Tuesday, September 3, 2013

Thoughts on Orthopedics and Knee Joint Injuries


  As a registered nurse, especially when the kids were small, I used to get top pay in the hospital for rotating to a variety of specialties.  Critical Care (Intensive Care) is my specialty, but it can be hard to get away at the end of eight to twelve hours, if you needed to pick up kids. When the kids were first starting public school (yes, before we homeschooled), and so I was one of the few nurses who absolutely liked to rotate as a fill- in to a variety of specialties. This included pediatrics, pediatrics special care, labor and delivery, post-partum, post partum recovery, recovery room, a variety of critical care units, same day surgery, emergency room,  urology, endocrinology,  and some others.  Despite the uncommon flexibility I was known for in those years, there were hospital specialties I don't like much, and in which I am limited.  For example, I am not a big fan of orthopedics.  My dislike of orthopedics dates back to nursing school when we were required to set up different types of traction. If it isn't correct, this is not only painful for your patient but it can be devastating to his healing.  I didn't much like the pin care either. Metal pins which went through the skin anchored the patient to some types of traction.
         I also had patients on Stryker frames and on Circ-o-electric beds, which allow the patient to be turned around in any position in order to provide his care without actually really moving him. There is a trap door in the back which allows for care to the backside.

The is a Cir-0-electric bed.

           This is a really important specialty and the nurses who develop these skills really should be admired but alas, I am not one of them.  Two of my five children broke limbs while they were growing up.  My daughter slipped while wearing tights on the oak staircase and fractured her elbow. One of my sons got a comminuted fracture of his arm when another son took him ice skating for the first time. It was all I could do each of those days not to run from the room screaming.   I don't like orthopedics and so I quickly send those with orthopedic injuries to a physician or the hospital, so long as that is away from me.
           I have been lucky to have avoided these types of injuries myself.  Recently though, the amount of work I have been doing has increased greatly. The four horses I own now take a lot of lifting, mucking, and activity.  We have had eight inches more rain than is normal in Virginia, and some of the pastures are muddy when they are mucked.  This seems to result in a twisting motion for my right knee. At first, it seemed simply stiff, and then a little swollen.  It seems that working on uneven rolling ground allows the knee to depend heavily on the medial and lateral ligaments of the knee.  I needed to prevent so much side to side motion and twisting while I worked.  I started out with a large ace bandage around the right knee for added support prior to mucking.  This helps a bit, but there is still burning on the interior aspect of the knee (the medial collateral ligament) when I am finished. I am considering a knee splint to wear just when I am working with the horses. Did I mention I dislike orthopedics intensely ? 

As anyone with a ski injury to their knee will tell you, this is one of the body parts God could have considered just a bit longer.

          For the purpose of redeeming this post as an educational one, and not simply one of my musings, I  should mention a bit about Knee Ligament Injuries:

An ACL injury -- or other ligament injury -- is sometimes hard to diagnose. Symptoms of a knee ligament injury are:
  • Pain, often sudden and severe
  • A loud pop or snap during the injury
  • Swelling
  • A feeling of looseness in the joint
  • Inability to put weight on the point without pain
If they're not treated at the time, ACL injuries and other types of ligament injuries may act up months or years later.

         An orthopedic surgeon will do a physical exam, possibly an x-ray, and sometimes a CT scan or an MRI.  Treatment can range from splinting to needle extraction of blood within the knee, and sometimes surgery.

       The things you can do to avoid the more sweeping treatments above is to stay off the affected knee to allow it to heal following a known injury.  Ice the knee for the first 24 hours, 20 mins on and 20 mins off.   Taking NSAIDs, or ibuprofen does not only address pain, but is necessary for the inflammation which occurs within these ligaments. It's better to take a low dose repeatedly over time, for this injury, than it is to take a large dose when you are writhing. Check with your doctor if you have stomach or gastrointestinal issues, bleeding disorders, or any reason not to take NSAIDs.   Elevate the knee while you are sitting.  Invest in a knee brace which prevents additional injuries while the ligaments are healing.

Really easy to use. It doesn't stink and you can keep it off your hands.

        I'm doing all of that plus painting the region that hurts with the new Ben-Gay that lives in the freezer. It's called Ben-Gay Zero Degrees.   It's hard to find, but really good stuff.    Also, make sure that if you have a knee injury you are wearing good shoes that keep you sure-footed.   Sandals and high heels are not only tough on ankles, but they can be tough on knees and make women in particular prone to reinjury.
       Now that I think about it, all of my grandparents had knee issues following injuries at one time or another.

No one is paying me to say this.  This stuff is great.


Sunnybrook Farm said...

You may not like orthopedics but at least you know how things work and can visualize what the problem is. I think I told you how my mother was a nurse back in the old days, she remembered all of that stuff from training and people would get her to explain what the doctor was saying in country English. Her father was a butcher so he could help out if she wasn't there. But seriously in a survival situation, it would be real good to at least explain things even if they couldn't be fixed right then.

JaneofVirginia said...

In a survival situation, it would be essential to stabilize the patient, splint the injury and stay off it as much as possible. A great many injuries will heal by themselves if they are in alignment and we allow them the time to heal. I don't think we can like every medical or surgical specialty, but we all still have to be proficient enough to function out there. Thanks for posting.

Sandy said...


I'm with you I don't like orthopedics. I've been to see one for my lower back and hips. I was having severe pain in my hips (specifically the left one. Doctor took several x-rays, determined I have arthritis in both hips, a bone spur (on left) and a bursa problem. He also diagnosed me with arthritis in my lower back. I've been through physical therapy (weeks), ice packs, and given a TENS unit to use. Besides stretching, exercising, ice and using the TENS do you have any other suggestions on what to do?

JaneofVirginia said...

My father had incredible improvement for similar symptoms using Glucosamine and Chondroitin which he bought in a large container, and followed the package directions on, which came from Sam's Club. I know they still have it because I use it on my elderly dogs. It takes three weeks to see any difference, but it theoretically increases the synovial fluid we make which is a "lubricant" of sorts. For women, at 50 a physician should draw blood for a Vitamin D level, and this should be replaced if the level is too low. Many of them also put their patients on Calcium Citrate 1200 mg/day. These are simple things, but I have seen them make a difference for many people.

K said...

RICE [Rest,Ice,Compression, and Elevation] will do wonders for a joint injury.

Improving the muscle tone around the knees will also improve the discomfort of the joint, along with the dreaded diet and exercise routine. These are just a few of my late night ramblings. Good night all....

Linda said...

Glucosamine Chondroitan with MSM helped me in three days to overcome pain I had in my knee for ten years. I was a skeptic when I took it, so it could not have been the placebo effect.

I asked you on my blog what to give a chicken for a cough. Could you tell me on my blog. She is still coughing a bit. Thanks.

JaneofVirginia said...

Thanks K., Yes, one of the reasons this injury has occurred is that the amount of work I have required it to do increased faster than the muscle tone on both sides of the joint. My diet and exercise routine are excellent. I think it needs to be protected from furthur injury while it heals. Thanks for your post !

BBC said...

Years ago I tried to shove my leg up my butt with a dirt bike and had a trick knee for years, then slipped on some ice one day and had a piece of crap. A doctor in Montana did a good job of fixing it.

JaneofVirginia said...

Linda, I am glad this helped you. There is data that glucosamine and chondroitin are effective for many types of joint issues. My vet puts all my dogs on it after age 8, and none of them have joint issues later. I do not yet use the MSM and need to research that better.
I will look up the chicken coughing issue and repost on your blog.

JaneofVirginia said...

Glad you're ok now. I can't see Obamacare being particularly good at allocating for orthopedics.

Sandy said...

Thanks Jane. I will see about increasing my vitamin D and calcium.

Hubby uses Glucosamine and Chondroitin MSM in liquid form. The problem, he doesn't drink it every day.

JaneofVirginia said...

Check with your doctor before supplementing Vit D and calcium. It is the right thing to do for a large majority of adult women, but every once in awhile there is someone with kidney stones which may be calcium based and the doctor will need to provide special guidelines. For most women, it's safe and beneficial.
I am told consistency with the Glucosamine is important. I'll let you know. I started taking it myself about a week ago. The one I chose is the full dose in one tablet, but it's large and tough to swallow.