Knee Injury Question (Taekwondo)

[Bruce Lee]

Thanks for responding ATTIreland.

From speaking to the 3 Physios and from my own physical perception of the problem it seems to me that the NHS physio is making the most sense. I find that most staff I deal with in the NHS are pretty good people but generally seem to be suffering from lack of resources etc.

The reason that she has given for her reluctance in sending me for a scan is as follows. She thinks that I will have to see a specialist first and if my knee is unstable when I see him he will recommend more physio before a scan but if I increase the stability and strength in my knee but still am experiencing pain then he will refer me for a scan. Does this sound sensible?

Also I have recently spoken to a friend who is a physio in a different area of the NHS who told me that they use a rule of thumb whereby they refer to specialist/for a scan after 6 physiotherapy sessions. I have my 5th session in a few days so I am about 3 weeks away from my 6th session. If I do not get a referral after the 6th session I shall consider some private treatment.

However I am not sure how I would go about combining NHS & private treatment, for example if I pay for an MRI which reveals the need for an operation that I cannot afford how do I proceed from there.

Finally does anyone have any ideas as to where I can research which type of cartilage I’ve injured as I have currently researched every site I have been able to find myself and 'meniscus' is as far as I have got.

I would really appreciate any help/advice that anybody is willing to take the time to give.

Thanks.

Bruce.

[ATTIreland]

Howdy Bruce,

As you can probably guess I'm Irish so don't have first hand experience of the NHS physios and was only going on the comments of individuals on here so good to hear you think they're good.

Again I'm not familira with UK health system but seeing a specialist first is a common practice here and I can understand her hesitency sending you if there is an unofficial (or official) rule saying you have to go for 6 sessions first.

Unfortunately this is the negetive side of having a public health system. They want to reduce the numbers going for scans and specialists to keep costs down (which is fair enough). In your case though you'll probably have to see specialist and get scan anyway so rather then costing say 2 physio visits+Specialist+MRI your now going to cost the system 6 visits+Specialist+MRI. If they allowed physio's more clinical decision making power then they'd likely save money but its a Doctor-led system so cant see it happening.

Anyway getting back on topic, the way to incorporate private and NHS would be if you got your MRI scan before the specialist visit you'd bring the report and the scan itself (on a disk) in to him which saves on the couple of weeks (months?) you'd spend waiting on an appointment for an MRI in the public system and then getting back in to see him. However there is a fair cost to this route so NHS is probably best way to go at the moment.

As for research check out link below. It has link to loads of info such as treatment and surgical approaches.

Meniscii - Wheeless' Textbook of Orthopaedics

Hope its helpfull

[evphysio]

Hi Bruce and ATT,

I hate to disagree (as I could easily be wrong) but damage to the meniscus probably would not result in swelling of the knee joint as it has very poor vsacular supply.

A quick test to find out if there's a tear in your meniscus is as follows: squat down so both your knees are fully bent over, now try and walk forward. you'll probably waddle a little like a duck (which is why this is called the duck walk test). If you can do both those things (fully squat and duck walk) without any pain then your meniscus are probably intact.

Bruce: does your knee ever "lock" or give way when you're walking?

Ev

[ATTIreland]

Hi Evphysio,

Not trying to offend or anything but are you a chartered physio or are you a physio student/anatomy student?

I only ask because of the way you phrased your reply:"damage to the meniscus probably would not result in swelling of the knee joint as it has very poor vascular supply". It reads as if you havn't seen a meniscal injury in a clinical setting before and are basing your opinion on a knowledge of anatomy only?

You do make reference to the duck walk test and ask about clicking though so I'm not sure what to make of your post.


As far as swelling goes, it is a very common sign of meniscal injury particularly if it comes on a little while after the initial injury, as described by Bruce. (rapid immediate swelling would typically be more associated with ACL tear or patellar dislocation).

As for clicking/locking/giving way/etc, while these are classic signs of meniscal injury they are often absent, so while their presence would definitely indicate a meniscal injury, their absence does not make a meniscal injury significantly less likely (I've found locking/clicking to be more of an indicator of severity of meniscal injury than a significant factor in out rulling them).

Anyway thats just my opinion and you could well be right but I wouldn't be putting any money on it.

[evphysio]

Hi ATT,

No offence is taken as I am physio student adn I did suspect I could be wrong. I wasn't trying to undermine yourself just practicing my clinical reasoning. And I indeed did word my reply as such because I have not seen an acute meniscus injury on placement yet.

So why would swelling occur in a damaged meniscus if there is no vascular damage? (not an argument but a genuine question)

[ATTIreland]

Hi Ev,

Good to see you your keen to practise your clinical reasoning and it'll stand to you when you get out practising.

To answer your question, firstly while its true that the inner third of the menisci are not really vascularised the outer 2/3 are to an extent. Therefore injury to the outer 2/3 can cause swelling from a vascular source. Much of the effusion caused with meniscal injuries is thought to be as a result of increases in synovial fluid secretion to protect injured tissue which is not reliant on a vascular supply.

Again it come back to the onset of swelling seen with meniscal injuries Vs. ACL injuries. With ACL rupture its largely a haemarthrosis (blood) so it happens quickly, while with the meniscal injury the synovial fluid secretion takes longer to become apparent.

Rough clinical guide:
'pop' + rapid swelling = ACL
twist + delayed swelling = meniscus

hope thats of assistance

[evphysio]

thanks for that, a nice rule of thumb.