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Old 12-08-2010, 12:02 PM   #1
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Should I have my knee scoped (stiffness and swelling)?

I'll try to keep this as brief as I can, though I'm admittedly not very good at that. I'm a 28-year old male. For several years now I've run three miles, three times a week, and walked that same course the remaining four nights of the week.

In late July, my right knee was a little stiff, though nothing too severe, on the day of a run. I ran anyway, and while afterwords it was still relatively fine, the next morning it was swollen and extremely stiff. I went to a walk-in clinic, as it was a weekend, and the doctor there, without taking any x-rays, said it was probably just strained and to stay off of it as much as possible for a while. I was given no crutches or anything, but instead just instructed to limit my walking to around the house and such.

A couple of weeks later, though the swelling and fluid on the knee had gone down considerably, the stiffness remained, so I went to see my primary care physician at the time. He's big on holistic stuff, and in addition to echoing the "stay off of it" sentiments, told me to consider "prolo" injections. Still no x-rays or anything else of the sort were ordered.

Anyway, as I was (and still am) dealing with some troublesome urological symptoms at the time (see the Prostatitis forum on this site if you're interested or might have any insights; I'd appreciate it if you did), I sort of put the knee on the back-burner while I tried to get that problem taken care of.

So long story short, after sort of giving up on ever having the urology problem solved, I decided to retrain my focus on the knee. I've since been to three different orthopedists, had x-rays done by all of them, as well as since having an MRI done that I've taken along to all of them. They can't see any problem in the MRI, other than a barely noticeable contusion on one of the bones that they all classify as very minor and probably already healed at this point (the MRI was done in early October).

The real problem, though, is that all of them have different opinions on what's wrong. The first originally chalked it up to my back, the second said it was a strained tendon, and the third feels it's a muscle imbalance, to which I questioned was a cause or a symptom (this has been going on for five months now, and I've of course been favoring my right leg when standing up from a sitting position or walking up and down steps).

At the recommendation of my first orthopedist, I gave physical therapy a try for about a month, and it made my symptoms significantly worse, though they improved over the course of about a week after stopping the exercises. As for my current symptoms, the knee is constantly stiff, I feel a clicking deep within the knee on about every other step I take, and at its worst if feels as if there's a rubber band or brace around my knee, restricting its movement. I've never had any pain in it, however, or at least nothing to phone home about. I've been told by all of the orthopedists that my range of motion isn't hampered at all when they're manipulating it, but that doesn't change the fact that it is difficult for me to move it, and I'm of course afraid to even attempt to run on it.

So here's my dilemma: The first orthopedist I saw said it could be a torn meniscus that simply isn't showing up on the MRI, and he's agreed to scope it and fix it if he finds anything. Originally, the surgery was scheduled for the 29th, but they called today and said they could get me in 13th. However, I've been trying to walk on it for recreation again the past two nights to see if maybe it is a musculature problem and working it out will improve it, and so far it doesn't seem to be any better or worse.

My question, then, is do you think I should go through with having it scoped this Monday? Five months is a long time to have been dealing with this, especially for someone as active as I otherwise am, not to mention having to cope with my other medical issue this entire time. I keep thinking that if they scope it they'll find something, fix it, and I can get back into my routine again. On the other hand, I fear if there isn't anything physically wrong and this is indeed just a mechanical problem, scoping it might only make matters worse, and perhaps set me that much further back on the road to recovery. I'm also curious as to how big of a deal scoping is, from someone who's actually had it done. My orthopedist says it's really nothing, but he's not the one who's going to be in the bed recovering.

Oh, and one more thing, if I may. My right foot tends to fall asleep the longer I'm up and about. I didn't think much of it at first, and when I mentioned it to the orthopedists they all told me it was probably unrelated, but I've noticed it was pretty darn tingly after my evening walks these past two nights, while my left foot remained perfectly fine. Anyone know if this could indeed possibly be related?

Sorry for all the questions and the length of this post, and thanks to anyone who happens to chime in with some advice or aid.

 
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Old 12-08-2010, 03:10 PM   #2
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Re: Should I have my knee scoped (stiffness and swelling)?

I'll start by saying that 8 of my 14 knee surgeries were scopes, so I know a thing or 2 about knees and arthroscopies.

First, you knee does sound suspiciously like a partial tear of a meniscus that wouldn't show on an MRI.

Second, arthroscopies were originally developed for diagnostic purposes because no tests were showing what was wrong inside a knee and believe it or not, not all MRI's show what is wrong either. So doing a scope to determine what is wrong is not out of the question. And if they find the problem, they might be able to fix it.

Scopes are not as easy as they say...you still need anesthesia and your knee will hurt after even if they don't do anything. In fact, the knee is so unstable due to fluid put in during surgery that it is very unstable and you can injure it easily in the days after scoping(done that too).

But if they do find a partial tear in the meniscus, it can be fixed and then you are okay after a recovery period with minor pain for the most part.

What if you don't fix it? You risk escalating arthritis in your knee as it grabs and flakes apart and slowly but surely acts as a loose ball bearing rolling around in your knee.

If it's not the meniscus, they they should be able to find out what is wrong and if it can't be fixed through the scope, they can bring you back at a later time and do the work or you can sign in advance to have the knee opened and the doc do whatever needs to be done at the same time.

But as one who has artificial knees....do what you can to keep your knee doing well. Fix what is wrong. It was my waiting for 2 years to fix a big problem that lead to my needing a total knee at 24 and having to wait until I was 47(they wouldn't do knees back then until you were 50+ but my doc caved). I lost 2 inches of bone waiting and you can't even imagine the pain.

Your doc's idea is feasible and probably in your best interest.

Jenny

 
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Old 12-12-2010, 12:49 PM   #3
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Re: Should I have my knee scoped (stiffness and swelling)?

Thanks for your advice, Jenny. I ended up scheduling the surgery for tomorrow, but after perhaps making the mistake of reading some other posts on this board over the weekend, I'm unfortunately beginning to have some second-thoughts. Thing is, I'm in discomfort practically 24/7 due to my other problem right now, and while my knee is an added nuisance, it's at least not a painful one. I've read some horror stories on these boards about people having the arthroscopic surgery done and being in worse pain for months after the operation, and that's honestly the last thing I need in my life right now.

I'm curious, since my MRI came back negative for a torn meniscus (or for anything else, for that matter), if the doctor goes in and doesn't find anything wrong, about how long might it take for me to be back to my current state after the procedure? I don't want to risk being on my feet too soon and end up inadvertently worsening my situation, after all. And if there is a minor meniscus tear, one that isn't showing up on the MRI, about how long can I expect that recovery to take? I've read anywhere from as little as five days to as long as three months, along with estimates on physical therapy ranging from two weeks to six weeks.

I just want to be normal again, or at least as close to it as possible. I can't seem to do anything about my urological problems, but I'm hoping I can at least take care of my knee for the time being. In the process, however, the last thing I want to do is complicate my issues.

Thanks again for any advice or wisdom anyone on here can give me.

 
Old 12-12-2010, 07:17 PM   #4
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Re: Should I have my knee scoped (stiffness and swelling)?

Knee arthroscopy has often been used as a diagnostic tool so feel comfortable in that. I've had some scopes where they found more damage than they saw on any test or any examination. I've also had an arthroscopy in which it lasted 15 minutes becuase it was used diagnostically and there was nothing they could fix or I'd have to schedule a bigger surgery.
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Old 12-14-2010, 09:07 PM   #5
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Re: Should I have my knee scoped (stiffness and swelling)?

Thanks for the advice, guys. I ended up going through with the surgery, although it happened about two hours after I was scheduled, and I almost backed out of it at the last minute as a result.

Anyway, so far I'm admittedly pretty miserable. I can't really walk on my right leg, and I've had a headache since I woke up from the anesthetic, but I'm hoping I'll gradually improve in both areas as the week goes by. I'm also scheduled to begin physical therapy this Friday morning, and I'll have the stitches removed the 27th.

Thanks again, you two. I hope I'll be able to update this post when I'm back on my feet, officially, again, so anyone who comes here in the future looking for some previous arthroscopic knee surgery cases for an idea of what to expect can use my experience as their guide.

 
Old 12-15-2010, 04:41 AM   #6
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Re: Should I have my knee scoped (stiffness and swelling)?

I wish you well and hope this helps. I'm having my own problems that no one else I have read of has had. Still pain 24/7 after 13 months since TKR. Finally took the bull by the horn and spoke to my primary care doc and asked for an MRI since nothing else is showing anything wrong. I am going today for that and have this terrible feeling in my gut that they will need to go back in. Sometimes we have to be our own doctor and advocate since it is our body and we know best how it should feel. I sure hope I am wrong because I don't think I could go through all of that surgery and rehab again.

 
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Old 12-15-2010, 01:45 PM   #7
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Re: Should I have my knee scoped (stiffness and swelling)?

Good luck to you too, Barb, and I sincerely hope everything works out for you. I should mention that my orthopedist did indeed find a minor tear of my meniscus, which he trimmed away, along with cleaning out some inflammation while he was in there, or something to that effect, anyway. I'm not really sure exactly what the other thing he did was actually, as I didn't get to speak with him firsthand post-surgery.

Anyway, though, the point is that I at least felt vindicated after the operation that I wasn't imagining or blowing the problem out of proportion. Once I'm fully recovered I actually plan on calling the two other orthopedists I saw to let them know. Not so much to say, "I told you so," but more so that they keep my problem in consideration should a future patient come in with a similar issue. After all, they both told me it absolutely couldn't be a tear of the meniscus, given the MRI and my lack of pain, and even the orthopedist I ultimately got to agree to the surgery said it was probably only a 10%-20% chance at best that there was indeed something wrong with the meniscus in there.

So you're absolutely right, Barb. We, the patient, are ultimately the ones who know best when something's not right. If anyone out there is in a similar situation, and you're given exercises to do and pain medication to take and told everything's fine in the meantime, only to have your symptoms worsen, then I urge you to get a second, or third, or as many opinions as it takes until you get someone who can actually help you to solve your problem. If there's one thing I've learned over the past five months, it's that life is too gosh darn short to just have to "put up" with something if it can otherwise be fixed. So listen to your body first, and then find a doctor who can truly help you to feel better again.

 
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Old 12-15-2010, 02:06 PM   #8
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Re: Should I have my knee scoped (stiffness and swelling)?

I had the MRI today and was told due to all of the stuff in the knee the MRI may show nothing but a blur. Then I would need a scope. I'm not sure who to turn to after I get the results. My daughter says I need to see a Spine doctor to see if any of this pain is coming from the back or neck area. I'm willing to try anything and any kind of doctor at this point. Even looking for a voodoo doctor would be fine with me at this point in time.

 
Old 12-15-2010, 02:30 PM   #9
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Re: Should I have my knee scoped (stiffness and swelling)?

Good luck with that, Barb. I actually had an MRI done on my back, as my orthopedist and urologist both suspected it might be a bugling disc problem that was acting as the root cause of both my knee and urological symptoms. In my case, however, after seeing two neurologists, I was assured that the bulging disc in my back (yeah, it turned out I had one) was extremely minor and not causing any of my problems. Which was both good and bad, I guess.

On the plus side, though, I can tell you that the MRI of my back was one of the most relaxing experiences I've been through over the past several months. Unless you're the type who's afraid of the enclosed space of the MRI, there's something almost soothing about the hum of that machine while you lie still in the relative darkness for a while. At least, I thought so. Beats getting a needle in your arm or probed in an intimate area by a relative stranger, anyway.

 
Old 12-15-2010, 04:36 PM   #10
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Re: Should I have my knee scoped (stiffness and swelling)?

Glad you went through with the surgery and sorry I didn't get back to you on the weekend. Had one of those stomach bugs were you just can't sit up without getting sick.

The reason I said to have the surgery is because I've been in your shoes. When my son was a toddler, I took him for a walk one day in his stroller. Stepped onto a path and twisted my knee and felt something very weird in my knee. Knew I did something bad but continued to walk home with him. Later, after hubby got home, I went to the ER.

I was literally laughed at. The ortho resident told me I couldn't have possibly torn my lateral meniscus(medial was already removed) because I would be in so much pain I wouldn't be able to walk. My knee, he said, should be full of fluid and it wasn't. This was before MRI's so only x-rays were done and they showed nothing. I was sent home.

So I then waited for an appointment with my regular ortho(took a month) and he said about the same thing to me. Implicated he thought it was all in my head and got nasty and threatened to fused my knee in 1 piece of I kept bothering him with thi(never went back to him either).

But I had an arthritis doc too(OA all over the place) and he thought something was wrong and got me into a knee specialist in Boston at the Brigham. Did a scope. Not only had I torn the lateral meniscus, the torn piece had flipped 180* and was wedged upside down directly under the center point of the femur and was digging a hole in the articular cartilage of my femur. He was totally shocked! Said it was the worst lateral meniscus tear he'd ever seen. Couldn't figure out how I walked on this for 10 months(that's how long it took to get help).

What these docs don't take into consideration is our pain thresh hold. Mine in very high. They assumed since I was a woman that it was very low. But the doc in Boston told me I had worse knees than most NFL players and complained less.

So I listen to my body and not the docs. Glad you did what was best for you.

Jenny

 
Old 12-19-2010, 09:14 PM   #11
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Re: Should I have my knee scoped (stiffness and swelling)?

Thanks for responding again, Jenny, and I'm glad you're feeling better. I have a couple of new questions now.

It's been a week since my operation now, and my knee doesn't seem to be a whole lot better. I'm in very little pain, even without any pain medications, but my range of motion remains more or less unchanged, almost as if my knee is jammed when I try to bend it. I've been doing some exercising my physical therapist gave me over the weekend, but they're limited to straightening the leg and strengthening my quads. So I guess my first question is, is it normal for recuperation to go this slowly? I knew that I wouldn't be out running or even walking without a limp by now of course, but I at least thought I'd be able to get around the house more ably than mere baby steps and occasionally even having to break down and break out the crutches again.

Which leads me to my second question: Is experiencing calf pain normal after this procedure? I didn't have it at first, but Friday evening, the day after my initial physical therapy session, I began experiencing some pretty intense calf cramps, which became worse when putting my weight on the right leg. I was on crutches again all day yesterday and through most of today to get around the house because of them, but as I sit here right now they seem to have subsided a bit (I was able to take a shower again after skipping one last night due to the pain, thank goodness).

Sorry to be such a nervous Nelly, but I really want to recuperate from this as fast as possible, and I don't want to have any setbacks. I continued to do my physical therapy exercises through the calf cramps, and I can't wait to go again tomorrow to ask my physical therapist about the pain, but in the meantime I thought I'd ask here to see if anyone else had experienced this firsthand, how you managed it, and how long it took you for it to subside completely.

Thanks again, everyone, and I look forward to your answers and comments.

Last edited by Ropes End; 12-19-2010 at 09:15 PM.

 
Old 12-20-2010, 10:53 AM   #12
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Re: Should I have my knee scoped (stiffness and swelling)?

Everyone is different in how they respond to surgery and even each knee is different on how it responds and each surgery. None of my scopes have been the same. My right knee recovers quickly but my left one takes forever.

When they do a scope, they pump your knee full of water to open it up and see everything. they also wash it out thoroughly when the finish to make sure they get everything out. So that joint was full of fluid when they finished.

In some joints, the fluid get absorbed and they swelling goes down and you are walking pretty well. In other cases, the fluid gets absorbed and your knee then starts to put out fluid as a reaction to the surgery and fluid so it swells up all over again and hurts a lot. It is your knee's way to telling you to go slowly and carefully and there's not much you can do except wait it out. It is your body's way to healing and that you can't change.

Your calf pain may be from all that fluid. Gravity pulls some of it into the muscles in the calf so it has to absorb too. But watch for signs of heat and redness that would indicate a possible blood clot forming in the deep veins of the calf. That is an emergency. Also, you can get Achilles tendonitis in the calf from all the manipulating of the leg during surgery. Some rest and time will heal that.

I've had scopes where I've walked out of the hospital with no assistance and others where I've been on crutches for 6 weeks. You don't know how your body will react to the surgery and all the fluid until after it happens.

It sounds pretty much like you have a pretty normal recovery going but you are impatient to get moving and I don't blame you. Nothing more frustrating than waiting for swelling and stiffness to go down post-op.

But hang in there and it will get better quicker than you think. Prior to 1975, if you had a torn meniscus, you ended up with a 2-3inch scar and 6 weeks of PT and on crutches and pain for months as the incision and cut muscles healed. I have 2 of those scars(2-3" for the inside meniscus, 6" for the outside one). So I know you want to go out and run and you will soon enough but it's your body and this is how it wants to heal. Give it time....it all sounds pretty normal.

Jenny

 
Old 12-21-2010, 12:31 AM   #13
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Re: Should I have my knee scoped (stiffness and swelling)?

Once again, thanks a bunch, Jenny. I went to my physical therapy session today, and right away my physical therapist went to speak with my doctor (they share the same building, which was pretty darn handy today). His assistant came back a few minutes later, gave me a quick examination, and then told me to go to the ER or an urgent care facility so as to rule out a blood clot. Four-and-a-half hours, some blood tests, and an ultra-sound at the ER later, I was sent home with a clean bill of health, along with some instructions on how to fend off muscle cramps in my calf muscles. Better safe than sorry, I guess.

Anyway, I seem to be a bit better tonight, and even though I still can't hardly bend my knee at all, I am getting around somewhat more ably than yesterday, I think. I hope I continue to progress steadily from here, and with any luck, I'll be able to enjoy my Christmas with substantially less pain and stiffness.

Thanks again to everyone who's chimed in here, and I'll continue to update my progress on a weekly basis or so. Hopefully, I'll only have good news to report from here on out. Fingers crossed on that one, anyway.

 
Old 12-27-2010, 08:29 PM   #14
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Re: Should I have my knee scoped (stiffness and swelling)?

Quick update: I had my stitches removed today, and everything's going well, I'd say. Starting Saturday night I could finally start to feel the knee beginning to loosen up, and it's been noticeably improving every day since. I'm nowhere near being able to walk for recreation or anything, let alone run, but I can get around the house pretty capably now, and taking a shower without having to worry about the wounds is amazingly less difficult, at least far as preparation time is concerned, anyway.

So yeah, for those wondering, I would say two weeks is about how long it took me to go from fairly incapacitated to more or less self-sufficient again. Although, I still haven't chanced to drive yet, as I worry the stiffness could slow down my reaction time on the pedals, but as far as everything else that goes with day-to-day life is concerned, I'd say I have a pretty good handle on it all.

 
Old 12-28-2010, 04:44 AM   #15
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Re: Should I have my knee scoped (stiffness and swelling)?

Wonderful to hear of your excellent progress. Wish I could have had the same. Here I am at past 13 months and ready to see another doctor since I can't get over this pain.
I've been told to stop all exercising until I see the new doc, which is not until February.
These Orthos are so hard to get into the first time.
Keep up the good work.

 
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