hurt knee on fall - do I need a doctor?

A snowHead

janeed, Yep I found a boot camp one locally, I think it's more equipment based but I might give it a go... Just know I'm going to be pummeled! rolling eyes

Jonathan Bell, thanks again!

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Well, the person's real but it's just a made up name, see?

Ok, saw the physio today. He couldn't examine me completely due to the pain and lack of movement, so has advised me to hold off seeing a consultant until my leg is able to be pulled around a bit more. He did suggest getting the GP to refer me for an MRI to start that ball rolling though. (I appreciate the discussion above, but getting on the waiting list whilst the swelling goes down can't hurt).

As far as he could tell ACL is still good and he thinks the medial ligament is probably still attached, so grade 2 strain. He's not sure if there is a cartiledge issue which might be causing the locking, but this might also be a pseudo locking due to pain. If the cartiledge does need surgery, it is usually best to wait about 6 weeks apparently.

He's given me crutches, which are making life a lot easier, and some exercises to keep the surrounding muscles strong and try and get the mobility back. He said the pre-hab element was really important in case surgery is needed. He was hopeful that in a week or so I should be able to bend my leg to 90 degrees.

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janeed,

Your problem still centres around the lack of diagnosis.

A knee surgeon should be able to examine you without making you too sore and still be able to tell you which ligaments are injured, even if too painful for the physio to assess. If a minor injury that is stiffening up quickly he/she will be able to tell physio to push your movement. If blocked by meniscus you need urgent arthroscopy. Even if more serious it may still be possible to get it moving ASAP. I wouldn't hold off on the knee surgical opinion especially if you now have a good recommendation. Again MRI will probably be needed but at this stage not as urgent as a plan.

The earlier you are permitted to regain full movement the quicker you recover.

Anyway, snowHeads is much more fun if you do.

Jonathan Bell, once again thanks for your useful advice.

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Ok, to update this thread:

Last week I went (privately) to see a knee surgeon, who carried out the same tests as the physio had. He wasn't able to make a proper diagnosis either. He thought the MCL injury was a grade 2, but couldn't rule out either ACL and/or meniscus injury as well. He said I'm need an MRI for a certain diagnosis.

The MRI appointment has just come through on the NHS, but it is another 4 weeks off. So I'm trying to decide if it is worth paying for a private MRI to get a diagnosis sooner, or just wait. The surgeon won't operate until I have full range of motion back, and the swelling has gone down anyway, but being self-employed it would be really useful to have a better idea of what treatment will be needed and the likely timescales, so I can start to cancel/accept contracts.

I could get a private MRI immediately, but am not sure if I'd need it with contrast or not, and this affects the price.

On the positive side, I'm getting around a bit more easily, can straighten my leg fully and have near full flex, although it is not comfortable.

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janeed,

Im sorry to hear you still have uncertainty. It can be difficult to commit to whether the ACL is ruptured but re- examining the knee when it is less sore, at about two weeks should be able to provide certainty. So reliance on the MRI shouldn't be necessary for the ACL, it also doesn't grade the MCL very accurately. The treatment of an isolated MCL is non operative in most cases but if ACL and MCL ruptured you will need to plan for surgery after the knee has full movement and the swelling settled, as suggested. That surgery can be delayed months once full movement achieved to allow you to plan.

However, it sounds like your surgeon wants an MRI to commit themselves to the diagnosis so for peace of mind and about £250' ish that might help.

After all it is free

Thanks for the advice again Jonathan Bell. It is good to know that delaying the surgery will not make the damage worse.

I'm 4 weeks in now. My physio is still unable to commit, as was the surgeon at 3 weeks. I think part of the problem might be I have overly flexible joints normally.

It now seems there is a week's wait for the private MRI I was looking at (after being told there was no wait and paying £40 for a 30 second 'referal consultation'). I've been told 15 days elsewhere. So I'm thinking I might as well save the money and wait the additional 3 weeks for the NHS.

janeed, you don't say where you are in the country on your profile, but Spire Cambridge Lea had next day appointments last week and offered to do it on the spot for me post-appointment in the same hospital. If it's something that you'd prefer to get done it might be worth checking around if you have some reasonable sized private hospitals around you?

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janeed, glad to hear you're getting somewhere with it. BMI The Alex usually have MRI appointments within a day or two and Stockport Imaging Centre too were able to offer my husband one very quickly but were more expensive. Bridgewater could also do a quick one. Don't know if that helps any Smile

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janeed,
Vista diagnostics in Waterloo can usually get you in quickly for about £275

Also I would ask for the referral / interview fee back on the basis that a week of waiting is poor service and they should have told you there was a week of waiting before they proceeded with the interview

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(too late to delete so edited to avoid talking to myself)

Well, it turns out that the appointment on 8th April:
a) would have been a triage appointment and not a scan
b) has been cancelled by my GP anyway, after the surgeon I saw has requested I transfer to his NHS list.

Despite the poor service initially, I've gone back to Pall Mall medical. They can get me an appointment for Thu at the Alex, and this costs £365 compared to the £490 the Alex quote. They also say they will email me results 2-3 days later, so no need to go to a doctor to get them.

Hopefully this will confirm the problem is just the MCL, and if not I'll be on the surgeon's NHS list with all diagnostics in place to proceed. At least, I think that is how it will work.

In case anyone else is looking in Manchester:

The Stockport imaging search directs to Aliiance Medical. They would only charge £199 but there is a 15 day turn around time.

The bridgewater costs £510 and the next appointment is 4th April.

Thanks for all the advice and suggestions. I was really struggling to figure out how it all worked.

You know it makes sense.

The MRI results are back and it doesn't look great.

"The posterior cruciate ligament is abnormal and thickened up to 1.5cm and high T2 signal within it suggests an intrasubstance tear.

The MCL itself is unremarkable though there is significant soft tissue thickening anterior to the medial collateral ligament.

There is a small joint effusion with fluid in the suprapatellar bursa. There is some oedema in the prepatellar soft tissue.

Further orthapedic referal with a view to arthroscopy recommended. Urgent referal to a knee surgeon recommended."

Oh well, at least it is a move closer to an answer. Hopefully the consultant appointment will come through soon so I'll know the next steps.

Otherwise you'll just go on seeing the one name:

janeed, hope you get the appointment soon!

A snowHead

A snowHead

That sounds more positive than I was interpreting it. Thanks again for the continued advice.

Well, the person's real but it's just a made up name, see?

[b]janeed[/

There is almost an oversupply of scanners within the M25. There are scans to be had, with a good quality report, but it still seems that getting an appointment and the medical/ diagnostic backup is really difficult. I am currently trying to get a volume discount on scans so we can offer a scan and appointment with one of our sports physicians. At the moment I would have to offer it at 495 but I'm trying to see if we can get it closer to 400. We would aim to turn around in 3 days. Would that compare to the sort of costs Snowheads are having to pay for getting an answer? Apologies to those who feel this post is advertising but this seems to be a really important concern for Snowheads.

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Jonathan Bell, my scan was covered privately so didn't see the cost for it, the two consultations came out of my outpatients allowance so I get to see these £210 for first then £105 for MRI follow up, I was then passed over to the physio and did a few months, not much communication going on between them (same hospital) as physio asked near the end "did the consultant ask you to have a follow up with him when physios finished?" Well he hadn't so I presumed I'm good to go? Still tweaks a little briefly on the medial side when loading the inside of my foot after being sat around for a while, injury back in June so hoping this will improve.

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janeed, as Jonathan Bell, says sounds positive! Very Happy

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I'm in Manchester so not sure how applicable this is but I paid:
- £220 for initial consultation with surgeon
- £40 for (ridiculous) private GP consultation (I needed this because I decided to go for the private MRI after I'd seen the consultant. He'd refered me to another hospital, but the scan there was mcuch more expensive, about £600.)
- £365 for MRI, week wait for scan, results by email 4 days later. I could have paid £199 for a 15 day turnaround.
I haven't decided yet if I'll pay to go back to the surgeon, or wait for the NHS appointment with him to come through. I don't know if the follow-up appointment would be cheaper.
I pay £38 for half hour of physio a week.

If I'd waited for the NHS I'd be having the initial triage appointment on 8th April, then would have to wait for scan appointment after that. Goodness knows when a NHS physio referal would have come through, but my leg would have been in a right state if I'd have waited.

Being self-employed I wanted an answer quicky, to be able to take/cancel contracts, and to plan in potential surgery. However, my physio advided me to wait a little while, until my les was mobile enough for surgeon to test. Even at 4 weeks, he wasn't certain of diagnosis. I'd have been able to get an appointment sooner if I had thought it worthwhile. For me it was worth paying, as the cost is offset by the potential loss of work if I take longer to get better. Much of my work is overseas, but I couldn't sit on a plane at the moment.

So, the costs you are talking about seem good compared to what I've paid. I probably wouldn't have bothered going to London though.

Hope that helps. Feel free to PM or ask here if there is anything else you want to check.

After all it is free

Just to add to my earlier post:

the main problem I felt was not knowing what to do, how the system worked and the options I had. I was lucky to get some good advice on this site, and I knew a grest physio from a back issue in the past. But otherwise I'd have been completely lost.

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Revised title: How on earth do I get a doctor?

Hurt knee 9 weeks ago.

Saw GP 7 weeks ago. He refered me to a clinical assessment service. Appointment came through for 5 weeks after that.

Decided to see surgeon and have MRI privately 6 weeks ago, as I wanted to know what was going on sooner.

Surgeon wrote to GP to ask for me to be refered to his NHS list.

GP wrote referal letter to surgeon's clinic and GP cancelled clinical assessment service appointment.

Then nothing. For 6 weeks. Chased it once, and was told the letter might have been lost in the post, so referal sent again. Still nothing.

Finally found out today that:
a) the GP had sent the referal in the wrong form (letter rather than booking via choose and book website)
b) the hospital had therefore ignored it
c) the hospital cannot take direct referals from GPs anyway for NHS work - these need to come via the clinical assessment service.

I've spoken to both GP and hospital this morning, and begged them to actually talk to each other to sort the mess out. But either way it seems that I'll now have to be refered back to the clinical assessment team, which will be many more weeks wait. Not to mention a complete waste of time and money, as everyone is agreed I need to see a specialist consultant.

ARGH!

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janeed, I feel your pain! I have taken the view that the NHS want to do the best they can but the bureaucracy is not understood by many and they simply have too many demands on their time and resources.

I have been asking questions at every stage, e.g. If you do X how does that work, how does that get me into the system, what will happen next, when, who is the next point of contact and I've been proactively making the calls and ensuring agreed arrangements are happening. e.g. when your GP wrote the referrel letter I would have called the surgeon's clinic 2 days later to a) check that they got it and b) ask what they were doing with it and what the next steps woudl be with timescales - rinse and repeat at every stage.

Speak (complain) to the hospital so see if you can get moved up the list for you rclinical assessment, If you don't ask you don't get, they clinic shiould have referred back to the GP, not have ignored the letter - grounds for action IMV

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Yes, it definitely seems like the issue is no-one understands the systems, or at least they don't understand them in the same way.

The problem with the suggestion above is that the clinical assessment has to be carried out at one hospital (NHS only) in order to be refered to the (private) hospital where the surgeon I have seen carried out operations (both private and NHS). The referal went to the private hospital, who should have got back to the GP, but the NHS hospital have never heard of me, and so have no reason to move me up their lists.

I guess I could pay to see the surgeon again to get a clearer idea of the treatment plan, but I'd still have to go through the NHS assessment service at the other hospital in order to get listed on his NHS surgery list.

The GP's secretary is speaking to the PCT tomorrow to try and sort it out.

janeed, the NHS hospital will have heard of you tomorrow, so my strategy would be a call to the them on Friday to see what is happening, (even if it wasn't their fault). Hopefully it will get sorted this week for you.

You know it makes sense.

Yes, when hubby had to be referred to specialist after his accident (not knees though), I had to chase up regularly with both surgery and hospital, Eventually after a short delay, and several phone calls, an 'URGENT' appointment came for 4 weeks time !! All he'd been told by French hospital was to see someone urgently in the UK, leave the neck collar on for 12 weeks, and get some physiotherapy.
Trying to get that appointment brought forward was a nightmare, but I eventually got through to the nurse in charge at the outpatient's clinic, and she rearranged it.

Otherwise you'll just go on seeing the one name:

Well the secretary called me back and made a referal using choose and book to the surgeon at a different hospital. If only she'd done that six weeks ago as the surgeon requested.

A snowHead

janeed, good. Very Happy

A snowHead

Well, the person's real but it's just a made up name, see?

Sucess!

I'd made a note in my diary to do some pestering today, but actually got a phone call this morning offering me an appointment on 29th (just over a week). so things are back on track.

I hear so many of these stories about NHS systems, and it is such a shame that they push the best medical staff out. My physio left the NHS for the same reasons too. So we're left with a few good staff who don't have the time and support to do their jobs well, and people who shouldn't be doing their jobs. In recent years I've seen doctors who:
- wrote an MRI referal without mentioning that I'd fallen, or even which knee was injured
- told me I'd cure my IBS if I pressed on my stomach as hard as I could
- told me when I turned 30 that I must hurry up and have children as he was fed up with women like me leaving it too late and then asking for fertility treatment
- diagnosed headaches as due to stress and gave me antidepressants, even though the pain only occured when I turned my head sharply to the left.
Honestly!

Sorry, rant over. Thanks for the continued support on this thread.

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janeed, more reasons for despair at the NHS. Good news that you've got your appointment Very Happy

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hello all,

So I saw the surgeon earlier this week. He didn't seem to think there was a need for surgery and couldn't see much good it would do. He grades the PCL damage as 1 or 2, and said it was easier to diagnose (as distinct from acl) now. He said I should recover function without needing reconstruction.

He said there is a lor of scar tissue around the MCL, which is probably causing the tight feeling I get at times.

He's said to carry on with the exercises I'm doing, and to push through the pain a bit more with them, especially the flexion ones. When I mentioned the grating feeling I get when I do squats he said injections might help with the pain if it becomes a problem. However, he didn't really suggest a cause of the sensation. Maybe I should have pushed on this a bit further.

He says my progress is slow, but within normal variation. I'm going back to see him in 2 months, and he says he might consider arthroscopy then if there is no improvement.

My physio however thinks my progress is a lot slower than normal, and he'd expect me to be here at 4-6 weeks not 12 weeks post injury. He did a lot of work on the scar tissue this morning, which made my eyes water but helped.

I'm not quite walking normally yet, as my knee doesn't bend enough unless I really focus on it. I can walk without the crutch, but need to really think about it. I need the crutch when it is windy, uneven, and to encourage other people to give me a bit more time and space.

Extension is normal when sitting, and I can get a straight leg when standing. However, it doesn't straighten unless I focus on it and it feels 'wrong' at the back of my knee when I do it, like it's bending too far back.

Flexion is a couple of inches off normal, and I can't sit on my heels without at least one cushion.

I still get swelling. There's a little bit all the time and it puffs up if I've been on my feet a lot, or sitting on a chair with it bent a lot. The only comfortable position is sitting on a bed/floor with my legs in front. This is also meaning I still daren't fly, which is restricting work options.

Has anyone else on here had PCL/MCL injury? Does this sound familiar to you? How quickly did yours progress after injury through to normal everyday function and then to being able to run/ski again?

thanks

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janeed, from a non medical background pov, it does seem a long time for an injury that doesn't require surgery to still be reliant on crutches. Difficult to compare injuries as everyone's will be different but I can tick a few boxes regards to some of the feelings in your post, It's been 11 months since my injury and it still feels far from perfect, the only time I forget about it is when I'm not moving. Did some damage (no surgery) to mcl/pcl/acl was never given the grades but you're welcome to view my MRI results if you can translate what it all means. I can straighten my leg when walking but only if I consciously make the extra effort, I definitely get the feeling that my leg would over straighten/hyper extend if I relaxed it too much, I think this is more of a mental block rather than anything physical and a habit born from months of protecting that last bit of extension, I did accidentally kick it out relaxed once and don't want to repeat the pain of it. That final bit between slightly bent to fully straight feels the weakest point to me but I was told by the physio It's because of the nerves that get damaged causes this feeling, hence all the balance exercises to rebuild proprioception in the joints. As for skiing, I started skiing after 8 months (UK slopes) doesn't cause too much problem, just come back after a quick break in the mountains to push it a bit more but found myself skiing in protection mode so didn't really enjoy it, I did however discover snowboarding which was far easier on the knee both physically and mentally!

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After all it is free

Gatecrasher, thanks for your comments. It's good to hear you are back on the snow again. I have been wondering how much of my problem is mental, and a lot of what you said rings true to me.

Jonathan Bell, your comments make a lot of sense. I had been wondering why the MCL hadn't settled, as everything I read says it usually takes about 4-6 weeks. But the discomfort (not really pain, more of a tightness) is around the back of my knee, which fits with your comments. Thanks for confirming this is normal, if unusual.

I guess I'll push on with the exercises and try not to be too impatient. I'm finding it tough as the weather at the moment is perfect for running, and my friend is having a hen do at Chill Factore today. Oh well, there may be hope for next season anyway.

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Yes maybe could send just the knee UPS to Florida! Laughing

Help!!

hurt knee on fall - do I need a doctor?

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