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Baker's Cyst AND Patella Subluxation

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Baker's Cyst AND Patella Subluxation

Posted by
Ann on June 04, 2000 at 12:29:19:

First of all, I want to express gratitude for this site. I have learned so much why I'm having the pain I am. I have searched the Glossary, archives, etc.Everything makes sense now. My orthopoedic surgeon wouldn't expound on his answers, and he doesn't know the answers to many of my questions.

I've had patella subluxation since I was 14 (now 32). I was born with lax ligaments and shallow tracks. I couldn't ever jog or run as a teenager without one knee or the other dislocating.

During my 20's, I couldn't descend stairs without a guardrail to depend on or else my right patella would dislocate.

When I was 29 I had a lateral release on my right knee. After therapy, the knee was the best since my problems developed. I could jog a little bit without dislocation, but could never get to a run. It felt great to at least play volleyball without worrying about the knee.

I'm usually active as far as yardwork, walking, housework, errands, etc.

Suddenly at the beginning of this year, I have stiffness, sharp pains in the bone and muscle spasms (felt like stage 1 labor contractions -- build up, plateau, letdown) in the shin. It hurt to walk. When I wore a slip-on brace, my gait is worse and more painful, so I stop wearing it. It is painful to bend my knee beyond 120 degree angle.

Now I pay for doing simple yardwork.
My surgeon explained that I have a Baker's Cyst(discovered on MRI) caused by the subluxed patella (very loose sliding when bending and walking).

He gave me a wrap around brace to keep my patella aligned. Physical therapy and the brace (and let's not forget pain meds) have enabled me to appear to walk normally.

I have pain still at night when I bend my knee in my sleep. It helps if I make a makeshift ace bandage wrapped around the right side of the patella to hold it in place at night (the doctor's brace is too constricting and uncomfortable due to perspiration at night).

Your site explained to me why the slip-on brace made things worse(pressure on the cyst), the spasms in my shin (cyst pressing on the nerves).

Something positive: Every summer I swim 1/4 mile every day. I'm still able to do this as long as I keep my knee straight. But while I can do this for exercise, I'm far from being able to do my normal active activities.

The Dilemma: My surgeon won't remove just the cyst because he says it will just return. He would only remove it along with "fixing it" -- knee reconstruction surgery (moving the patella ligament and stapling it to the tibia along with tightening inside ligaments). There is a chance that my problems will worsen from the surgery.

This is major surgery. I am a stay-at-home mom attending college full-time while my children are in elementary school. It would be a 6-month recovery as well as being painful. I'm not sure it's necessary. Due to my lax ligaments, this surgery most likely will be a temporary fix.

My surgeon said to just keep wearing the knee brace, take Advil, do physical therapy at home. He told me he thinks I'll need the surgery. When the brace wears out, just call him, he'll give me another one until I decide to have the surgery.

QUESTION 1:
Can we just have the cyst removed like I was reading in your archives (sutured to prevent reoccurrence)? Is it really necessary to have the total knee reconstructive surgery?


QUESTION 2:
I was reading about the SR preventing Baker's cysts, but can it solve the one I have now without surgery?


QUESTION 3:
Another variable in the Formula: I am an HMO patient. I want a second opinion because this doctor doesn't know the answers to my questions and just offers this surgery as a trial to solve the problem. I have to have the PCP and this surgeon's recommendations and approval by the HMO director.

My next follow-up is 2 months from now. My husband suggests getting the 2nd opinion now, not after the follow-up. What do you think about this as well?



Re: Baker's Cyst AND Patella Subluxation

Posted by Paulette on June 04, 2000 at 13:48:13:

In Reply to: Baker's Cyst AND Patella Subluxation posted by Ann on June 04, 2000 at 12:29:19:

Hi, Ann

I'm not a Doctor and DR Stoll is answering a few posts as he recovers from an illness. Good to hear you've been reading through the archives and the glossary. In the glossary DR Stoll suggests some books to read. Since you're going to college, might have the opportunity to check out these books from the campus library.

As a child I could run short distances but would tire quickly and almost always come in dead last at relay events. I had hard time trying to hit a baseball and would always be last picked for teams. (wonder why?!) When I did hit the ball it would go about 10-15' in front of me and very rarely would I get to first base without being tagged OUT!

Now when I was playing around my house without pressure of competing, I could do just as much as my younger brother and then some. One of the original "Tom Boys" of the late 50's - early 60's. I did these things in order to kind of baby sit my brother for my parents who worked all day and most of the night. Needless to say the numerous times I'd fall from trees, skating, running and falling walking up flight of stairs.

There just isn't enough time or room to list the number of spills and illnesses I've had in my lifetime. (still under 50, though not for long.:-()

I was referred to this BB in middle of December of 99 after a non curable medical condition. Due to car accident about 3 1/2 years ago finally had to have my hip replaced a year ago. Fell in January of this year tearing the lateral meniscus on knee of same leg as implant. This was after my HCP session with DR Stoll middle part of January of this year. During that session I learned that I had Lifetime Total Body Bracing along with numerous other conditions effecting my major body systems.

The number one thing DR Stoll urged me to do was to learn and practice SR (skilled relaxation) 3 x daily for 20 minutes. Just about went bonkers trying to do this and finally did as he suggested and found a Rolfer. I've progressed a great deal since middle part of January and have a long road ahead of me on my wellness path. Now I actually listen to people. (bull headed on top of everything else)

I've got a wrap around brace for my knee which I wear on again off again as it slides down impeding my walking ability and sometimes causes me pain. (so I take it off) When I exercise I normally do in the pool all of my physical therapy workouts, including treading water.

The first Orthopedic Surgeon who treated me told me it was just a matter of time before I'd find it necessary to have my hip replaced. Told him at that time "Totally Unacceptable" and joined a gym to try to get into shape and diet. BTW, the Orthopedic Surgeon who did the surgery on my hip was the fourth Doctor I had consulted about my condition!

Really can't answer your questions, however, suggest you follow your husband suggestion to obtain 2nd opinion now prior to follow-up. Do as mush reading from DR Stoll's suggested books, archives and start to practice SR.

I wish I knew even just 20 years ago, what I know now from this health education BB. There's no way I'll ever be able to repay DR Stoll for all the help and information, except to get well and be an example!

Sorry to ramble, but I can kind of imagine what you're going through and wanted to stress the importance of second & third opinions, learning and doing SR daily. Hope this helps you out in some way and I wish you the best of luck. Not on BB much since transitinal point in my life since end of May, but I still tend to "lurk".:-)

Take care of yourself & your family

Paulette



Re: Baker's Cyst AND Patella Subluxation

Posted by Walt Stoll on June 05, 2000 at 11:53:19:

In Reply to: Baker's Cyst AND Patella Subluxation posted by Ann on June 04, 2000 at 12:29:19:

Hi, Ann.

Let me make comments in the order you brought them up in your note:

1. Have you ever heard the adage: "To a hammer, everything looks like a nail!"?
2. ALL of your symptoms and diagnoses are at least greatly aggravated by the condition known as "bracing". SO, the SR is the simplest and most effective thing you could do to help your long term condition.
3. I agree with your surgeon's opinion about not doing surgery at this point. Until you have eliminated some of your susceptibility factors, the problem would just recur. Since he has not a clue as to what those factors are, he can only say not to do the surgery without total reconstruction. Even with that, he knows that you have a less than 50% chance if improvement. However, since his training has nothing to do with functional causes of these conditions, he has nothing more to offer.
4. You may well have progressed to the point where surgery will be necessary. However, you do not know that until you do all the things (short of surgery) what would help. Even then, any surgery would be a lot more successful since you had dealt with the causes PRIOR to the surgery.
5. Your 1/4 mile swim is adequate exercise. Since every medium sized community now has an indoor pool and they ALL have available time for the public to do underwater exercise (the very thing you need) you now have no excuse to do this only in the summer. You need to avoid weight-bearing exercise at all costs for at least the next 2 years.
6. You need to spend the next 2 years becoming an expert in your condition so you will be in a lot better position to make the correct decision for you when the time comes.

For temporary relief, Chiropractic, Rolfing, essential fatty acids, Alexander Technique, glucosamine and acupuncture should be considered. See the glossary for any unfamiliar terms.

Hope this helps.

Walt



Re: Baker's Cyst AND Patella Subluxation (Archive under Knees.)

Posted by Walt Stoll on June 05, 2000 at 11:57:32:

In Reply to: Re: Baker's Cyst AND Patella Subluxation posted by Walt Stoll on June 05, 2000 at 11:53:19:

Forgot to archive.



Re: Baker's Cyst AND Patella Subluxation

Posted by
Ann on June 08, 2000 at 08:25:49:

In Reply to: Re: Baker's Cyst AND Patella Subluxation posted by Walt Stoll on June 05, 2000 at 11:53:19:

Thank you for answering my questions so thoroughly. I do have one more after reading your response: What is meant by underwater exercise?

I do leg lifts (30 of each leg -- abductor,adductor, front and back swings) before I swim the laps. Is that adequate?

As far as water aerobics is concerned, my kneecap is too loose and the cyst prevents me from bending my leg enough.




Re: Baker's Cyst AND Patella Subluxation

Posted by
Ann on June 08, 2000 at 08:58:34:

In Reply to: Re: Baker's Cyst AND Patella Subluxation posted by Walt Stoll on June 05, 2000 at 11:53:19:

I have another question after reading your response. You said to avoid weight-bearing exercise at all costs for 2 years.

How do I do that? That's what I was doing for physical therapy (I have had improvement with physical therapy,which also uses e-stimulation), and now at home. From what I've been told, the stronger the leg muscles (especially the VMO), the greater chance of the patella alignment.

These are leg weights wrapped around the bottom of the leg and the exercises are done on the floor. I am only up to 6 pounds at this point. The highest weight is 20 pounds, but I am certainly far from reaching that.




Re: Baker's Cyst AND Patella Subluxation

Posted by Walt Stoll on June 09, 2000 at 08:19:07:

In Reply to: Re: Baker's Cyst AND Patella Subluxation posted by Ann on June 08, 2000 at 08:58:34:

Hi, Ann.

There is a lot of difference between "weight-bearing" exercises and exercises like you have described here. Weight-bearing is when you bear weight on the limb. The exercises you have described her are among the best you can do. Under water exercises are the only thing that would be better and they are a lot more bother. You need to get to the 20# level as soon as possible.

SO, every step you take is a weight bearing exercise and you should be avoiding stairs; you should park as close to the doorway to the Mall as possible (handicap parking) while using a wheelchair for shopping, etc.

Hope this helps.

Walt



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