Odd injury after a roll back entry...some thoughts and help?

[Zef]

I'm back and sadly smarter reading Zef's messages then from my appointment today.

The ortho doc said that it was odd since after palpating the knee and leg in that area, I genuinely only have discomfort and not actual pain. The meniscus is presumably fine. He is of the mindset that it is either leaked synovial fluid, a hematoma, or a "bunching of the muscle". He said that he would like a simple x-ray first since it will show if there is a fluid build up (like a Baker's cyst that someone mentioned above) or possible vascular issues.

I already had the x-ray done and dropped off the CD to his office. They ordered it stat so hopefully it will be read sometime today. I have another appointment tomorrow at 415pm where he will "hopefully be able to drain it if it's simply fluid" or order a more appropriate scan. I assumed he meant an MRI and then I inquired if an U/S can be done instead and he said yes.

He said the odd part is that there is slight sensitivity exactly where I pointed to having injured it, but that is still not sufficient enough to explain a strain or a tear based on what he saw and felt.

I will again update you all once he sees the x-ray. I almost wish he had simply ordered the correct scan right away since it doesn't sound like a basic x-ray will provide much information. For my appointment tomorrow, the sports medicine doctor will also be there along with ortho. They seemed a little more intrigued then I wanted them to be.

Is the Doc you visited named Dr. Obvious?

He sent you for an x--ray to see if there is fluid in the area...fluid = swelling...that was already confirmed...an x-ray will not show anything about the soft tissue and won't indicated what kind of fluid it is. He also told you it was "odd" that you have sensitivity "exactly" where you "injured" it.

I am not sure why you want ultrasound. An MRI will have much more detail and will be the more definitive diagnostic tool....a good Ortho doc will want an MRI of the injured area whether or not an ultrasound is done and whether or not the ultrasound indicates anything.

What makes it hard to make an assessment over the interwebs is that it is not a good forum to obtain a good history or really have a dialogue about the nature and location of your discomfort and anything else associated with the injury such as restricted movement, etc. There are also special tests that need to be performed to check the stability of the joint and what muscles are involved...for example pain upon plantar flexing the foot against resistance with the knee bent as oposed to the knee not bent can rule out certain muscles and indicate more specifically which ones may be involved. Palpating the injury can tell quite a bit as well. There are some basic questions that on their own don't necessarily indicate much but combined with a detailed history, and physical evaluation can reveal quite a bit...then the diagnostic imaging is used to confirm the assessment as a diagnosis.

The good news is that if you had ACL, PCL, MCL, or LCL tear, particularly one with resultant instability, the doc would have most likely indicated that because it would have been noted when he checked the stability of the knee.

A bakers cyst (which can be caused by leaked synovial fluid), a hematoma due to a rupture of muscle fibers (strain/tear) are strong candidates based on what you have provided here.

As I indicated in my initial post, there are a lot of possibilities....many of them are treated the same regardless of the actual diagnosis.

It will be interesting to know what the definitive diagnosis is. In the mean time keep your leg elevated, especially at night and stay off it as much as possible until you know that your normal activities wont make it worse.

-Z

 

[jal102]

Is the Doc you visited named Dr. Obvious?

He sent you for an x--ray to see if there is fluid in the area...fluid = swelling...that was already confirmed...an x-ray will not show anything about the soft tissue and won't indicated what kind of fluid it is. He also told you it was "odd" that you have sensitivity "exactly" where you "injured" it.

I am not sure why you want ultrasound. An MRI will have much more detail and will be the more definitive diagnostic tool....a good Ortho doc will want an MRI of the injured area whether or not an ultrasound is done and whether or not the ultrasound indicates anything.

What makes it hard to make an assessment over the interwebs is that it is not a good forum to obtain a good history or really have a dialogue about the nature and location of your discomfort and anything else associated with the injury such as restricted movement, etc. There are also special tests that need to be performed to check the stability of the joint and what muscles are involved...for example pain upon plantar flexing the foot against resistance with the knee bent as oposed to the knee not bent can rule out certain muscles and indicate more specifically which ones may be involved. Palpating the injury can tell quite a bit as well. There are some basic questions that on their own don't necessarily indicate much but combined with a detailed history, and physical evaluation can reveal quite a bit...then the diagnostic imaging is used to confirm the assessment as a diagnosis.

The good news is that if you had ACL, PCL, MCL, or LCL tear, particularly one with resultant instability, the doc would have most likely indicated that because it would have been noted when he checked the stability of the knee.

A bakers cyst (which can be caused by leaked synovial fluid), a hematoma due to a rupture of muscle fibers (strain/tear) are strong candidates based on what you have provided here.

As I indicated in my initial post, there are a lot of possibilities....many of them are treated the same regardless of the actual diagnosis.

It will be interesting to know what the definitive diagnosis is. In the mean time keep your leg elevated, especially at night and stay off it as much as possible until you know that your normal activities wont make it worse.

-Z[/


Good morning,

I promise I realize that internet doctoring is futile, but I wanted to know if anyone had a similar incident to me and a subsequent injury. They did mention some more in depth tests they need to do this afternoon related to stability and a few other things. I only asked about an U/S because I have had that procedure in the past in lieu of an MRI which was initially the doctor's choice since the wait was awfully long and the doctor changed directions. I will absolutely do whatever he feels is best. I believe the person today will be "more" useful for me based on his everyday work. By going yesterday morning I was able to set up an appointment with the correct doctor this afternoon without a wait. If I waited until he himself was available the appointment was weeks out.

I actually laughed out loud when I was told it was odd the injured area was sensitive. I did see that as a bit obvious. I did the x-ray since they requested it and I figured the more info the better. Was it useful? Nope! The one piece of info I did receive is that they are relatively confident I do NOT have a tear as you indicated above.

I'm genuinely curious what I'll be told today. I'll share the diagnosis thoughts and treatment plan afterwards. I'm secretly hoping it will be as definitive as possible even before he is able to see whatever diagnostic test he orders.

My new friend Lump has to go because it is mentally annoying me and like when you have a paper cut on your finger, I now keep dinging it and touching it.

Thank you again and fingers crossed my saga will have an ending today.....

Jacky

 

[Zef]

Based on your response I can understand the ultrasound in lieu of or in conjunction with the long wait time for an MRI. The ultrasound in your previous injury gave the doc the diagnostic arse coverage to move forward with treatment. Without knowing this was part of your experience, it came across as odd that you had "requested" an ultrasound as you mentioned it a couple of times in your post. It now makes sense.

For the x-ray, some folks are bothered by unnecessary radiation exposure, and some folks don't care. Also, most don't bat an eye lid at it because their insurance is picking up the tab, but I find x-rays for soft tissue injuries when there is no implication that bones are involved to be an unnecessary time and expense burden from a patient standpoint. It may be useful if an avulsion fracture is suspected but that would show up on an MRI and more than likely on an ultrasound. Some doctors are selective about these things, and others just order them as routine...the tendency, from a medical malpractice standpoint is to order the x-ray and not think much about it as it is CYA type of thing. Perhaps, god forbid, you had bone cancer or other such tumor that would be seen on a radiograph image, but it did not get diagnosed for 2 months while you were waiting for the MRI appointment. That sort of thing looms on in the back of some doctors minds so they just adopt a policy of F-it and routinely order tests/images like that. Its all good, but from a philosophical standpoint is part of the soaring cost of health care in the US....and most folks don't question it because an x-ray is not considered by most to be an invasive procedure.

I wish you luck at the doctor's today for good news and a speedy recovery. Let us know the final diagnosis.

Cheers,
-Z

 

[jonhall]

Hope you get some good news.

In late June of 2012, I injured my left leg playing tennis 4 days before a trip to Cozumel. Knew I definitely strained the Achilles tendon, but that it was not a complete tear, and the emergency room doctor recommended seeing an ortho. Ortho (next day) recommended wearing boot and anti inflammatory for 2 weeks and appointment with different ortho. Went to Coz without the boot and dove a few days but as I was reclining in a lounge chair with an alcoholic libation, I looked at my foot which was double it's normal size and thought the pressure on my foot/leg of going deep and surfacing couldn't be good so I didn't dive anymore. Twenty days after the injury (and still not wearing the boot as it hurt more than the injury) I had an MRI which showed small tears in the gastroc and ankle. Opted for physical therapy which continued until the end of Sept. at which time I was given the okay to play tennis again.

Joined a gym so I could continue working out and using weight machines and was pretty faithful through the winters of 2012, 2013, 2014. In late 2014 I started feeling pain in my right knee. Was playing tennis 3 times a week and still using weights. Stopped with the weights (knee pain) but kept playing tennis, although I was wearing braces and hobbling around. Fast forward to June of 2015 - I had an MRI that showed a tear in the right lateral meniscus, a partial tear in the ACL, a ganglion cyst, and osteoarthritis. Opted for cortisone shot from an ortho. It worked well for me but the effects only lasted 1 to 1 ½ months (you can get one every 3 months) and I'd have to wait and gut it out until I could get another shot. Fortunately my diving trips were when I was pain free. I eventually got the cortisone shot from my doctor who used a different mix in the shot and which lasted longer. Had a shot in spring of 2016 and gave up tennis for the summer. Resting the knee was probably the key as I was able to do things pain free. Didn't get another shot until Jan. 2018, as I tweaked my knee playing tennis and we were getting ready to take off for Cabo. Haven't had a shot since.

As I mentioned, taking it easy for an extended period of time was probably the key. I still play tennis 3 times a week and am back to going to the gym but have no pain. The knee does get stiff, especially after sitting for an extended period of time, but that's probably to be expected for an old guy!

Again hope you get good news!

 

[jal102]

Dear Johnhall,

Yikes that was the painful injury that kept on giving not in a good way. It's nice to read that besides some stiffness you are now able to be relatively pain free. Resting is always the key to healing and I'm sure if I had come home and stayed more physically calm, I would've been ok. Timing was in your favor if you got to go diving right when you were pain free and I'm glad you're still playing tennis. I hope you're able to continue the activities you love and thank you for sharing your story with me. I rested yesterday which felt odd and hopefully we will both be perfectly fine and shot free moving forward.

Jacky

 

[jal102]

I had my doctor's appointment yesterday afternoon with the sports medicine ortho person and left pretty content. He is absolutely certain my ACL, PCL, MCL, and LCL as well as my meniscus are all fine. He did all kinds of stability testing and stretches and said that based on what he was seeing it was most likely a synovial fluid build up from pressure that very well may be residual to my roll back injury from about 6 weeks ago.

He said that since he can access the fluid build up from the side and not risk snagging things like my femoral artery that he would try to drain it and see how that goes. He removed a little over 30cc of fluid and told me to use a compression garment for a few days to try and avoid it from returning. According to him the fluid was blood stained synovial fluid and he shared that most likely I did strain or slightly tear something (can't remember what he said it was) but that I didn't have the pain associated with a full tear or something that needs further treatment IF the fluid doesn't return.

He banned me from the gym for the rest of the weekend and said if there was no swelling/fluid build up by Monday morning I could return to my normal daily activities. If swelling in that area returns he stated I needed to return and have an MRI of the area to check for any residual soft tissue damage and I was also to contact him if I had any pain there.

I'm not too sure that this is a full diagnosis, but it seems like if the draining fixed the issue then he felt I was ok due to the lack of pain and full strength he saw in all the testing he did.

Zef, I again want to thank you for the wealth of information and the help you gave me. I'm hoping this is the end of my story and everything just goes back to normal. I will share if it swells up again and he needs to do more diagnostic testing.

Thanks again everyone and my next post will hopefully be about an amazing dive and not like this one!

Jacky