Rudi Posted October 20, 2011 Share Posted October 20, 2011 Are there any doctors / physios or medical people out there who can help me?!! A couple of days ago my 12 year old daughter landed badly on her leg at gymnastics and hyper extended her knee. It swelled up and she can only bend it a small amount and cannot straighten it. She can hobble along on it, but she says it feels like it's going to collapse on her all the time. So my friend the Google doctor tells me this is a classic ACL injury. So yesterday we went to the docs and she sent my daughter for xrays and an ultra-sound. The xrays did not show a break (I did not expect them to) and I am not sure what the ultra-sound showed. When we were having it done the guy doing the ultra-sound said there was some damage to the cruciate ligament, but it did not look like a massive tear. He also said that what the ultra-sound could tell us was minimal, as it can only really see the outer parts of the knee and apparently the cruciate ligaments are further in. He suggested that if the scan did not reveal anything that an MRI would be needed, as there was obviously something going on with her knee. So later we had a phone call from the nurse at the surgery saying that everything was fine. OK I said, that's great news, but my daughter has a very swollen knee and is struggling to walk, so what should she be doing - resting or keeping it moving? She had NO idea and said she would talk to the doctor. She came back later and said when it stops hurting she can have physio on it. OK - so now we have "everything is fine" to "needs physio" so I was completely confused. I asked her how long it would be before we could expect it to feel better - her answer "when it stops hurting" yes I said, I get that, but are we talking days? weeks? months?. She just did not have a clue. So now I have my VERY active 12 year old, unable to walk properly, in pain and I have no real idea about what treatment she should be having and whether she should be moving, resting or what?! She was supposed to be on a Guide camp this weekend which she has had to pull out of, so she can have a quiet weekend and rest her leg, but what then? How long to I let it hurt for? How long to I wait to see a physio? Do I accept what the doctor says? I am completely at a loss here. She is a netballer and obviously needs her knee back working again asap in order to continue playing. HELP!! Any advice would be really useful! Love Rudi x Quote Link to comment Share on other sites More sharing options...
Guest The Pom Queen Posted October 21, 2011 Share Posted October 21, 2011 Hi Rudi I am so sorry to hear that, it will be pretty painful for her. If she has damaged her CL then she should really have a splint to help her walk. I can only advise from a veterinary care side, she should be getting plenty of rest and not putting weight on it, personally I would keep her on bed/sofa rest for 48 hours and if it is no better then take her back. It really does depend on how damaged the cl is, it could heal quickly or it may take months and if this is the case and it's not getting better they may look at operating, we say 4 weeks minimum cage rest. Don't worry I don't expect you to put her in a cage lol x. Remember as well I am not a Dr hopefully one will come along soon and offer you more advice. Quote Link to comment Share on other sites More sharing options...
Harpodom Posted October 21, 2011 Share Posted October 21, 2011 does sounds like a possible ACL injury. How long ago did this happen? Difficult to advise, could you post some pics of the knee, including range of movement? You could just ask the dr for an MRI referral. Should cost around $300 (no rebate if referred by GP) but at least you'd know what you're dealing with Quote Link to comment Share on other sites More sharing options...
Guest littlesarah Posted October 21, 2011 Share Posted October 21, 2011 Hi Rudi 'If in doubt, investigate further.' That's the motto we give to our students (podiatry, so lower limb is what we do!) There are clinical examinations that can be performed to test the cruciate ligaments, but on an acute injury, they could cause pain. As the sonographer told you, ultrasound (whilst very useful for lots of conditions, and very safe as well as very quick) is designed for assessment of superficial structures, not the inside of joints. If I were you I'd make an appointment with the GP to discuss the radiologist's report from the ultrasound scan, and to have them explain their diagnosis. Then you could ask about the possibility of onward referral or further investigations. It may be worth seeing a physio even during the acute phase, because they can advise about what measures to take to optimise recovery. Quote Link to comment Share on other sites More sharing options...
Rudi Posted October 21, 2011 Author Share Posted October 21, 2011 Thank you for your advice. I think we will give it the weekend and review things on Monday to see how she's going. Luckily we had some crutches that we'd forgotten to return to the hospital so she's gone to school with those today. I have also strapped the knee to try and stabilise it a bit. I was just so annoyed with the doc and nurse last night.......the doc because she couldn't be bothered to speak to me directly to answer my questions and the nurse because she honestly had not got a clue what she was on about!!! Thanks again Love Rudi x PS Yes Kate, I did consider a cage - I have my old boy cat who did BOTH his cruciate ligaments in when he was a young lad - OMG it was a nightmare trying to keep him contained for so long!!!!! Quote Link to comment Share on other sites More sharing options...
LKC Posted October 21, 2011 Share Posted October 21, 2011 My brother in law had an ACL injury from playing rugby. I think that he was told that alternate hot and cold compresses would help with the swelling, and was given anti-inflammatories for the pain. I have no idea about medication at all, but maybe try the hot and cold. I think he used a hot damp hand towel (obviously not hot enough to burn) alternately with a bag of frozen peas wrapped in a tea towel. I would probably be tempted to go back to see the GP, especially if she is in pain. Our eldest daughter possibly has congenitally absent ACL's. We noticed when she was about ten months old that she could kind of dislocate the lower part of her leg. We took her to see the GP and then a consultant who said that that was the probable diagnosis, but that no further tests were needed to confirm it unless she had problems. I would say that she is more clumsy on her feet, she frequently trips over nothing and when I ask her she says that her legs just fell, but nothing more than that. I hope your daughters knee is better soon. Quote Link to comment Share on other sites More sharing options...
Guest littlesarah Posted October 21, 2011 Share Posted October 21, 2011 Just the cold during the first 48 hours post injury - cold, not ice (ice can lead to reactive hyperaemia which isn't the desired outcome). After that, ice is pretty pointless, according to the evidence. Contrast bathing (i.e. hot/cold) has been shown to be much less effective than cold alone, and is more commonly used in chronic (longer-term) problems to alleviate symptoms. Elevation can help to reduce swelling - the limb should be higher than the level of the heart for that to work. Not easy in an active child! I hope the injury turns out to be not too major, and that your daughter makes a speedy recovery. S Quote Link to comment Share on other sites More sharing options...
katkin Posted October 22, 2011 Share Posted October 22, 2011 Hi Rudi, Hope your daughter is doing ok at the moment. From what you've described about the mechanism of injury (hyperextending the knee) it might not necessarily be an ACL injury (anterior cruciate ligament) - this is commonly injured when twisting and pivoting the knee when the foot is planted on the floor (Michael Owen type injury for those who remember). However it could well be the posterior cruciate thats been damaged in hyperextending the knee - did the doctor say which cruciate it was? Basically the cruciates are 2 ligaments situated inside the knee joint that cross over to provide stability to the knee joint. The fact that your daughter describes it feeling very unstable could be indicative of ligament damage. The reason doctors tend to xray is to check if the ligament pulled off a small part of the bone where it was attached (avulsion injury), so that's good news if that came back clear. An MRI is likely to give a better understanding of whats happening with the knee. However as others have said, clinical tests can also lead to a diagnosis - the reason the doctor may have said come back later is that when the knee is in the very acute stages of injury it can lead to false testing - i.e. when you assess the knee everything is painful so difficult to pin point the problem exactly. Either way it sounds as if you've got a daughter with a very painful knee and it definitely needs further assessment. The main thing in the meantime is to try and reduce the pain and swelling - RICE is the acronym to remember; Rest - trying to reduce the amount of time walking around on it, good that you've got crutches but make sure that they're the correct height Ice - wrap a frozen bag of veg/peas in a tea towel is often the easiest way. Ice should only be applied for 20 mins at a time, then remove for 40 mins. On 20 mins, off 40 mins. Repeat as required. Compression - bandaging as it sounds like you've already done (though make sure that its not too tight to cut off circulation) Elevation - as others have already described, elevate the leg. Gentle range of movement (i.e. bending/straightening) can also help to reduce the swelling and keep the joint mobile, within whats comfortable pain wise. If you're not convinced about this doctor then I'd get an appointment with a sports doctor or physio after the weekend and they should be able to advise you further. Without actually assessing the injury its difficult for any of us on here to give you a full answer, so getting further professional advice is the best way forward. Unfortunately i don't know of anyone to recommend, but maybe others on here can help...? Let us know how she gets on. Katkin (UK trained physio going through the epic process of Oz registration) Quote Link to comment Share on other sites More sharing options...
Rudi Posted October 22, 2011 Author Share Posted October 22, 2011 Thank you Katkin Well she is currently sat on the sofa with her leg up on several cushions and every time she tries to come off the sofa I tell her to sit down.......the usual answer is "but I need the toilet" :wink: I am going to get her to do as little as possible this weekend!! We have a fabulous physio who we saw many many times whilst my older daughter was diving. He knows his stuff and I trust his judgement, so we will book in to see him next week. The injury happened on Wednesday so is ice still something I should be using? I think the advice is usually that it is only effective in the first 48 hours after an injury. Her knee is still swollen though so if it will help, then we will use it!!! Love Rudi x Quote Link to comment Share on other sites More sharing options...
Rudi Posted November 16, 2011 Author Share Posted November 16, 2011 Just thought I would update you on things! My daughter had an MRI on her knee. It showed a tear in a muscle behind her knee, bruising in the bone at the front and a tear in the medial meniscus cartilage. She has been undergoing physio and at first it was thought that she may need an operation to fix the medial meniscus tear. However, her rehab has gone really well and she's off her crutches and walking around really well. It was great to get her off her crutches as she is now in the UK visiting the rellies. Thanks for everyones advice Love Rudi x Quote Link to comment Share on other sites More sharing options...
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