Cannot bend knee after 18 weeks in cast- now casted for additional 4 weeks

Hello, I am a 60 year old woman with cerebral palsy. Back in December I had my leg casted in an attempt to lengthen my hamstrings. My left leg was only casted for 3 weeks and got full range of motion back. The right leg is considerably more contracted so every time I go back and get the cast taken off, they say it is still too contracted and put a cast back on for a few more weeks. We are now at 18 weeks with my right leg casted in full extension.

Last week they took my cast off as a trial run. I had it off for two nights and was completely unable to bend it. Because all my limbs are effevted by my CP I was not able to get around or stand up independantly with the right leg not functioning. So, for my safty, they went ahead and put the cast back on. I will have it take off again 4 weeks form now. So it will be a total of 22 weeks in the cast. My concern is, I was not able to bend the knee AT ALL during the two nights the cast was off. This seemed to suprise my doctors. When I got my left cast off (the one that had been casted for only 3 weeks) I was able to bend it after just 2 hours. My concern is that when the cast comes off in a month, I still wont be able to bend it. The doctor is talking about using a split cast then so, I will be able to have that on during the day in order to get around as needed.

What can I do to help regain my bending? Do I need a PT? Aqua threapy? How long will the recovery take after the cast comes off in May?

-GumbyLady

It is very common that a knee is difficult to bend following a cast. This used to be extremely common when it was the treatment of choice for dislocated patella's. Now I am happy to say that this is not the case. I wonder why if you could not bend it that you needed to go back into a cast? Seems a little weird.

For sure you will need rehab to get the leg moving following the cast removal. Perhaps if you don't have the money or access you could begin with working in the pool, even just trying to walk around in the pool if you are ok on the safety side of things. You can always get a flotation vest like that used for water running to help if your independence is a little challenged in the pool.

Thank you Physiobob. I appreciate your insight and speed. I'm beginning to wonder if I should consider the hamstring release surgery at this point. I elected to go with the serial casting hoping to avoid going under the knife but I never expected it to take so long or for the results to be so mixed. At what point do you think it would be beneficial for me to consider surgery?

Surgery aside, if I get PT and exercise in the pool, how long do you think recovery will take? It seems to me, the longer i have the cast on the longer my recovery will take.

Thank you!

PS. They put the cast back on only so I would not fall down at home alone. I can walk in the cast and get around. But since I was unable to do so with my leg out of the cast they put it back on, maybe as a quick fix?

No way to tell you how long as this is a brain issue and everyone is different. Your therapists/neurologists could consider using some botox with the casting and rehab as that is what it was originally used for. Well that is if the contracture is related to spasticity. If it is just a shortening due to non-use then casting will only work as long as the exercise is able to move the limb through the new range of motion that was created. Also the fact you mention they needed to put the cast back on for you to walk but that you couldn't bend it with the cast off seems to me that fear is more the factor there and possible weakness in the quads. The only was to get over that is get off the cast and rehab, hence the split cast is a great idea.

Do let us know how you get on :-)