Knee injuries -- when do you see an ortho?

[KevinF]

A neighbor of mine was walking her puppy three days ago; apparently she got tangled up in the leash and the dog pulled her down. She quickly discovered that her knee hurt too much to stand. My girlfriend and I went over to pick her up and took her to a local urgent care (her request; didn't want the hospital). Urgent Care x-rayed her knee and said there's nothing broken ("just a sprain") and put her on crutches and sent her home. My understanding is that an x-ray wouldn't show the extent of soft-tissue damage though.

In the meantime, my girlfriend and I have been trading off dog-walking duties as all three of us live in the same neighborhood.

It's been three days; she can hobble around better and some range of motion is returning to the knee, but she says it's still pretty sore, etc.

At some point I feel I need to encourage her to get her knee 'properly" evaluated. Would a "fully torn ACL" type injury appear to be "improving" on its own or would "three days in" be "SHOOT ME" levels of pain, etc.

Basically, she thinks she's going to be fine (due to some improvements), and I'n not sure that "some improvements' is a reliable indicator of the severity of an injury. And I really don't want to be her backup dog walker for an extended period; i.e., if she's really hurt (like, "surgery needed" hurt), I don't want to be doing this for "months", so at some point we need clarity on the "this will heal on its own in days or 'we need professional medical attention because it won't'".

 

[Philpug]

A neighbor of mine was walking her puppy...

Uh huh.... neighbor???? Hmmmm

 

[KevinF]

Uh huh.... neighbor???? Hmmmm

? I'm not sure what this means. I'm fine. My girlfriend is fine. And my girlfriend's dog is fine. There's a third person and a second dog in this story.

I thought in a collection of skiers - a sport known for not being particularly kind to knees -- that there would be consensus as to when it's gone from "hurt" to "injured".

 

[Andy Mink]

Many people go forever without knowing they have a torn acl. As the swelling subsides, it will *feel* better but it might not *be* better. @AKMINK walked around for quite a while after her ACL tear before surgery with little to no pain, just weak and unstable. She should probably seek professional assistance.

 

[JeffB]

I defer to the actual doctors here, but I have a good bit of experience with unplanned injuries, whether my own or my kids who are fairly high level athletes. Not that anyone plans an injury, now that I'm thinking about it. At least not sane ones.

A x-ray isn't going to show soft tissue injuries. An MRI will.

Most people with ACL, MCL, or PCL injuries describe a feeling of instability.

Anyway, if you want to find out with a physical exam, you can usually do it by having the injured person lay down on their back with their knees up and feet on the floor/surface like they are in the sit-up position. Then you hold their thigh steady and pull the lower leg at the calf towards you or to the side. If the calf/tibia/fibula moves relative to the upper leg which remains stationary, there is likely a problem.

Again, I'm not a doctor, but I recently have stayed at a Holiday Inn Express.

 

[Dave Marshak]

I knew it was time to go to the doctor when my neighbors wouldn’t walk my dog anymore.

dm

 

[Sibhusky]

I defer to the actual doctors here, but I have a good bit of experience with unplanned injuries, whether my own or my kids who are fairly high level athletes. Not that anyone plans an injury, now that I'm thinking about it. At least not sane ones.

A x-ray isn't going to show soft tissue injuries. An MRI will.

Most people with ACL, MCL, or PCL injuries describe a feeling of instability.

Anyway, if you want to find out with a physical exam, you can usually do it by having the injured person lay down on their back with their knees up and feet on the floor/surface like they are in the sit-up position. Then you hold their thigh steady and pull the lower leg at the calf towards you or to the side. If the calf/tibia/fibula moves relative to the upper leg which remains stationary, there is likely a problem.

Again, I'm not a doctor, but I recently have stated at a Holiday Inn Express.

Yes, usually with knee injuries, my husband and I have had people yanking on our lower legs to see how the attachment to the knee works or something. He's torn each ACL and I've broken a knee cap. So for us the next step AFTER the yanking and wiggling was always an MRI. (They knew from an X-ray my patella was broken, but then the MRI for "and what else".)

 

[Tony S]

"I ran your case by the Internet and they all say that if you want me to continue to be a good neighbor you need to go to an orthopedist."

 

[Tony S]

PS: Don't touch her, let alone yank on anything, unless you want to be back here with lawyer questions again. If you were close enough to her for that you'd already have told her to go to the doctor.

 

[fatbob]

I didn't have an ACL for years and could walk, cycle,ski. In the end what did for me was stepping up or down stairs. No single outcome.

Plus X rays not necessarily perfect. I fractured a Tib plateau that wasn't picked up til I had a later MRI.

So the answer is probably Lachman test and an MRI. Plus kind and generous friends who'll look after the dog during appointments.

 

[silverback]

Hard to go wrong recommending she see an expert.

 

[JeffB]

PS: Don't touch her, let alone yank on anything, unless you want to be back here with lawyer questions again. If you were close enough to her for that you'd already have told her to go to the doctor.

Meh, I'll cover the lawyer part. That's what I have done for 22 years. Med-mal defense exclusively. Yank all you want. There's immunity for Good Samaritans in every jurisdiction. And also assumption of the risk on the part of the recipient.

#WillWorkForBeer

 

[Living Proof]

My lifetime learning is I now visit the Dr. on a proactive basis, not reactive. Sooner than later works! Kicking myself in the butt, I've been struggling with a minor wrist issue thinking it would just heal. It is getting worse, Just made appointment with a hand/wrist specialist.
My knee history is 10+ years ago, a knee doc told me my cartilage was minimal, 5 years later it was gone and could not ski. Did a total knee replacement, and can ski now. X-rays do not lie!

 

[David Chaus]

Soooooo..... there's the advice we can solicit for ourselves, and advice we can give those in our family and close friends, and then there's the unsolicited advice we may feel tempted to gift to someone who is not all that close to us.

Tread lightly.

If it comes up in conversation, ask if you can offer a suggestion, if the neighbor says yes, then you have the opportunity to offer your advice to seek an orthopedic provider who may want to order an MRI, or if that sounds too scary, at least go to a PT. It could also be the case that any referrals needs to first go through their primacy care provider.

Even though we may all be compassionate souls that just want the best for our fellow humans (or even if we just want to avoid dog-walking duties for others' canine family members) I can only assume the neighbor is in fact an adult and capable of making up their own minds as to when to seek care.

 

[David Chaus]

Now assuming the situation has nothing to do with a neighbor and the question is really about when to seek care for a knee injury, it really depends on the whether there is impairment in one's ability to function. My knee injury last year made it hard for me to walk, work and sleep and I was in a lot of pain from contorting my body as I compensated.

Several months of PT did wonders for me and I skied the whole season, including a stretch of 9 days in a row of skiing during and after the Aspen Gathering.

 

[VickieH]

My experience -- Xrays in an ortho's office did not even show the fracture of my proximal tibia. I was sent for an MRI, which showed the fracture and damage to the ACL. So ... your neighbor does not have a diagnosis yet.

Unsolicited advice that I feel tempted to gift someone who is not all that close to me: After, say, a week of being good neighbors, you and your GF should go away for the weekend. Y'know, so she can explore dog-walking options for the longer haul.

 

[Wasatchman]

I didn't have an ACL for years and could walk, cycle,ski. In the end what did for me was stepping up or down stairs. No single outcome.

Plus X rays not necessarily perfect. I fractured a Tib plateau that wasn't picked up til I had a later MRI.

So the answer is probably Lachman test and an MRI. Plus kind and generous friends who'll look after the dog during appointments.

Wow, that must have been some hairline tib plateau fracture. My non-displaced fracture was immediate and high pain without any ability for weight bearing.

I've heard of people not knowing they have toen an ACL but you're the first I have heard of not knowing they fractured their tibial plateau.

 

[Wasatchman]

Do you know if she fell on her kneecap? There is all kinds of cartilage under the kneecap that can be damaged and cause problems that won't show on an x-ray. Often even an MRI isn't great at showing that and a scope is what is needed to really see the extent of that type of damage. Then there is meniscus, tendons, etc. that also don't show on x-ray and MRI is needed to diagnose.

There is a pretty simple test that is highly accurate to test for ACL tear that they probably would have done at the urgent care I assume. It's still possible it could be an ACL tear but highly unlikely if that physical test is negative.

It could be just a bad sprain but after a few days I would probably see a specialist for peace of mind especially if there is significant swelling in her knee.

 

[mdf]

If your neighbor gets back to walking the dog after a week or so, you could argue that either she didn't tear her ACL, or she doesn't really need her ACL. (I lived and skied without one for years.)

If she still has a mobility issue by the time you are sick of taking care of her dog, she needs to see a doctor no matter what the issue is.

 

[surfsnowgirl]

Michael tore his ACL last April. He knew when he went down that something happened to his knee but he wasn't in any pain and if careful could walk fine. He walked to the car at the end of the day. We got an Xray/MRI a few days later which showed a full ACL tear. What the MRI didn't pick up was the meniscus tear that the doc saw in surgery and repaired it while he was in there. I would definitely recommend getting an xray and MRI. As the doc explained to us what someone chooses to do with the results will be up to the patient.

A friend of mine wife tore her acl skiing and didn't really care if she skied again so she chose not to have surgery. She still has some discomfort and fear over hurting it more but on she goes. I would have had the surgery if I were her but it's her choice.

What fooled us at first with Michael's knee is he really didn't have any pain.

I think your friend should at least get it checked out so she can know for sure and have full information to make her decision.