No Range of Motion (ROM) for 26 weeks in my left knee

[friendsfan]

i haven't had any ROM for 26 weeks since my injury, I've had a arthroscopy and MUA, I've also had plenty of physio but they are refusing to see me now due to no improvement... What are the long term effects of this

I just want some opinions. thanx

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[sdkashif]

Kindly describe your case presentation in a little bit more detal like which areas or joints of your body have been affected as a result of trauma. What is the current assessment and investigations along with given treatments to you by your clinician.

[friendsfan]

its my left knee, i fell from a crouching position with my knee bent at 40 degrees and its been locked in this position for 26 weeks....
my 8th week into the injury i had a arthroscopy and MUA, the arthroscopy showed a MCL tear and the surgeon says my knee is "battered" (i dont know what he means by this)
i started physio after the surgery and ive had physio for 3.5 months with no improvement..
my physio is refusing to see me due to no improvement, my OS wont see me until ive been to the pain clinic next week..
im unable to walk without crutches, i just want to know the long term effects of my knee having no ROM for this amount of time
thankyou

[physiobob]

Can you tell us your age, work status and what exactly caused the fall? Also when you had the MUA did the surgeon say you had considerable range on the table when under anaesthetic?

Have you got skyline views of your patella (knee cap) on x-ray?

[friendsfan]

im 25, i work as a healthcare assistant at my local rehab hospital (im obviously off sick)
i had my nephew on my back giving him a piggy back, i crouched down to let him off, which he did no problem, and then next thing i knew i was on the floor i dont know what happened...
the surgeon says he achieved full ROM when i had the MUA,
ive had x-rays on my knee ive had 3 different lots took, i dont know if its been skyline view.. ive also had a MRI which came back showing no real changes

[rockin ronnie]

from the info u've given, the surgeons are not likely to go anywhere near u and the pain clinic may well be ur best friend. Get some good analgesia on board and bend it! If too sore then u may be in need of a psych work-up, the pain clinic will cover this. Good luck, terrible few months for u.

RR

[friendsfan]

do you mean i have a terrible few months ahead of me? or ive had a terrible few months?

[Physio-Oms]

hey.....interesting case....
have u had a CPM done after the surgery? (continuous passive motion)
and 26 weeks is 5 months or so......thats really serious...
i believe its an indication for surgery!

[friendsfan]

my physio tried me on a CPM machine a couple of times but my knee wouldn't budge.... its 6 months, ive now developed a strange gait where my knee and hip rotate inwards, (wish i could walk without the crutches)
i too think i will require more surgery, i just dont know what kind

[Physio-Oms]

hve they scheduled another arthroscopy for u?
they should....

[friendsfan]

what good Could another arthroscopy do?
what could be achieved from it?

[jwilso]

i'm not sure why you feel that an arthroscopy is indicated. he's already had one and under anaesthetic he had full ROM. hes had an MRI which was ok. i'm kind of reading between the lines but my feeling is that both the surgeon and the physio that you have seen have the impression that it is not a physical problem that you have.i might be wrong but my gues is that they feel that you have a non-organic region for not bending your knee. ie it is a mental block or that something has gone wrong with your pain perception. hence the referral to pain clinic. i am concerned at the time scale invloved and you will have developed contractures by now. you need some strong analgesics and a strong physio. you will have to work through the inevitable discomfort. also another thought i have is that if you had an MUA and had full ROM that may suggest that you havent developed contractures and so this could suggest that you must be taking your knee through full range at some point every day(this could be when youre asleep and not realising it ) is this possible? food for though maybe????

[friendsfan]

im a she not a he...
my physios feels that there is a block to my knee somewhere (ive seen about 6 of them) i keep getting passed on.... however i feel that if they kept on with me i would have achieved some ROM
whats contractures? i highly doubt my knee moves when im asleep as its always the position..

[jwilso]

contractures are when soft tissues shorten in length due to not being taken through their normal length(ie normal joint range)

does your knee move in any direction or is it locked completely?

it sounds like youve had quite a bit of physio and didnt really make any progress. what makes you feel that if it was continued you would have gained some Range of movement.

i am assuming your on crutches to get around are you able to take any weight on your affected leg?

what did the physio say to you when they stopped treatment?

[friendsfan]

my knee is completly locked..
yer ive had a lot of physio but it felt like no-one really gave me a real chance before passing me on to someone different, and they would all contradicte each other. i feel if id have been able to stay with just one and keep doing the same things we may have got somewhere, (i had 6 physios in 3.5 months)
im on crutches coz i fall without them, i should be FWB but not all of my foot touches the ground making it near enough impossible to have full weight going through it.
my last physio session 3 weeks ago she said to me that she is going to discharge me until ive seen my OS again as its a waste of my time attending when she feels there is no improvement.

[jwilso]

do you have problems with sensation,temperature of the limb, sweating of the limb, hair growth of the limb etc. apart from being locked does it look different ( eg colour, swelling, muscle tone etc)

if the consultant feels there is no ortho problem it could be something like RSD (reflex sympathetic dystrophy) known also as complex regional pain syndrome. has anything like this been suggested?

[friendsfan]

yes my knee does look different but not in any of the ways they'll be lookng for RSD, the only differnce is it looks deformed...ive been taking pictures of my knees, so i can see how its looking
i think my ortho is hoping it is RSD, but none of it seems to fit with me

[Hayden123]

I was just curious as to what the MRI report showed. You said there was no real changes but what was the initial reports findings. Also, how much pain are you currently in with a scale 0-10. Do you have constant pain or just when you try to bear weight on limb. Has your pain level changed since the accident? Also, could you describe some of the treatments that you did for therapy sessions? It sounds as though you have had a rough road so far. Are you able to bend or straighten the knee at all. Why did you have so many therapists? Did you also go to that many different clinics or did you have hospital PT, rehabilitation center, home health, and then outpatient therapy? Have you been to the same MD or have you also seeked another opinion? It sounds as though from what you are saying that the only finding was a injury to medial ligament or was there ACL, meniscus injury as well.

[jwilso]

can you post any of the pictures on this forum?

[jwilso]

Any other past medical history? and are you on any medications for anything at the moment?

What type of ward/department do you work on normally?

[friendsfan]

hayden123.. the mri showed no real changes from what the arthroscopy had revealed.. the is pretty minimal really id say its usually 1-2, unless someone tries to force it to bend, which then it can shoot up to 8...it is just painful when i try to weight bear or if my knee is unsupported, my pain level hasnt increased since the accident.
ive had hydrotherapy where i was either just walking in the water or i'd float and my physio would pull my leg in all directions trying to get it to move...and on land physio they was just trying to do simple stretching exercises. im unable to bend or straighten my knee,
i had so many therapists because none of them knew how to deal with it and just passed me on its outpatient PT,
i have seen 2 orthopaedic surgeons who both gave contradicting reports to each other, one says my knee just straighten out when i went under the anasthetic and the other says they had to really manipulate it.
and the only injury ive been told of is the MCL.

[friendsfan]

jwilso..hopefully there should be a attachment here.
theres no other medical history, im not taking any meds, although i was taking diazepam and tramadol before physio..
the ward i usually work on is a rehab ward for the elderly

[jwilso]

thanks for picture
you have a lot of muscle wasting in your quads and calf muscle as you would expect.

what does it feel to you is stopping the knee from moving. is it something superficial(muscles) or something deep( joint) or is it pain or something else.

if you have seen 6 physios over 3 months then you have been passed around a bit. its a shame that one of them didnt stick with you for a bit longer and take on the challenge with you. did they pannic at your lack of progress?how often were the physio sessions? have they completely discharged you? often in situations like this the physio could work closely with the pain team. whats the point in them reducing your pain if youre not going to have any help getting it going?????also what does your GP make of your problem and you being discharged?

im sorry that my questions are all over the place but i just write them down as they come into my head.

[friendsfan]

you're welcome, do you think my knee looks deformed? and what do you mean by theres alot of muscle wastage as i cant see it?
it is a mixture of all 3 that i feel is stopping my knee from moving (if i can go to physio dosed up on diazepam and tramadol there was definitly not much pain)
pain isnt the biggest problem...
yes they did panic at my lack of progress they all said to me we should of seen some improvement after a couple of sessions, i was having physio 2-3 times a week, but i personally i dont think it was enough,
today i have had a letter from occupational health giving me a appointment next thursday with the extended scope physiotherapist after ive been to pain clinic, so there might be some progress there.
my GP isnt too concerned about my problem as he says im in the right hands, he doesnt yet know that ive been discharged.

[jwilso]

i dont think that your knee looks deformed as such.just looks flexed.it doesnt look like its the quads holding it flexed as there isnt a great deal of tension in the patellar tendon.

as for the muscle wasting i am observing the bulk in the muscles. the calf wasting is marked and there is a smaller bulk of the inside quads muscle(VMO). its hard to tell from the photo but the blood vessels in the limb look slightly darker in colour in your affected leg.

any more photos? some in standing might help.

glad to hear youre going to see an ESP. are you geting pressure from your employer?

waiting your response,

john