Gary’s Right Knee: Gary is yet to have any form of knee surgery and last saw Dr Coffey in December of 2015. He is a prison officer who experiences a number of pains around his lower back, upper right leg and right knee. This has been an ongoing condition for over a year. Gary still gets numbness and tingling in his thigh, pain in his calf and a pinching in his hamstrings. These pains cause him to toss and turn at night making it difficult to get back to sleep. After conversation, Dr Coffey isolates the thigh pain to Gary’s pre-existing ‘meralgia paresthetica’, though thinks the pains lower in the leg could be secondary symptoms of Gary’s knee issues. When asked if Gary can walk without pain he demonstrates by lifting himself out of his chair and limps before he regains his natural stride. Apparently he used to enjoy walking for recreation and to keep his weight in check but says because of the discomfort he no longer walks as often. Torn Meniscus:
After a physical examination Dr Coffey reviews the X-Ray and MRI Scan, to explain Gary’s knee cartilage has a slight tear. The position of the torn piece of cartilage means the meniscus isn’t fully functional. There is also a degree of cartilage thinning but the torn piece of cartilage catching on the roll of the knee is causing the majority of his pain. There are also degenerative changes in Gary’s back which could be causing some of the pain. But due to sciatica being unpredictable it is harder to determine. Dr Coffey then talks about Gary’s treatment. Arthroscopy: Gary’s torn cartilage makes him a candidate for an arthroscopy. This is a minimally invasive form of intervention where a thin headed arthroscope, (telescope), is inserted into a small incision on the knee. These small incisions are the keyholes of keyhole surgery. The arthroscope is then moved into the site of the source of pain within the joint. In Gary’s case the telescope would locate the torn piece of cartilage and efforts would be made to trim the loose cartilage away from the meniscus plate as a whole. The option of an arthroscopy means Gary could be in and out of hospital in a single day. Post-op Gary can walk on his knee as he feels comfortable. As for returning to work he can go back in a couple of weeks. This delay is only due to the potential physical nature of his work, (being a prison warden). Otherwise he could sit in front of his computer screen the moment he got home. The recovery process is to be taken steadily, not rushed or avoided. And when Gary does go back to work he’d need to take on lighter duties until his full strength returned. Time will tell: Before Gary leaves he asks Dr Coffey; ‘If he should have an arthroscopy now or wait?’, and; ‘if walking without having surgery would just tear his meniscus and make surgery more inevitable?’ Dr Coffey said the answer to both his questions was up to his pain: ‘If your knee is painful enough then surgery is worth thinking about, because the tear in the meniscus is not going to go away. As for activity tearing the meniscus; it’s always a possibility you could increase the damage, but not walking to avoid it happening was self-defeating.’ Dr Coffey then recommends that the wait and see approach was still open to Gary, but that any worsening of his pain would mean an arthroscopy was necessary.
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