Knee injuries -- when do you see an ortho?

[Rudi Riet]

You have to live with your body for all of your corporeal existence. As long as you have health insurance: see the ortho ASAP.

Do not pass go.

Do not collect $200.

Signed,

An orthopedic adventurer

 

[Rich_Ease_3051]

The human knee is the greatest joke foisted upon humanity by evolutionary biology. We have a very, very high ceiling with what we can achieve athletically with insane blood circulation through our powerful hearts and what almost feels like limitless muscle strength and strong bones that can break through the pull of earth's gravity and unparallelled (in the animal world) skin excretion of heat and sweat to assist but then there are these 3 little ligaments holding us back.

The body sings "Push It to The Limit!"



but the knee says "Sorry and Fu*k You Body, Just Walk".

 

[Pequenita]

When I was 15, I "tweaked" my knee skiing, and I went down on a sled. The ski clinic checked me out, decided it was a sprain, braced me, and I was sent home. Sometime in the next few days, I was walking diagonally up a hill (no snow - just a regular hill), and my knee went out. Eventually, an MRI and surgery showed that I had partially torn the ACL, sprained the MCL, and torn up some meniscus for extra points. It's unclear which incident caused what damage, but I suspect that the second fall was caused by being a 15-year-old wandering around with an undiagnosed partially torn ACL, sprained MCL, and torn meniscus, and the second fall didn't cause more damage.

Whether to go to the ortho now depends on how active the patient is, their age, and their level of pain and stability when doing whatever activities they do. Someone who is 70 and only walks on flat, paved sidewalks will have a different calculus than a 40-something who plays rec league basketball once a week.

 

[bbinder]

So the consensus seems to be: seek additional care. Or don’t. And you and your girlfriend should go away for the weekend. My knees have severe damage and have never been operated on. I have often done nothing after an injury. Then again, I have often sought advice from a medical person after an injury. Neither changed the fact that my dog needed to go out for a walk. So, ease away from your good samaritonship. Unless you don’t want to.

 

[Jwrags]

It has been 3 days and she is improving. Give it time to see if she continues to improve. In all likelihood it will resolve. If it doesn’t in 1-2 weeks then seek care. Chances are even if she wants to see an ortho doc it will take weeks and by then it will be resolved or not.

 

[mdf]

my knee went out

For general interest, not really relevant to your neighbor...
During the years I had no ACL, it would "go out" a couple times a year. It never hurt after the initial injury (until the eventual reinjury that sent me to the ortho), but it was a definite "I should not have done that" feeling.

One time it went out I was helping get something heavy and awkward into a pickup truck (lift and twist). Once was skiing deep powder in Casper Bowl at JH, slashing my tails to try to exaggerate the face shots.

My ortho said my condition was what a previous generation would have described as "having a trick knee."

 

[mdf]

It has been 3 days and she is improving. Give it time to see if she continues to improve. In all likelihood it will resolve. If it doesn’t in 1-2 weeks then seek care. Chances are even if she wants to see an ortho doc it will take weeks and by then it will be resolved or not.

Which means try to get her to make an appointment now. It can always be cancelled later.

 

[Sibhusky]

My husband never had surgery on either ACL. He doesn't ski anymore, but does bike occasionally. He also trotted over to the grizzly successfully and saved our daughter, so one could say the knee has worked sufficiently well for 45 years. But, the reason he gave up skiing was the 2 ACL's and then a dislocated shoulder. All that made him paranoid about skiing. Myself I would have had the surgery, but giving up skiing meant he could sleep in.

 

[Tony S]

This conversation is a hoot. @KevinF, your problem is now solved. Just send her a link to this thread. Communication complete. You might need to move, though.

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

No doubt you're right. You may have missed the last episode of "Kevin and the Law," though. Guessing he doesn't want to test his rights.

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.)

Ah. So basically you're saying her problem can be solved with rear entry boots. Got it.

 

[Gary Stolt]

Allways good to get more information about what is wrong concerning a health problem. Now the question is what to do about it. We tend to accept surgery to get things back to normal. A wise physician once gave me some advise about my less than perfect shoulder that hurts with a torn, detached rotater cuff. He asked if I could play golf with it (knowing I play golf). I said yes that I could. He asked the same thing about skiing. Again, yes I can ski (although some of you may dispute that). He then said if I could live with the pain, revealing that my shoulder may still hurt after surgery, that recovery is difficult, and that it is possible that my sporting activities might be limited after surgery, it may be better to at least postpone surgery and concentrate on healing exercise.

 

[fatbob]

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.

Yeah my knee snapped forward inline on a bump field on the Men's Downhill at Snowbasin. Ice didn't ease the issue. Got X rayed the next day down somewhere near Roy who put me in a flexi splint and issued me crutches saying it was likely soft tissue but wait for swelling to subside. After a repat flight got the MRI at home. Turns out I have a relatively high pain threshold after lots of previous knee injuries.

 

[crosscountry]

3 days is too soon to tell either way.

While I'm no doctor, I've visited them frequently enough to have seen a pattern. Technically speaking, your neighbor had clearly "injured" her knee in some ways. Perhaps a torn ligament? But unless that ligament was completely detached, it may just grow back without any surgical intervention. And if it eventually needs surgical intervention, it's typically not urgent.

I belong to the school of "see a doctor sooner rather than later". But obviously your neighbor belongs to the other school. Of the many times I ran to the orthopedics, some of them ended up being sent home to just wait for it to eventually "get better".

Whether she sees a doctor or not, it probably won't help speed up your release from dog walking duty.

 

[cantunamunch]

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.

We'll know the real story when @KevinF starts a "How to train a dog for skijoring?" thread and starts looking at Maine / Gaspesie hut trips.

 

[Wade]

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.

I didn’t know about a non-displaced tibial plateau fracture for about a week until I went for an MRI.

The clinic at Alta told me it was almost certainly an ACL tear. I went home made an appointment with and ortho and was told the same thing and scheduled an MRI to confirm ahead of surgery.

The MRI showed a partial ACL tear, complete MCL tear, and the TP fracture.

I had been walking around on it for a week including walking half a mile each way to take my 2 year to pre-school every day because my wife was 8 months pregnant and needed to stay off her feet. I figured that while it hurt a bit, the ACL was already torn and I wasn’t going to do any more damage.

The ortho got the MRI results and called me to tell me to get off my feet immediately. She said there was a chance that the tibia plateau fracture could displace if I kept walking around on it, and if it did, I’d be looking at surgery to put it back together and then 18+ months of rehab.

Everything wound up healing the way it was supposed to without the need for surgery and 9 years later, it’s sometimes difficult to remember which knee it was.

 

[Tony S]

Yeah my knee snapped forward

Can we, just, not use phrases like that? Looking for the "slightly nauseated" emoji.

 

[KevinF]

For the record, I did speak with my neighbor this morning. She said she's been weaning herself off the pain meds, but effectively hasn't left the house since the injury.

I mentioned that the swelling will go down and mobility will improve regardless of the extent of the injury and that for me, I would want to know the full extent of the damage before trying to resume "normal" activities. i.e., decreased pain and increased mobility does not mean you didn't do real damage. You know what it's not (i.e., a broken leg, courtesy of the x-ray); you don't know what it is. I would want to know what it is, not merely what it's not.

She seemed receptive to the ortho idea. I don't know if she followed up or not; I said I'd be happy to drive her to the ortho if needed. In my mind, I did my "due diligence" in that I informed her that "progress" -- while definitely a good sign -- isn't necessarily indicative of "not having suffered a severe injury".

 

[Pequenita]

@KevinF I wouldn't use "not wanting to walk the dog" as the metric for whether to suggest the neighbor get medical care. For a neighbor that you wouldn't have drinks with or invite to your home, etc., I'd suggest to them once, "Hey, you should get that checked out." For someone you see regularly, I'd ask the next time I see them, "How's that knee feeling? Did you get it checked out?" If they keep complaining about it but not do anything about it, I'd tell them to get it checked out. For someone that I know well that has an active lifestyle and who I care about, I'd probably tell them a couple times to get it checked out. But ultimately it's a medical decision, and unless paying for the health care is the issue (can of worms), whether to seek medical care is personal.

ETA: personally, not being able to leave the house because of a physical injury is enough for me to seek medical care, but again,

PS: I think you're taking "due diligence" to a level that it doesn't need to, because of your experience with skiers and knee injuries. If that same neighbor had a hernia or something you're completely unfamiliar with, my guess is that you wouldn't be struggling with that the same way. There's no duty for a neighbors to vet medical situations. I mean, I guess there's the moral/conscience argument that if you knew that your neighbor had a fracture, you didn't say anything, and then they were permanently disabled, you'd feel bad. But how is that different than if your neighbor was obese, had a terrible diet, didn't go to the doctor for 15 years and probably type 2 diabetic? I digress....

 

[Tony Storaro]

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'".

Absolutely make her go to a hospital. She needs MRI. A torn ligament may feel like improving, one can even think they are allright but completely torn ligament doesnt heal I think. Surgery is needed.

My doc said I could live with the torn MCL but it s a ticking time bomb.

 

[cantunamunch]

My doc said I could live with the torn MCL but it s a ticking time bomb.

You gonna get that fixed? Or are you just giving up on opening swinging doors?

 

[Tony Storaro]

You gonna get that fixed? Or are you just giving up on opening swinging doors?

Oh, it was 3 years ago. Upon hearing I could forget about skiing I immediately agreed to surgery. Spinal anesthesia is no fun trust me on that but they did let me watch the whole process on a monitor so all in all it was a good deal..
And besides I now have a beautiful scar on my knee which I tell people I got when saving 5 guys and their 3 dogs from an avalanche.