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Old 05-28-08, 06:05 PM   #1
StanP
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MRI best for an injured knee after an accident?

Hello everyone,

I'd like to know something about use of MRI immediately after a rather bad accident where a knee was quite injured.

Yesterday (Tues. 27 May) a car collided into my left side and the left side of my dear, classic, steel-tubed, quite old, in-tip-top-shape ('til the accident yesterday) sturdy touring bicycle. I had the right of way-- the 18 y. o. driver got a ticket from the police for failure to yield when I had right of way on a designated bicycle path which was crossed by a driveway to the parking lot of a business and of a public park. The collision threw me onto the car hood and then I spilled off the hood onto the ground. My legs got beat up and two fingers in the left hand were sprained (and are very swollen and discolored now). An ambulance took me to the hospital where the only things done were cleaning and dressing the bleeding leg areas, an X ray taken of my left hand, and an X ray taken of each leg. [All the X rays were negative: no broken bones.] But I'm worried about my left knee which must have been badly concussed and wrenched and twisted I suppose. Since, due to the accident yesterday, the left knee is very unstable now (I use crutches and/or rely on an Ace bandage wrap). I'm worried about serious internal damage such as tears to the important tissues that make a knee stable and strong. Is an MRI - of a damaged knee - best to have *very soon* after an accident or is it not so important if some time passes after the accident? Bicycling is very important to me and I don't want to have some disability which would prevent bicycling in the near future.

Thanks
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Old 05-28-08, 06:26 PM   #2
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Speaking as an RN, I would think that since the X-ray showed nothing significant, then an MRI wouldn't be done unless you have unexpected issues recovering function of your knee. I imagine you have lots of swelling/bruising and pain with any movement. You need to talk to your MD or other practitioner about your concerns. Sounds as if you would benefit from physical therapy.
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Old 05-28-08, 06:33 PM   #3
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Thanks JanMM for your comments.

I believe that soft tissue damage is not revealed in an X ray. That's why I asked about an MRI. I'll soon talk with my doc to see what he thinks about an MRI.

About physical therapy: I know that wouldn't be good right now while I'm healing from notable injuries sustained yesterday but maybe I'll need p. t. later.
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Old 05-28-08, 06:51 PM   #4
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When I injured my knee the orthopedic specialist insisted on an MRI...

My knee was very swollen and I could not move it. I had a torn lateral meniscus.
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Old 05-28-08, 07:10 PM   #5
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X-rays don't really show damage to ligaments. You really need the MRI to look at the internals of the knee. I injured my knee last year and needed surgery. The X-rays only show some of the issues, but all the really nasty stuff was exposed when the MRI was done. I would not do any PT until you know the extent of the injury. I did not know the full extent of the injury and was still riding short distances and when my knee just would not get better, I had the MRI and discovered that I was making things worse by riding.
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Old 05-28-08, 07:38 PM   #6
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Thanks JanMM for your comments.

I believe that soft tissue damage is not revealed in an X ray. That's why I asked about an MRI. I'll soon talk with my doc to see what he thinks about an MRI.

About physical therapy: I know that wouldn't be good right now while I'm healing from notable injuries sustained yesterday but maybe I'll need p. t. later.
Right. Too early for PT. Ice/elevation is probably the therapy for the time being - if the injury was yesterday.
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Old 05-28-08, 08:24 PM   #7
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I'd let the doctor decide the best way to diagnose it.
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Old 05-28-08, 08:43 PM   #8
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As a physician, I can assure you that the plain radiograph (x ray) of your leg will not show ligamentous injury. Now, soft tissues are visible on a radiograph as well as joint effusions, however as stated before, ligamentous injury is not. A unstable knee needs to be evaluated by a trained physician with physical examination and most likely an MRI. Do not let an injury go, as it could cause much more trouble in the long run.

Hope it helps.
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Old 05-28-08, 08:47 PM   #9
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I'd let the doctor decide the best way to diagnose it.

Me, too. Why would you NOT listen to your doc here? This injury is a big deal to you (it would be to me, too), but it's likely something your doctor has seen many times. My guess (as a non-physician but many-time patient) would be that he's trying conservative treatment first, and if you don't respond in a reasonable time, he'll step it up. That's a responsible course of action from the standpoint of keeping costs down and getting maximum return on your dollar, and since a delay won't endanger your life or affect your eventual recovery, it sounds reasonable to me.
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Old 05-28-08, 10:52 PM   #10
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As doctor #2 [family doc] chiming in here: RICE is your therapy for now [rest, ice, compression, and elevation]. You should be non-weight-bearing for at least five days [ten may be needed], and have a complete knee examination by your physician, when the swelling and pain are resolved [it may still hurt to the touch or with weight bearing after 5-10 days, but that wouldn't be surprising!].

The vast majority of people with knee injuries can start PT, given you have intact ligaments at the time of your exam. Ortho will be normally be consulted straight away, with obvious ligament tears found on exam, especially ACL or PCL. Meniscal injuries sometimes need surgery, but many times do just fine with time and proper exercises! MCL or LCL tears are almost never repaired surgically. In my medical group, MRI is usually reserved for people who don't respond to PT, so the orthopod can see what they are going to 'fix' before going in!

I hope this helps!! Glad to read you weren't more seriously injured!

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Old 05-29-08, 11:19 PM   #11
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[U]............and have a complete knee examination by your physician, when the swelling and pain are resolved [it may still hurt to the touch or with weight bearing after 5-10 days, but that wouldn't be surprising!].

The vast majority of people with knee injuries can start PT, given you have intact ligaments at the time of your exam. Ortho will be normally be consulted straight away, with obvious ligament tears found on exam, especially ACL or PCL. Meniscal injuries sometimes need surgery, but many times do just fine with time and proper exercises! MCL or LCL tears are almost never repaired surgically. In my medical group, MRI is usually reserved for people who don't respond to PT, so the orthopod can see what they are going to 'fix' before going in!

I hope this helps!! Glad to read you weren't more seriously injured!

- JP
Thanks for this info Dr. JPatkinson.

I did see my doc today. He and I knew that due to the swelling, the fluid in the left knee, and the awful pain I had when I might do various, simple, loaded or unloaded movements or motions with the left leg, he could not do a thorough examination of my left knee. He said he would do what he could to try to understand what was damaged inside. From his examination, he said I probably have an MCL injury which he thought was a rather bad one. He didn't order an MRI but said he felt it was quite important for me to be seen by an orthopedist and would arrange for me to be examined by one in a few days.

He outfitted me with a nearly full leg length, easily removable (with many velcro bands), leg immobiliser which keeps my left leg straight. He also prescribed 600 mg ibuprofen and omeprazole to protect my stomach from damage done by ibuprofen.

So soon I'll see the specialist who will tell me or find out more about my left knee internal injury.

Perhaps I'll have more news for you soon.

Thanks to all who offered help here.
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Old 05-30-08, 05:17 PM   #12
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I hope you got the plate number because all of this sounds expensive, time consuming and painful. Your next step is to get in contact with a lawyer if they start surgery. Since the police report went in your favor, you have nice lump of cash at the end of the road. Best of luck.
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