Here’s a follow-up to the case about the twisted knee (read about it here, if you want the background):
Options for treating and working up the guy’s knee included simple stuff like rest, ice and a knee immobilizer. Additionally, my fantabulous American health care system gave me the options of providing the pt with a CT or MRI, Xray and/or referral to a orthopedic specialist. I also could have mentioned that skiing and any other sport involving coordination + velocity should be bypassed from that moment forward.
I picked R-I-C-E, first and foremost. R-est, I-ce, C-ompression and E-levation tend to cover a multitude of musculoskeletal injuries. I put a knee-immobilizer on his leg, which really does little for the joint other than force it to stay still, which leads to much less pain, which leads to less involuntary muscle flexion, which might help healing but helps the pain for sure. Finally, I prescribed clinical-strength anti-inflammatories. I did not get imaging or send him to a surgeon.
It has been about a week now, and he is doing reasonably well. It will be a long time until he forgets to think about his knee when he is doing any sport. He may never have perfect use of his knee, although I still expect a full recovery at this time.
MRI is considered the gold-standard for knee (and joint) injury. But a good physical exam by a real smart doc (jury’s out on me) is statistically just as likely to identify joint pathology. When I started med school, this ohooollldd doc gave us a lecture on the physical exam. I can see why they picked this guy for the lecture because he stood up there growling for an hour about how he could diagnose pathology just as well as these “young docs who don’t know nuthin’ except for how to order more technology.”
His dictum is less true when it comes to detecting early cancers, etc., but he is right to some extent. We use more imaging than we need to, and it contributes in a small way to the higher cost of medical care in America. This patient is recovering as fast as can be expected (that is to say, sloooww) under the circumstances. He probably wouldn’t heal any faster with surgical intervention, either. He just needs to wait it out.
And I hope he keeps skiing.