*** INJURIES AND MEDICAL PROBLEMS ***

[Young_Spike]

Ive had a problem with my knee and when I run the nxt day it swells up and i cant walk on it ive been to the doctors and F****** devastated.
:cry: :cry: :cry:
doctor says i have to wait until sept/oct to have an appointment with an
orthopaedic guy who will then (after a long wait) do something about it
(hopefully) the old B****** didnt even seem ars*d. the joys of the NHS.

its getting a bit lyk the military - hurry up and wait!

so now i cant run until ive had it sorted which will be months then months
of rehabilitation after that. the MOD form says il be
''permanently unsuitable'' but f**k that all I want is in and i dnt plan to
miss it for anything.

hopefully il be on next years induction or hell maybe the regs when I
finish college!!

soooo devastated i think im going to go and cry... 8O
well maybe not that devastated.

anyone else had anything like this happen to them?

YS

 

[angrydoc]

You will need either an MRI scan of your knee or possibly an arthroscopy, where a small camera is introduced into the knee joint. Your fitness or otherwise for naval/military service will depend on what these investigations show. Could be any number of things. Two months wait for this in the NHS isn't bad at all!

Bear in mind, though, that if you do need an operation then there will also need to be a period of rehabilitation - building up the leg muscles again etc - which may take 6-9 months with physiotherapy. It has been done, though, but it very much depends on the diagnosis.

Sorry to be the bearer of bad news!

 

[Young_Spike]

time doesnt matter i can go in later as long as i will be able to run on it? wat u recon doc?

YS

 

[angrydoc]

We need to wait for the MRI / scope. Advantages and disadvantages of both. An MRI scan can be pretty precise, but can miss some things. On the other hand, it doesn't involve cutting and doesn't even involve radiation - the scanner is basically a big electromagnet.

Arthroscopy involves a day-case admission to hospital, general anaesthetic (ie knocked out), a small cut (4-5mm) on each side of the knee and a camera into it. If there's a bit of cartilage torn, that can be repaired at the time. If there's a ligament problem, you'll probably be brought back for repair at a later stage after the whole thing's been explained to you.

If your surgeon requests an MRI scan, then you may need an arthroscopy +/- ligament repair later.

Those are the two common problems with sporty knees, but there are others. On the other hand, you may have a problem which is transient - ie it sorts itself out.

However I'd need to check BR 1750A (Naval Medical Standards) to see what the entry criteria are for post-op knee patients. Life in the Armed Forces is pretty tough on knees!

 

[Young_Spike]

i know for a fact its not ligaments, the doc sed my knee is forward which is a better sign and theres fluid behind and above it. he says it isnt grinding so may not be cartiledge.

i have the application form accompanying documents here...

on medical it says...

Unsuitable Conditions:

menisectomy (knee cartilage operation) within last year - i can wait a year :roll:
surgical repair of a ligament at all - yikes! hope not
chronic joint disorders, arthritus, gout, ankylosing spondylitis - hope not

i definitely need something done so hopefully its a year-wait kinda thing.

YS

 

[angrydoc]

Could still be a number of things. Wait for the consultant opinion and take it from there. The waiting game is a bastard but, unless you're in BUPA, there's not much choice! Any probs, drop me an email and I'll look it up.

d

 

[andym]

Sounds to me as you may have a form of Arthritis brought on by excrsise.When i say Arthritis i mean inflammation of the Joint.This inturn sets off the inflammatory response of which one is increased fluid to the affected area.It may have an underlying injury element to it as well,or you just plain over using the joint.(As a piece of design the knee joint is terrible,only to be surpassed by the elbow.)You may have some degree of retro patellar roughening which may acount for some of your problem.Has the knee ever locked up when bent?I would suggest you either limit your excercise or go to the swimming pool and get some low impact excercises there to keep muscle tone with out stressing the joint.

 

[Floppyjocky]

Young-spike - whatever happens it is important that you remain positive in your own mind. If you can't run at the moment then swim or concentrate on upper body work. I have had an arthroscopy, it was bad news for me but for the other 6 guys in my ward at the time (who had a similiar op) it was good news, they could all be repaired and on their way so wait and see.

Good luck mate

 

[Young_Spike]

i just hope to god that its not ligament i can wait years as long as i can still go in.
looks like have to focus on the time now and not ahead, maybe as seen as i would have no time to work whist at college and in RMR phase 1 i may aswel get myself that car i thought i couldnt afford.
the swelling and pain has gone down so tommorow night im gonna go to the parade night do the PT and tell em whats happening then il just have to wait for the next appointment. once again hurry up and wait.

not to worry. cheers for the advice lads.
if anyone else has had similar, post a reply.

YS

 

[andym]

If you do excersise i suggest you strap it up.There are some diagnostic tests you can do for a ruptured cartlidge,such as the MacMurray Manoeuver.If you know of any Doctors should be able to do it for you.As for ligament then also there are some tests they do.It basically involves the Dr trying to move the bent knee forwards and backwards over the Tib and fib heads,if it moves excessively then it suggests cruciate lig damage.Both these will be performed by an Orthopaedic surgeon with ease.It may help you to take Aspirin as this will enable any lactic acid crystals be removed from the joint space/fluid,as well as the anti inflammatory action.

 

[Young_Spike]

i searched on google and i ended up on arrse and a guy described the same problems. they suggest it may be Iliotibial Band Sydrome (I.B.S.)
although since being young ive always had trouble crouching then rising was the problem i had to take the weight off whilst extending my leg.

i dno i still have to wait for the scan but can you get in the corps with IBS?

http://www.ourhealthnetwork.com/kneepain_itb.php

YS

 

[SMUDGER879N]

I have what they call "degenerative spondylosis" (bone crumbling on the joints) in my lower back, after a fall at work. It leaves me with much the same results as that chap with the knee problem. Doc reckons that if I ever get arthritis in it, that would mean a wheelchair job? It leaves me limited as to mobility at times as to how far I can walk, or even move.
Still, I do have the odd good day, its the having a pint bit I miss, as I cant have any booze at all, it clashes with the medication, according to the doc. I suppose that's what caused all the throwing up the last I had a bevy?
Cheers Smudger.

 

[angrydoc]

Lactic acid in the joint? And my arse plays the banjo!

Lactic acid is a by-product of metabolism which gives muscle pain on exercise! If there's lactic acid in any joint then there's something there (ie bacteria) producing it. This, by definition, would be a septic arthritis which is an orthopaedic emergency.

Retropatellar roughening - you mean degenerative arthritis. Unlikely in his agegroup, although possible.

In addition the symptoms complained of were swelling and loss of function. Pain was not mentioned. Aspirin is rarely given for these symptoms - strong anti-inflammatories such as diclofenac sodium (voltarol) would be more appropriate here on an as required basis, but ultimately will not solve the problem.

Conversation as to the cause is hypothetical, and either a scan or scope is required. Mentioning big words helps no-one!



angry doc

 

[andym]

Lactic acid in the joint? And my arse plays the banjo!

Lactic acid is a by-product of metabolism which gives muscle pain on exercise! If there's lactic acid in any joint then there's something there (ie bacteria) producing it. This, by definition, would be a septic arthritis which is an orthopaedic emergency.

I was in error,i meant to say Uric acid.I never heard of Lactic Acid
causing a bacterial infection though.

Retropatellar roughening - you mean degenerative arthritis. Unlikely in his agegroup, although possible.

No, i dont mean degenerative arthritis,i mean Chondromalacia Patella.


In addition the symptoms complained of were swelling and loss of function. Pain was not mentioned. Aspirin is rarely given for these symptoms - strong anti-inflammatories such as diclofenac sodium (voltarol) would be more appropriate here on an as required basis, but ultimately will not solve the problem.


Aspirin is not used as much these days as it once was.However due to the side effects of NSAID's and COX2 inhibitors,these are now no longer considered first line treatment.NICE recommends that if any NSAID's are used then a PPI or similar drug must be given cocomitantly.In my (not inconsiderable)experience short term treatment with Aspirin fares better than NSAID's.Short term is the caveat here.

Conversation as to the cause is hypothetical, and either a scan or scope is required. Mentioning big words helps no-one!


A vast majority of joint(esp the knee)problems can be diagnosed to a high degree of certainty without resorting to the time and expense of a scan,be it MRI,CT or Ultra Sound,by simple mechanical examination performed by any competant Orthopaedic surgeon.


angry doc

 

[angrydoc]

Andy,

Lactic acid doesn't cause infection - it is produced by bacteria. Therefore lactic acid in a joint is a sign of infection. Uric acid in a joint is a sign of gout. Unlikely to present in one large joint and nowhere else, although usually tested for if we aspirate the knee. In young people, I have never seen one come back positive. Something that we should note here is that the knee is swelling - we don't know if it's intra- or extra-capsular swelling. This could merely be a reactive pre-patellar bursitis (although I doubt it).

Chondromalacia patellae is a condition much more common in females in their late teens / early 20s but will not lead to joint swelling. Therefore, this is unlikely.

Iliotibial Band Syndrome (mentioned by Young Spike himself!) similarly does not cause joint swelling.

NSAIDs not considered first line treatment? I've never heard of that NICE guidance (and the website is down so I can't check it), but I would be surprised if they recommended concomitant use of PPI with NSAIDs in all cases. I very rarely cover patients with PPI - it is usually sufficient to advise taking the tablets with or after food and reporting back if they have any heartburn symptoms. Those at risk of GI bleed etc should not be given NSAIDs under any circumstances, PPI or not. However, if you were to give out a box of omeprazole every time you give someone ibuprofen the NHS would be bankrupt within days and, let's face it, the punters wouldn't take them. In any case, anti-inflammatories are temporising measures in cases like this one. They should be used when the knee swells - if the knee is not swollen then there is no point taking tablets. They will have no effect on the underlying problem (unless it is a bursitis!).

Granted, clinical examination normally narrows down the diagnosis in most cases. However no orthopaedic surgeon, never mind general practitioner, would ever suspect a diagnosis and not investigate. We may have done this in years gone by but with current litigation rates the subsequent claim of negligence would be indefensible. And since this guy is doing his best to get into the forces I suspect CAAMB / medical referees will require evidence of whatever diagnosis is suspected. Remember that clinical diagnosis is basically a best guess until special investigations confirm. If I had been refused entry to the forces because of a knee problem that hadn't been investigated I would be an even less happy bunny!

Requesting investgations is not the sign of an incompetent clinician - the days of being brave and trying to "wing it" are long gone!

 

[angrydoc]

Oh, any by the way, the McMurray test is a basic test and if the GP hadn't done it then I would be very surprised. Also, asking if it had been done is completely pointless - I don't know about you but I have never said to a patient "I'm just performing McMurray's test - oh, and could you turn over for a bit of Apley's".

And aspirin doesn't remove uric acid from the joint either - you need to alter uric acid metabolism for that using allopurinol (about three weeks after initial treatment with NSAIDs / colchicine). If you have given aspirin to someone with gout then that is clinical negligence as aspirin actually increases serum uric acid!

 

[andym]

The price of Generic Omeprazole is peanuts compared to branded Omep.By avoiding just a single admission for Gastro bleeding would offset the cost.I never suggested that the requests for investigations was not a sign of incompetance.CP may mainly predominate in females however it is also seen frequently with people that take regular rigourous excersise.All i was doing was pointing out that what he presents with sounds like it had no ligament componant.

 

[Young_Spike]

angrydoc dont be so sure mate, the GP never touched my knee, he simply sat at the computer finger typing and grunting. he sounded as though i was telling him a story that boring him or keeping him awake. he sounded more sorry for me than he was actually going to do anything about it.

this is one reason im so pi55ed off with the long wait (which i now discover is looking at November/December rather than Sep/Oct) because if he looked at himself but then still refered me to an orthopeadic surgeon then maybe he was at a loss to what it could be but as seen as he was averting his eyes from my direction and hardly looked at me im sure he was just being lazy the old tom tanker.

he wasnt even my usual doc the usual 1s overbooked because people request to see him instead of their own. hes really good and i wish id insisted on seeing him now but sh1t happens and im gonna have to wait until nov/dec now.

andym has provided outstanding advice (more than my own doctor) its put my mind at rest as seen as the only fitness i do i now cannot, unless i want to not be able to walk the next day. with running and cycling out of the question im trying to hold off the drink for fear of putting on weight.

the circuit training is hard to do unless i have done some running just before it and now it seems useless. the cardiovascular level i had built up to is now slowly going to rat sh1t and im gonna end up getting out of breath walking down the street as seen as it going to be over 12 months until i can work-out again.

YS

 

[highanddry]

New to the site. Greetings to all.
Young_Spike, I'm having bother myself actually. About a month ago I sent off my forms applying to go on a POC. I got a letter back from the AIB last week informing me that I have been classed as permanently medically unfit for entry due to cruciate ligament damage in my left knee that happened in 2004.Naturally I was shocked by the letter. I never had a surgical repair to the ligament and it seems to have healed well and isn't affected by any training including doing bergen work with my OTC unit, so under the advise of one of the AIB staff I'm putting together a substantial appeal with medical records, consultants reports, x-rays etc. Even so I'm still worried that I won't be allowed to enter the application process and will always remain a recorded biff in somebody's filing cabinet.
H&D.

 

[Young_Spike]

i feel for ya mate n wish you good luck i know i was pretty pi55sed about this. if you didnt need surgery and are ok now i dont see the point in refusing you entry, but unfortunatly im not the AIB and i dont call the shots. whats the MO at your unit said?

YS