Question: Knee Injury - No Mri?

[gr8outdoors]

My son recently fell skiing (he just turned 13). He was able to finish the run and get back on the lift to do another run (we weren't at the base area and he thought he was OK). When he was on the lift with no foot rest, he said his knee really hurt and ended up sideslipping the last half of the run, then called it a day. There was no immediate swelling, bruising or limping. He thought he was almost healed and went to baseball practice 5 days later and had skipped a weekend of skiing. After running and throwing from the knees, he came home in pain and the next day was swollen, bruised and limping. I took him to the orthopedist and they did an x-ray (nothing broken) and told him no physical activity until after his next appointment, which is scheduled 2 1/2 weeks after this appointment. The diagnosis was a bruised knee. He has pain on the lower portion of the knee cap (originally he said it hurt on either side of the knee cap). Does this seem like a correct diagnosis or should an MRI have been done?

It's so difficult because I want him to heal yesterday, but I know that can't happen...

Thanks for any advice anyone may be able to provide.

 

[badger]

If your son has a history of sports activity, he is the perfect age to be developing Osteochondritis dissecans. His symptoms are very classic. However, they could just be due to the fall. Doing an MRI this early in the game might be premature. If the symptoms don't resolve within after awhile (not overnight...never happens), then I am certain your orthopedist will reevaluate your son.

 

[gr8outdoors]

Thank you Badger! I'll have to look up Osteochodritis dissecans. He has been skiing since he was 5 and is a fairly active child otherwise as well.

 

[Pequenita]

I'm assuming the orthopedist did tests on the joint (Lachman, drawer, etc.) during the exam, which ruled out the need to do an MRI.

Although, I have no idea what on earth a "bruised knee" is.

 

[jgab]

It's incredibly difficult to locate/diagnose a knee injury through just an xray. An MRI will show damage to cartilage/bone around it much more clearly, & give you a better idea on how to go about repairing/healing it. I'd ask for one, just to know.

 

[volklgirl]

I've found that without traumatic immediate and intense swelling and bruising, most Dr's won't order an MRI right away, partially due to cost and scheduling. They should do manual manipulation and ROM tests then allow a reduction in swelling for up to 4 weeks. At that point, if the pain continues or other symptoms occur, an MRI may be in order.

Any type of ligament or meniscus damage will take from 6 weeks to many months to begin to heal and symptoms to subside.

 

[litterbug]

I've found that without traumatic immediate and intense swelling and bruising, most Dr's won't order an MRI right away, partially due to cost and scheduling. They should do manual manipulation and ROM tests then allow a reduction in swelling for up to 4 weeks. At that point, if the pain continues or other symptoms occur, an MRI may be in order.

+1. If I'm right, it takes time to even schedule an MRI, so if the manual tests were hard to do because of the traumatic pain he might have just wanted to give the swelling time to resolve. Can you say RICE? I tend to say ARICE because an OTC anti-inflammatory like Advil helps move things along. Just don't let him get cocky because it relieves pain.

 

[gr8outdoors]

We were told ibuprofen and ice. He saw a physicians assistant at the orthopedic's office, which is why I wasn't confident in what was/wasn't done. My son wasn't acting like he was in a ton of pain when the PA was doing "stuff" to the knee, although my son wasn't so good about "relaxing" the knee when told to do so either. Thanks for all of the advice - I know nothing about knees.

What are ROM tests?

 

[Downunder Diva]

ROM = Range of Motion tests. The fact that your son did not relax his knee perhaps indicates a degree of guarding to protect the knee. Good luck to him and I hope it's not a serious injury. Icing does wonders BTW

 

[Leila Zucker]

Coming in to the thread late...how is your son doing? Did he heal up and get back to normal activity, or did he not improve and eventually get an MRI? If so, did the diagnosis change?

I'm an ER doc, and typically we see people after knee injuries, xray their knees, put them in an appropriate wrap or brace and send them for orthopedic follow up. We rarely if ever find out what happened afterward. I would have examined your son's knee for instability and point tenderness, and if I did not find any with a negative xray and ability to bear weight, I would not have suspected any serious injury.

MRIs are expensive and I think they prudently should only be ordered after reevaluation just as the orthopedic PA did.

I hope he has healed well and is back on the slopes/ballfield.

 

[altagirl]

I'm assuming the orthopedist did tests on the joint (Lachman, drawer, etc.) during the exam, which ruled out the need to do an MRI.

Although, I have no idea what on earth a "bruised knee" is.

I'd agree with that. If they do the normal tests for joint laxity and those didn't show any issues, an MRI would be a waste at that point. If the swelling/bruising goes away and he still is having issues with instability, lack of range of motion, catching or pain, then it's time to go see a specialist.

But I think it's with good reason that they don't order MRI's without good cause. Not only with cost, but backups for people who need them. I've heard in a lot of places you could be waiting weeks or months to get one. Doing them before you know there is reason to, just for peace of mind won't help that. Because if it's a joint injury that requires surgery, they won't operate until the swelling goes down anyway, so doing the MRI early is unnecessary. If it was a broken bone, then they might, but they'd see that on the x-ray.

Hope he is feeling better!

 

[gr8outdoors]

My son is feeling better and back to normal activities. Unfortunately the snow here didn't hold out long enough for him to get back to the slopes (on decent snow anyway - our home mountain, although open, looked pretty bare the weekend after he got the "go ahead") this season. He is back to baseball practices and gym class and is doing well.

I had no previous experience with knee injuries and that is why I was wondering if what was done was the right thing. Turns out it was!

Thank you all for your input!