can be hard to work on, but if you find the right doc, they can be fixed.
Wow...what a heartbreaking story. I'm very sorry to hear you went through all that. Yes...your point is well taken there that a person can only know their own pain and the doctors don't.
You say that you have Great therapy. What do you consider the hallmark of great therapy. I'm about to start with a therapist, and I'd like some insights on knowing what to look for in a good therapist.
Thanks...eversomuch for sharing the story. I do hope your other leg works out as well as the first.
I have read about the lateral release surgery and not all of it is positive, so its really great that it worked out for you!
Wow...you have certainly been through a lot of surgeries! That is amazing.... My heart goes out to you and its sounds like you are working with some very professional docs. This is excellent and inspiring.
Your point is well taken...the docs are not universally bad. Still, all it takes is one bad doc to ruin your life and leave you in a lot of pain.
If I had to do it over again, I would have not got into a doctors office without a friend, and I would have gotten creative about making that happen if I had to. Unfortunately, even if you sense the danger, your friends might not...since its not them that will get injured or have their life destroyed. That only means they need some creative persuasion. Too bad I didn't get creative....and I really regret now that I was such a fool.
Now...of course that I'm so injured, my friendships were killed. Can't work or take a shower. So...nice downward spiral.... The days just running into one another with so little change...
If I had only been creative...
I called the PT place today to ask them if I should come over to see them for evaluation. Since I'm so wrecked, I fear that they will tell me they can't help me, or that my swelling is too extreme (it goes from my feet to my chest). The doctor didn't write anything much out on the PT sheet, so I had to explain why that was the case. I fear that they will touch me, or try to make me move in ways that will foster more problems for me...
Do you know if they will want to SEE my legs? Will they want to touch them? Will they poke and palpitate them...where the pain is the worst? I'm scared because EVERY doctor I have been to has contributed to my downfall...and I don't want to be a fool and offer anyone else the opportunity to make me worse. I can't even look at my legs right now...I'm so emotional about them.
I guess I worry about having also missed out on getting good info from doctors and was hoping they could fill in the blanks for me with a few things, and that they could help me to NOT atrophy....if its possible without injuring me. So..I'm trying to be measured in my search for wellness..safely.
Its hard to try now. Its been such a nightmare. I just want to know that there is a light at the end of the tunnel.
You guys are so great...so inspiring and full of great info. Thanks again for sharing.
I can't wait to see what they say you have. Patella tracking or meniscus....you could have both. That would really be bad..
Yeah...the swelling and the maltracking thing seems kind of strange.. I thought the same thing about mine. I thought...if I could eliminate the swelling the slipping would stop...but then again, I started to worry that the slipping WAS causing the swelling though annoyance of the surrounding tissues. OY!
Still...if the patella is not tracking, my understanding is that it needs to be addressed, and that could mean PT, or surgery or both. Sheesh....
Is this doc doing an MRI for you. They say an MRI will show how disrupted the ligaments that hold the patella in place are. They can be stretched or torn...or not show anything at all. MRIs can be under read...meaning they don't necessarily show things in the kind of true detail that they really are. When it comes to patella...the tracking is best evaluated by CT scan at various degrees to see the flex points of maltrackage. I've read that anyway...as a static picture of a motion joint...doesn't always tell whole story. I just read that yesterday...so it might be rarely done.
It doesn't show where you live, but if you live near a University or teaching hospital...then a second opnion buy a new Ortho Surgeon would definitely be warranted. These type of practices are generally the best docs. And yes your observation of CatScans being rarely done for knee problems was correct, MRI's are the standard test and they show the pattala tracking with no problems. Now as far as PT goes, yes they will touch your legs in order to work whatever excercises they deem necesary to fix the problem. There also could be palpatation of the knee cap if that is warranted. A TENS unit might be applied for the nerve pain and probably icing for the swelling, it just depends on what your doc prescribes. And if the orders aren't clear enough, they will most likely contact the docs office to check what they should do. Are you on any kind of medicine regiment to help control the pain? I know this type of injury can be painful, but it definitely should not be as debilitating as you have described. I would really think about getting a second opinion.
SoftCrush- My doc gave me the results.. I have a tracking problem with my knee cap. He gave me a cortisone shot ( his idea) and said to come back in 4 weeks. He said that if the cortisone shot doesnt help then he will do an arthoscopic lateral release surgery. He said my knee is really really swollen.. and he said I have some roughness on the back of my knee which he said he will scrape off if/when he does the surgery.. I have to say the cortisone has helped the pain.. not 100% but has helped its just super sore from the shot.. It is still very unstable but I am trying my hardest to stay off of it. I have had this problem for 3 years.. It wasnt really bad until recently the past few months.. My family doctor had told me that it was normal for it to slip out.. Not knowing I thought he was right since he was the doctor. Now I know to get a second opinion if I ever have questions.. I just am glad to have some answers. I have an appt on Oct 21.. and I will find out what we do from there..
He just did a MRI on me but he was able to see all of that on a MRI.. I know not everything can be seen on a MRI though..
It sounds like you are so on target with things. Really appreciate your contribution here.
I just got back from the PT place and unfortunately it didn't go well. The young woman seemed to be on a war stance from the outset, and my questions got her really worked up. She started screaming over me while she had me lying on the exam table that my distrust issues are not from something she did, and that my reluctance to move my legs like she asked, showed I wasn't ready for help.
I was told that I should go home and think about it, and call back with my decision.
I'm unfamiliar with a tens unit...so that might be interesting. Is there some things I could buy that might help do you think?
Re: other things you mention.
The PT woman had told me that MRI doesn't show everything last time I was there, but today she told me that if my doc had ordered PT and that the MRI showed everything as being healthy, then there was no way there was anything wrong. It was such a strange and obvious contradiction.
She also said being active rids you of swelling after injury, and yet as I have done RICE, the swelling has reduced....so what she was saying seemed to be out of step with my experience. I had tried to be active with my patella slipping and it CREATED swelling...and she said that since that was weeks ago...it doesn't mean it will happen now. Besides she said...this slippage complaint was only "according" to me -- not a verifiable fact.
I've only just gotten rid of the worst pain in my knee a couple days ago (keeping the leg straight with a wrap, and crutching around)...but she insists that this was nothing to do with the injury. She said the pain is from the lack of ROM. The thing is...I'm trying to let the healing take place...it's not that I CAN'T flex it.
My ankle is also sore...so I'm trying to stay off that as well and I try to keep that in a bandage and protected. Before she understood that...she proclaimed with high invective that my knee was affecting my ankle now. LOL I explained...the ankle was badly swollen from old scar tissue when my dog jumped on it....months ago. Its still healing and painful. She wanted to know if I saw anyone about it...and I said I mentioned it to my doc...but that he didn't take an interest in it.
She seemed annoyed at me for that too...
Its been a non-stop train wreck...and I don't know where it ends. I only know that I either got to try another PT place or another doc...or both. Maybe I should hold off on PT until the swelling is in better shape...and THEN try to get to PT?
I still don't know what PT involves. If the cornerstone of PT is palpation for documentation purposes...(which I know will injure me right now...and/or flexing my patella out of place), I think I should hold off until I heal better. I just wish someone could simply coach/support me through safe patella building moves...rather than run a strict document driven agenda on me while yelling in my face. I want to regain my life without further injury. Apparently that is terribly offensive to some people.
Do you know of a type of therapy or a type of sports wellness coaching like that?
My leg hurts more now that she has been monkeying around with it...and I'm SAD. I've cried endlessly over this, and you would think someone might understand how I feel, but apparently I'm just bringing out the worst in everyone.
YES..Kat...I do take advil and I do a lot of icing. All day and night... The doctor didn't mention any of that, but I read on-line that these things could be helpful....and so far they have been. Its just taking a long time.
softcrush! If there is one thing i have learned is in order to do well in physio you need to find one you trust completely! that is definitely where i went wrong with my first physio therapist! They left me on machines doing things wrong and these things all caused more damage!
I found an amazing physio therapist through websites online! I scouted out the best because i wanted someone who wasn't going to get mad at me or not go by how i felt! I just got released from my physio program last night! I wouldn't have finished that program after having my surgery if i stuck with the place i was at before hand! Its the environment that makes all the difference! I don't know how much of a help saying this is! But i would go with your gut! i know i have been told you can't ignore it! You have to do something about it or it can get worse, but if you need PT find a place that works with you. the PT's are suppose to be there to inform the patients and answer the question you want to know!
Wow I can't believe how you were treated. I certainly wouldn't be visiting the therapist there anytime soon.
One thing to throw out there for you, MRI's are not always accurate, in fact I had 3 very innacurate ones, two of which invovled my knee. First off my knee was buckling but the MRI said my ACL was just dandy. After much insistance I had arthroscopic surgery and what the doctor found shocked him. My ACL was not fine, it was not tore but the elasticity was completely gone. When he picked up the acl it flopped back. It was reconstructed.
A year later I keep having knee pains, turns out my knee cap was tracking wrong, again after much insistance and an MRI that said nothing was wrong with me at all, I had another scope only to find a hole in my femur the size of a quarter caused by poor tracking. I had to have my PCL cut to remove the tension. No telling how much damage would of been done had doctors continued to ignore the problem.
Have you ever considered getting a second opinion on the situation?
No matter how great your illness or pain, there's always someone else who may be worse off.
Wow...Am I ever blessed to hear from you! Thanks so much for taking the time to respond. REALLY appreciate that.
Yeah..you are right. A second opinion couldn't hurt. I'm pretty sure this guy has got it right, but that doesn't mean he actually does. He is probably reading the MRI and X-rays correctly, but he was not interested in trying to explain how my pain and swelling might be connected/consistent to my reported injury. He almost seemed to imply that no injury even took place!
I AM VERY very sorry to hear about your having gone through those things. Its so upsetting and bewildering when you are left in the dark, and the doctors think that bullying you is going to help convince you that you aren't experiencing what you KNOW you are experiencing.
I'm glad you pushed on and find it frightening that you had to get that far down the road to get a proper diagnosis. WHAT a trip that has been for you.
Did the PCL cut help with your tracking issue? I hear different stories on the lateral release. Did they ever say your PFML or your retiniculum was comprimised?
I worry that if I don't heal well from the patella dislocation, I'll be left with an issue like you had, and AM very determined if possible to make sure that doesn't happen. I can't help feeling that there is a small window that needs to be capitalized on while the healing juices are still rolling around in my knee...and that is KEY to full recovery. This is why I'm so VERY careful at the moment.
At the end of the day, I have to do what I think is right for me...
My patella was slipping after the dislocation was reduced, so I immobilized it for a week and have kept it wrapped for the past few weeks, waiting for the swelling to decrease. I thought I was doing really good with all that, keeping my weight off it, until I encountered the PT.
SHE totally upset the knee again while making me lay face down. She took my wrap off.... then bent my knee farther than I said was okay...and now the swelling in the knee joint and around and under the knee cap is back. The frightening sharper pains are back...too.
All that so she could fill out a sheet of paper....and throw it in a drawer.
I really got to get this swelling down all over again...so that will take a few weeks, so I must be patient.
After reading what your PT experience was...at this time my reccomendation would still be to go to another ortho doc if possible, and then have him send you to a different PT person if that's what he wants to do. I can tell you though, PT is going to be a bit painful and they are going to make you work your knee and exercise it....the whole point is to get your knee stronger and to work it so that they can push the fluid out of your knee joint that is not supposed to be there. PT works, but you have to be willing to do what they tell you to do, and you also have to have a therapist that works with you and encourages you, which it sounds like this person definitely was not.
When I had my surgery 3 weeks ago, the surgery was on Monday, which was a total reconstruction of my knee with an ostiotmy of my tibia, and that Thursday morning I was at PT.
Sometimes we need to be persistant. Doctors can read MRI's correctly but it doesn't say that the MRI is accurate, they do not pick everything up particularly things like elasticity being gone. They are fine diagnostic tools but if your quality of life is compromised by severe pain thats a true indication of a problem regardless what any test says.
I've not had any issues at all with tracking since the release. I was worried the side to side movement would be compromised but all seems pretty stable and it's been many a years since then. The hole in my femure healed itself over time. The MRI again never detected that.
The thought at the time, after getting a second opinion, was that one of my screws were backing out from the ACL reconstruct I had a year previous so thats why they started with a scope and removed one of the screws. The PCL was so taught and the hole was found during the proceedure. My knee was constantly swollen, docs knew I had OA and no cartilage so kept blaming the pain on that.
I bounced back really quickly for the most part, probably one of the easier surgeries I had in comparison to the many others. Once in a while I do have a burning sensation in the back of my knee. I still have other major knee problems but too stubborn to get a replacement (after 4 THR's that's the last thing I want)
Did the doctor not offer you a compression patellar brace? They had me in one for a while prior to the surgery, it helped some, but the surgery was the fix for that particular issue.
They did not say if my PFML or retiniculum was comprimised at all so I'm guessing that was a no. It is not uncommon for people who have ACL reconstructions to find their PCL becomes too taught and releases are often needed as a follow up.
My mom has the same problem, has no history of ACL issues, never had any surgeries either. Her kneecap in fact totally dislocates on her but this is due to a collagen disorder called Ehlers Danlos Syndrome. She's just lived with it. I'd hate to see what the inside of her knee looks like, scary thought. I too have EDS and it is believed that is what played the factor in the original ACL being so lax.
Good luck and keep us updated. Be your own advocate and don't give up!!
No matter how great your illness or pain, there's always someone else who may be worse off.
Wanted to add one more thing after reading Kat's post. You do need a different therapist. Yes there will be some pain but I was taught by my therapist excruciating pain is not normal in any type of physical therapy. I am still appalled by your treatment.
If by chance you do have the surgery, work on getting your quads as strong as possible prior to the surgery. A kind therapist can show you simple at home exercises you can do to strengthen them up. This pretty much is the rule for any major knee surgery. Your quads play such a major part in keeping your knee stable and functional.
No matter how great your illness or pain, there's always someone else who may be worse off.