Here’s an inspiring story from clinic last week

Back in October I saw Mr D for a couple of appointments. The first time I called Mr D’s name..

A 72 year old man hauled himself up, and..

Bent over needing support, 

He looked older than his years + sat down with a ‘sigh’. We began to unpick what was going on..

The referral was from a spine surgeon colleague

Mr D was complaining of back + knee pain..

BUT his knee x-ray films didn't look that bad..

He was also seeing a cardiologist and general medical consultant. There was a good team of experts around him..

  

Left Hip => 15mm cyst, otherwise good joint space.

Lower back => Old fracture, narrow spinal canal + several trapped nerves.

  

Left L3 nerve root injection 3 weeks previously 

Which was ‘good at the moment’

  

After a full assessment we booked an MRI scan of his knee. 

 

I jest..

He’d had mechanical instability for 3 months, so that was the next step. And the scan showed..

  

Left Knee => Severe Osteoarthritis (OA), a meniscal tear + grade II MCL injury.

  

MRI scans show everything. From the 3x scans..

Ask yourself 'which problem we should pick to focus on..?'

  

The story, as ever, was key.

  

The back injection had resolved Mr D’s left buttock pain and 'most' of his left knee pain for 36 hours. 

  

However, he was left with a feeling of instability in the left knee. Particularly walking up or downstairs. 

AND he’d fallen 8 times over the last 6 weeks, 

  

Mr D also still had aching pain over the inside of his left knee and down his shin.

  

There was pain down the outside of his left leg when stretching his sciatic nerve. And both hips moved painfree. 

The left knee moved well from 0° to 130° 

BUT there was pain in the left shin at full knee bend / flexion. 

AND there was tenderness over his medial ligament.

BUT no tenderness at the front of the knee or when pushing on his kneecap. 

There was a palpable click over the inside (medial) but no pain with it. Importantly..

  

..showed only mild decreased medial joint space 

  

That joint space or gap between the bones, tells us us Mr D is a little way off joint replacement. 

Which raises the question of arthroscopy / knee scope..

  

  

Back: degeneration + trapped nerve in the back => being well looked after

  

Knee: OA, meniscus + ligament knee => some catching but mainly aching pain on the inside, with OA that ain’t that bad on X-ray films

  

Hip: looking okay.

  

 

The easy thing at this point would be to book Mr D for surgery:

BUT the catching element of Mr D’s pain was manageable. The aching and instability were not..

  

That medial ligament would heal, but it takes time. Sometimes as long as 12 to 18 months.

  

And don't forget.. his legs were weak

 

  

  

That's an active choice in my clinic

  

3 We agreed to meet again after 3 months..