Hello everybody.
This week I’d like to introduce a
special case that might shed some more light on Vincent’s philosophy.
What Roger is going through is
extremely rare. It all started with a routine knee surgery. Everything was
going to be fine, until he got a staph infection after the surgery and was
hospitalized for 3 weeks. The damage was so severe that he couldn’t bend or
straighten his leg at all. They performed another surgery on his knee to wash
out the infection, and he was lucky to live past it.
After that surgery, he spent weeks
immobilized, resulting in an immense buildup of scar tissue. Surgery after
surgery, they tried removing the scar tissue, but it kept on building up again.
Eventually, his patellar tendon got so tight that it started to shrink. Since
it is attached to the kneecap, it dragged the kneecap down the more it shrunk.
When his kneecap moved down a couple of inches, it only made him even more
immobile.
There were no experts in Arizona
that knew how to deal with his problem, so he ended up travelling to the
Steadman Clinic in Colorado to see an arthrofibrosis expert. After another
surgery trying to remove the scar tissue, an orthopedic surgeon at the clinic
decided to remove the patellar tendon and cut it out completely, which is what
is so unique.
In recovery, his kneecap moved back
to its normal position. However, without a patellar tendon, he has instability
in his knee, and there is no longer a tendon protecting his ACL, which happens
to be reconstructed from an incident he had 20 years ago. He came to Synergy
with an active range of 90 degrees flexion, meaning he couldn’t bend his knee
past that angle. His leg muscles, particularly his hamstrings and calves, were
so weak from atrophy that he couldn’t carry any weight on that leg.
Furthermore, he came at serious risk of injuring his ACL. Vincent was able to
break down enough scar tissue to where he can now flex at 130 degrees and
extend to around 5 degrees, almost completely flat.
Looking forward, he will need a
procedure involving the injection of carbon dioxide and saline to inflate the
joint and avoid traumatizing it. Then they will put in a graft that will
perform as a patellar tendon, protecting the knee and allowing him to move
freely. The surgeries will cause him to lose his active range, and he will get
weak again. But at least he is now able to have that surgery, and he is
prepared for the long journey ahead. The graft will affect not only his active
range (how far his muscles can move the joint) but also his passive range (how
far the joint can be moved by someone else). And even though he will never
fully return to his state years ago, we can help him get his life back
together.
It's so wonderful how much physical therapy can help someone out, and it's so important to keep in mind that surgery and therapy work hand in hand. Could you by any chance post some diagrams of the regions which you mention in your post? It would make it a bit easier to visualize, though I think I get it to an extent.
ReplyDeleteGreat point Daria! I should have those posted shortly.
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ReplyDeleteHow's it going Zack? BASIS Flagstaff here.
ReplyDeleteI was looking at a couple of blogs on Scottsdale in my free-time (boss let us out early today) and I came across yours
From the looks of it, it sounds like you're really busy, so if you get a chance, I have some questions for you.
For Roger, have you any knowledge of any follow-up treatment? You said that he won't return to his previous condition, but what are some of the physical therapies that might 'help' him?
-Josh
Hey Josh! Thanks for your interest!
DeleteFor now, we have to build the strength back in the muscles that suffered from atrophy from all the surgeries. He is slowly beginning to be able to pull his leg back and forth, and recently has begun to walk somewhat normally. We strengthened his hamstrings and calves with cycling and squats, and developed neuromuscular pathways for bending the knee by making him actively bend it over and over again, but with us monitoring to make sure he doesn't compensate with hip rotation, which would cause a limp.
When he goes in for his upcoming surgeries, he will suffer a setback, but at least have a foundation to build upon.
Zach, thank you for the reply. You mentioned that Roger might not fully recover or revert to his previous degree of fitness.
DeleteHow concrete is that? As in, since you are continually training his muscles, can he build back his original muscular strength?
Well the limitations that are concrete are going to be the graft and the support system around it. So its mechanical. But he will still be able to walk and run, as those activities don't require too much bend. I appreciate your interest in my blog! Hope you enjoy Josh.
DeleteHi Zach....this was a fascinating and really sad story of an operation gone bad. It is fortunate that Vincent was able to help this person. If you were to enter into this field, I wouldn't be surprised if you never encounter a case similar to this. This certainly was an example of whatever could go wrong did go wrong. He is indeed fortunate not to have lost a leg due to the infection.
ReplyDeleteHearing the specifics of such a unique case is really interesting. Thanks for sharing, Zach! I agree with Daria about seeing a diagram of some sort, although your description was quite thorough. I would imagine the knee is a rather tricky area to treat with physical therapy. Are there any other areas of the body that you see need to be treated more or with different approaches?
ReplyDeleteWell all the main joints, like the elbow, shoulder, hip, and ankle that do a lot of work throughout the day are the trickiest. The hardest cases are when surgeries fix one problem but create another.
DeleteZach, physical therapy is quite a journey for both the patient and clinician it seems, one set back creates obstacles for the patient as well as the clinicians. This truly isn't a typical case and I imagine talking to they surgeons office would help keep the train going in the right directions. Do you think in a situation like this having a close relationship with the surgeon would help keep the treatment cohesive? Keep up the good work. I look forward to your next post.
ReplyDeleteThanks Emily! I actually imagine that they usually counteract each other, especially since surgeons tend to favor surgery and therapists try to avoid it. But I think they have to have a relationship for exchanging information about the patient. I truly believe that the patient will react more favorably to what they decide after seeing both experts.
DeleteThat is quite the story Zach! It must be heartening to know that you, as a physical therapist, are capable of putting a person's livelihood back on track. Do you happen to know what exact physical therapy Roger will undergo to repair his leg?
ReplyDeleteThanks Alfred.
DeleteYes. Basically, we are building up his hamstrings and calves through isolated exercises, like repeatedly flexing his leg as far as he can. These muscles suffered from atrophy so much that they are the first obstacles to the next surgery.