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Old 08-06-2012, 07:54 PM   #1
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Lightbulb Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Injured my right knee, went in after MRI was neg and they found I had a cartilage tear down to the bone so they did a microfracture surgery. I (obviously) had to overcompensate while on crutches and then limping when beginning to walk. i had swelling in the left knee for the past 5 weeks or so. I can fully bend it and straighten it but do have some pain upon straightening as well as when I get up from sitting on the ground. I went in for my 6 week post op appt and told him about that knee hurting and he said that he did something called the 'bounce test'. He let my knee fall while we were talking and I remember saying 'ouch!' as soon as I felt it fall....almost as though it was going to snap or pop out of place. He said that that was a sign of a positive bounce test which would point to a meniscus tear since I also had pain around where the plica / joint line was. He said he is going to perscribe therapy for that knee as the same time as my operated knee so that we can see if it will heal by the next appointment which is in 4 weeks. If not, he is going to suggest doing arthroscopic surgery on that one to see what is going on. . . anyone else have any experience with the bounce test / meniscal tear from overuse, etc? Wondering if I will just be able to ignore it after I am able to fully walk on both knees evenly....lol

 
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Old 08-09-2012, 03:13 PM   #2
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Hi mamatofour!

That's a new one on me! My Ortho surgeon never mentioned that test when I complained of pain in my left knee about two months before my right TKR surgery in April of 2011. He just simply said that I was compensating because the right knee had no cartilage left and sent me for a confirming MRI on the left knee. Sure enough - I had a fairly big meniscal tear in that knee. Since I didn't want him to replace both knees during the same hospitalization, he said he could do an arthroscopic repair on the left knee and "maybe" buy me a few years before I would need a TKR in the left knee. When he opened the left knee during last year's surgery to scope and repair it (which he did after completing the right knee replacement), he discovered that I also had torn my ACL (anterior cruciate ligament) pretty badly. He cleaned the knee out and repaired the meniscus and ACL as best he could, considering the serious osteoarthritis in the knee. At first, when I went for my first couple of follow-up visits for both the right TKR and left arthroscopy, he "thought" he'd bought me about 3 or 4 years before I'd need the left knee replaced.

However, unfortunately, and through no fault of the job my surgeon did with the scope, eight months later (this past December) I was back in his office complaining that the left knee was very painful again and starting to "buckle" on me on occasion. He took a quick x-ray and said that the osteoarthritis had progressed more rapidly than he thought it would, and I'd probably need the left knee replaced within a year or less. By mid-January, it was so painful, that I begged him to please do the TKR surgery the first available date in March! (He had tried giving me two cortisone shots six weeks apart - that Dec. visit and then in January, but neither one worked at all.) So he agreed it was definitely time for the left TKR surgery. I was actually "happy" to go through with it because my pain tolerance threshold had been shot to heck by late January! We scheduled the surgery for March 23rd and I was to be his first case of the day. (It was a Friday.) I was so motivated going in, that I told my Ortho surgeon, that if I got to my Unit room early enough in the afternoon after Recovery, that I planned on getting up on the walker the same day of surgery! He said that was fine with him and he added that he thought my recovery from this TKR surgery would go a lot faster because I already had the other knee done and completely healed to help stabilize my walking while rehabbing. Sure enough, I started the quicker rehab the day of surgery as I said I would. I walked 200 feet on the walker the afternoon of the day of my left TKR surgery! My surgeon was so amazed when I told him two days later when he saw me on his rounds, that he nicknamed me "rascal" because I was always up and about on the walker my entire hospital stay!

When he opened my left knee to begin preparing the knee for the prosthetic replacement, he found the knee to be in a lot worse shape than he expected to find! He told me later when he stopped in Recovery to check on me, that the knee was really very bad. I had absolutely no cartilage left and there were only remnants of the ACL, all of which he had to clean out before he could even start cutting the bones to shape them for fitting the prosthetic knee in there! The diagnosis on both knees according to the surgical reports which he gave me copies of a couple of months ago was "end-stage osteoarthritis." That is why I needed the TKR surgeries. Even if I could have taken the Synvisc injections (which I could not because I was allergic to the family of drugs Synvisc is in), it would have been a waste of money for the injections. My knees were so far gone, that I had no other choice but to have both TKRs!

Now, for the first time in seven years, I am walking normally and balanced and without pain in my knees! My surgeon did a wonderful job and he's my Medical Hero for giving me back full mobility without pain! (Now he's treating me for back and shoulder arthritis pain.) Actually, for the back, he turned me over to my pain management doctor for nerve block injections (I have three more sets to go and hopefully they should last at least half a year or more. I'm not a candidate for spinal fusion surgery because of my severe scoliosis and spinal stenosis - he said fusion surgery would actually make things worse! My oldest cousin had 3 spinal fusions in the last 20 years and they did her squat! I told my surgeon about her, and he used that as the comparative explanation as to why he ruled out the same surgery for me.) As for my shoulders, which he just diagnosed osteoarthritis and bursitis in both, on Monday, he's taking a more conservative approach to treat me for that. (Even though he said my left shoulder is way worse and weaker than the right one.) He said he doesn't mind treating it surgically if and when it becomes necessary because he said I'm such a good patient, but he wants to give me a breather from surgery for a couple of years after all I've just been through with the knee replacements! Luckily, for now, the x-rays on Monday, showed no tears in either shoulder's rotator cuff, which was the "good" news! For now, he is having me go for 4 weeks of physical therapy for the shoulders and I will follow up on Sept. 10th with him. If that is not enough, he'll probably send me for further therapy and maybe give me cortisone shots in both. I'll keep you posted on this.

You know, everyone on this board keeps mentioning "microfracture" procedures and I have no idea what that is. My surgeon never used that term with me, not even in my surgical reports. I guess I'll have to look that up and/or ask him what that is when I see him next month.

Last edited by ldy12; 08-09-2012 at 03:20 PM.

 
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Old 08-15-2012, 11:14 PM   #3
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Oh wow! I am so glad you are pain free now....and glad you found a surgeon who helped you otu enough to find out the problems and fix them rather than make you wait in pain!

I did a microfracture which was where they take cartilage and trim it up and take the torn pieces off and then drill into your bones so that it can cause yoru blood to clot and new cartilage to regrow. What sucks is that it isn't as good as the normal cartilage and will break down quickly and very easily tear if injured again. I am going to PT for that, can straighten my knee *almost* flat but bending it causes a painful pop / snap deep inside to the point I feel a deep bone pain. It is still so swollen and I can bend it a little more (very little more) than 90*. When I lay back and bend my knee, it is extremely painful and tight and feels almost like it did before I had surgery (best I can describe it is that it feels as though it will explode deep inside and there is a sharp pain)

now on my 'good knee' I feel it pop if I turn a certain way, it is swollen, and feels almost as though behind the knee cap is causing pain...and the medial joint line is hurting both to the touch and when walking. I am 25 and feel like I'm 90 when I walk .LOL. I ache with every step and can't get off the floor without being in pain. Now I can bend it and straighten it which makes me wonder if I tore my meniscus or not? When i get up from the chairs, I HURT from both knees.

As for the bounce test, he picked my leg up, held my ankle and bent it a little and let it drop and I felt this pain in my knee deep insdie that felt as though it was going to pop out of place and hurt inside as well. With the pain and the way it dropped (i guess the way it presented when it dropped he said) he said I tested positive and that was 'meniscus tear until proven otherwise'. same he said before with my cartilage tear in my bad knee. I want to just get surgery done, I want to skip the MRI since the MRI showed nothing in my knee the first time around. I know he probably needs it if he goes in for surgery but I just hate to play the waiting game and doing it over again,...last time it took over 2 months of waiting, PT, shots, etc before doing anything. ::sigh:: LOL

 
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Old 08-16-2012, 04:49 PM   #4
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Carol,

I did an online search for the bounce test, and it is a valid way to test for meniscal tears. I just thought I would share.

 
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Old 08-16-2012, 07:24 PM   #5
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

The best orthopedic surgeons often use things like the bounce test. MRIs are very expensive and take time to come back. A knowledgeable doctor can screen for meniscus tears and certain ligament tears in just a few minutes with a physical exam, and then he already knows what to tell the radiologist to look for.

 
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Old 08-16-2012, 08:36 PM   #6
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

i went into my Physical therapy appointment today. She said my swelling in my 'good' knee is now more than the one I had microfracture surgery on and is getting concerned with it. She also did the bounce test and told me what it was and how they check for it and I again showed positive for it. (which i knew if I did once i would again) and explained all my symptoms.

Sadly, I don't trust MRI's anymore. They work wonderfuly when they do work but my last one I had a large cartilage tear down to the bone and my MRI came back clear which caused everyone to brush me off and not do anything about it until this doctor came along. He finally told me they aren't 100% and wanted to go in surgically to see and there he found it. He said it was so odd it didn't show being that large of a tear. I wish we could just skip the whole MRI process. LOL! And the exercises they gave me that were the same for the microfracture knee actually hurt my other knee more! Felt as though it was going to dislocate or snap at any moment. Another doc appt in 2.5 weeks and we will go from there. Debating on moving it up or making a seperate appt since it is a different part of the body than what my post op appointment is for. PT said that she wasn't sure if it was my MCL or patellar tendon since it was tender all around but mostly at the medial meniscus area. Then again they thought I tore my LCL on my other knee when it was just a cartilage tear. LOL.

 
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Old 08-17-2012, 05:09 AM   #7
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

It's true, the reading can miss things. For the most accurate diagnosis, your surgeon needs to consider the MRI report plus the actual films plus his physical exam plus your description of symptoms. Because there's so much information in an MRI, it helps if the doctor reading it has some idea of what he's looking for.

For knees, the actual MRI doesn't usually miss things, but the reader might. (For feet/ankles, because there are so many different bones, even the MRI can't always see everything.)

 
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Old 08-17-2012, 08:00 PM   #8
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

an urgent care doctor, radiologist, 1 orthopedic surgeon, and the hospital staff at the surgery on the day of all said the MRI's looked clear but apparently it could have been the way that i was lying which caused it to look as though it was not damaged. I also had the CD of films, acutal films, and 2 sets of Xrays done which were normal too If the MRI's were showing something, i feel scared that they all missed it.....LOL!! And my ortho is supposed to be a 'great ortho' in the area according to the reviews online. I will see if he will do the MRI and what it shows when we go in again. In any case, I am SO glad that he is one of those docs that listens to what you say and doesn't just go off of an MRI if he doesn't see anything on it. lol

 
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Old 08-19-2012, 05:35 PM   #9
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

mamatofour,

I think the fact that your doctor listened to you about your issues despite the MRI showing nothing is the most important thing. I am another person who had an mri that was completely negative (and I know my ortho surgeon can read films correctly). There are some reasons why an mri may not show everything. I always have some degree of motion artifact which makes the images slightly blurry. This is not the fault of the technician. It is due to involuntary muscle spasms. That is out of everyone's control. If a tear is small or in an awkward spot in your knee (depending on how you are positioned), it may not show up on the films either. I also have a surgeon who will listen to my concerns and take them seriously even if the films do not show a problem. He doesn't automatically want to cut me open, but he will if he (and i) feels the benefits outweigh the risks of a wait and see approach.

 
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Old 08-19-2012, 09:48 PM   #10
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Quote:
Originally Posted by ozfan79 View Post
mamatofour,

I think the fact that your doctor listened to you about your issues despite the MRI showing nothing is the most important thing. I am another person who had an mri that was completely negative (and I know my ortho surgeon can read films correctly). There are some reasons why an mri may not show everything. I always have some degree of motion artifact which makes the images slightly blurry. This is not the fault of the technician. It is due to involuntary muscle spasms. That is out of everyone's control. If a tear is small or in an awkward spot in your knee (depending on how you are positioned), it may not show up on the films either. I also have a surgeon who will listen to my concerns and take them seriously even if the films do not show a problem. He doesn't automatically want to cut me open, but he will if he (and i) feels the benefits outweigh the risks of a wait and see approach.
It is so nice to know I am not the only one who's MRI's showed nothing....(not that that is a good thing, but nice to know I am not alone. LOL) I am also happy I have a doctor who listens, and is one to say that medicine is a wonderful science but not an EXACT science. I think for this time around I will only be willing to wait because of the fact that it is important to get my microfractured knee back to normal before starting back at square one, however it is getting to the point where walking is painful no matter what so I might as well just get it done as soon as he wants. I can't place my ankle on my opposite leg which is getting worse (the twisting hurts) and it is all of a sudden popping with every little twist I do (example is reaching for a drink I will turn to grab it and feel a pop and pain directly afterward) Sorry to ramble on, I am just thinking and trying hard to debate as to whether or not go back and mention my pain or just wait a few months for the pain to go down in the other knee and then request surgery on this one if PT / RICE doesn't work

 
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Old 08-19-2012, 10:02 PM   #11
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Waiting for a few weeks to a month to see if PT/RICE helps while your microfractured knee heals some might be a good idea. You want to have one knee that is at least somewhat stronger than the other. It should make rehab a little easier because you won't be trying to strengthen two weak knees at the same time.

 
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Old 08-20-2012, 11:02 PM   #12
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Re: Testing Positive with 'Bounce Test' sign of Meniscal Tear?

Quote:
Originally Posted by ozfan79 View Post
Waiting for a few weeks to a month to see if PT/RICE helps while your microfractured knee heals some might be a good idea. You want to have one knee that is at least somewhat stronger than the other. It should make rehab a little easier because you won't be trying to strengthen two weak knees at the same time.
Very true....I think it has been about 8-9 weeks of it hurting and swellling to the point of being more painful than the microfractured one but at this point, healing the microfractured knee is more important so it can support the other when I go through surgery.

 
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