Knee Replacement...Now Shoulder Surgery

[WV Sawmiller]

   Good to hear. If you lose that stick I bet I can find some folks to make you a new one. :D

[Nebraska]

Sounds really good, making great progress, I probably shouldn't suggest this.... but sounds to me like you could  about go do your pt workout in a deer blind if your seasons still going. ;)  Especially if you can drive a stick and shop at walmart.

[Magicman]

I have plenty of time if/when I decide to go because our deer season extends until the end of January. 

There are some scheduling issues so I will have another PT session this morning at 11:00, and then not have another until Friday afternoon.  I believe that most of my progress goes to my PT homework and then the test comes when I go to the PT gym. 

I don't want my knee's future to be determined by what I fail to do now.  I want success.

[kantuckid]

Dr. said that I would walk that day and be discharged the next.  If I waited until next year it would be outpatient, no overnight stay.  

The fastest option to fix both the knee and the shoulder was to do the knee first.  Crazy thing is that the knee doesn't hurt....but the shoulder does.  :

I am just picking up on your "medical thread". I see your knee is coming along well. Per your shoulder- Of course we are each unique but my 76 year old left shoulder had a full tear from a number of sources-age, osteo, and years as an athlete then much labor of various sorts. I do strongly think that mine had several "self-heals as they are called and actually quite common too. probably the 1st time was in 1959 as a HS wrestler, 2nd as a college football player. My doc tried the cortisone shot but no result. In 11/2014 he sewed the rotator cuff back together along with 4 titanium screws in a SQ pattern, think of a SQ box with a titanium cable strung to each corner and with an "X" in the center too. It took much PT and months of hard effort to get to full overhead reach. I don't say that lightly either, I really had to work hard! I did experience the difference in the hands on provided by certain physical therapists vs. some others who seemed crude and of little help. Reminded me of an old time chiropractor I once knew who had the same "magic hands".
I also had two, anterior hip replacements via a different doc (who does anterior & posterior hips) and now seeing that doc as he does knees as well. With THR's my doc has you walk & climb steps,, same day, then if an early surgery your home that same day.
Knee, I've had 3 cortisone shots which do help ( been living regular lifestyle, bicycles, sawmill, shop and farm work) but wanting another sooner, not later! but my next appt.is 1/13/20 and with the doc, not the PA who gives the shots. Osteo made medicare not able to do a cleanup surgery as they 1st had hoped. I now have meniscus tears on both sides of that knee and pains tolerable but it lacks the strength I've had in my active lifestyle up to now. I wear an elastic sleeve which makes it feel more stable.
It is generally said that the shoulder and the knees are the tougher joints to PT- I will say that I saw partial tear people recover much faster than my full tear, like several months overall.
Knees I've heard everything from horrible joint replacement experience to glad I finally got it done. Keep up the hard work and play come spring...

[Magicman]

I thought that my PT session this morning went well.  My flexion improved from 127° to 129°, and the extension from 2° to 1°.  Not much but I think that these final numbers will be slow to attain.  She is now adding weights to the various exercises which I told her was cheating.  She has also added some different exercises and I expect that there will be even more.  I will be on my own with homework for the next two days.

Too DanG cold to do anything but add another stick on wood on the fire anyway.  

[alan gage]

the extension from 2° to 1°. Not much

It's not much in terms of degrees but it's substantial if you think of it as percentage gained. Same percentage as going from 10* to 5*.

Alan

[Magicman]

That plus loosing that last 1° puts me at 0° which is what the other leg measures and is a completely straight leg.

[Ed_K]

 You are really lucky to have a great PT. My neighbor had a hip replacement last summer the PT came and when he complained of the pain she told him to sit in the recliner and it would be ok  >:(. He can barely walk and can't stand straight up. I feel sorry for him but it was his choice.

[kantuckid]

With my first hip replacement I did PT in a large room in a nearby town. It was interesting to observe how various people of all ages and physical conditions dealt with PT. The HS kids, of course were not there long and gone before you know it. Those people carry lots of weight (I'm trying to be kind here) stumbled through even the most mundane PT, I felt sorry for them just watching.
Living rural, there are no PT people who come to the homes. It's drive to PT or nothing.
My 95 yr old MIL, a home stay, alzheimers person, gets meager at home PT in her area via Medicare as the rules don't allow enough PT to do her any good, sad but true.
The out patient PT medicare cap has been removed in 2019 from what I just googled.

[Magicman]

Today was PT day again.  My flexion (bending) improved from 129° to 134°. She said that 125° is considered OK after knee replacement so I am good to go in that category.  My extension (straightening) improved from 1° to less than 1° but it is not 0° so I have to continue with the misery of straightening and stretching that knee back.  Of course my PT homework also includes flexion so everything gets a workout at least twice daily.  She did fuss at me a bit about walking without the stick.   :

Due to Christmas, I will only get two PT sessions next week; Tuesday & Friday.

[Poquo]

Glad to hear your progressing well . I used to call PT the Torture Chamber but they do a great job making broke things work again .

[doctorb]

Magic-

Once again I'm chuckling at your recovery, which is truly going great.  There's an adage in orthopaedics that "you can't see 5 degrees."  Let me explain.  

Of course you can "see" 5 degrees difference in angulation from one thing to another.  But when you are measuring a person's range of motion (ROM), you place a goniometer (kind of a clockface device with hands/arms like two identical minute hands) that can measure angles at joints.  You place these "hands" parallel to the bones on each side of a joint, and the angle is easily measured.  The problem is accuracy.  Placing the goniometer arms exactLy parallel to the bone, which you can't see because of skin and muscle, is really an educated estimate, a SWAG!   So measuring down to 2 degrees one day and then 1 degree the next, sounds like a slight improvement, and it may be, but we can't be sure.

The important and overwhelming good news is the trend over days and weeks.  You obviously have gained back much of your extension and now you'll work for the very last bit.  Your flexion is great and will improve as well.  So don't focus on the day to day number, just look at your knee and say "it's better than last week and will be even better the next".

[Jeff]

That is exactly what this non doctor told him yesterday!  That the one% was probably wrinkles!

[Magicman]

I certainly agree because I watch them align their goniometer gizzmometer each time and realize that they are only doing their best to align it with my bones.  I can certainly tell that I have made good flexion progress because I can bend my knee back further, and extension progress because I can now feel the bed beneath my knee at night.  There is still some swelling which is also affecting my ROM.  I am doing two home PT sessions each day that take about an hour, so I have had no mercy on the knee.  I am pulling back (flexion) as hard as I can physically pull with no regard to pain, and the extension exercise is pure misery.

Wrinkles or no wrinkles, I am expecting to be discharged from my in-office PT this week.

[thecfarm]

Just like the Doctor told Brenda,you can't harm the knee,work it!!! Sounds good. There was a certain degree that they was looking for. Good enough to do stairs they said. You must be way past that now.

[Magicman]

I had a different PT this morning who read 135° on my flexion and still less than 1° on my extension but he pushed down on my knee and got 0°. I still have a ways to go yet with the extension.  He looked and saw where the Surgeon ordered 20 PT visits, so I still have a couple more weeks to go.  Still gotta strengthen those thigh muscles and stretch whatever it is behind the knee which is the hurting part.   :-\   Also, I have been sorta lax about icing the knee after my homework PT.   :

I can walk fine without the walking stick but they still want me to use it, saying that it forces me to straighten my knee when walking.

[doctorb]

Magic-

Between PT efforts, when you're lust lazin' around, put your leg up straight in front of you. like sitting on a couch and putting your leg up on a coffee table.  Keep your toes pointed straight toward the ceiling.  Place a pillow under the ankle and a few inches of the calf (Achilles tendon area) only, so the rest of the calf, the back of the knee, and the distal thigh are unsupported.  Let gravity work for you while you're reading or watching TV.  Just let the leg sag into extension.  You can periodically do quad sets in this position as an isometric exercise to strengthen them as well.  Using your quad in this position also straightens the knee.  Further, use a device (like a PT loop, an Ace bandage, or even a towel) to dorsiflex your ankle while in this position (pull the toes toward your nose).  The Gastrocnemius muscle also crosses the knee joint and needs to also be stretched.

If all else fails, have someone sit on the knee.   Just kidding!  That's a joke ;D,......but placing a little pressure onto the anterior knee is just fine.  Some patients use the weight of the ice bag to help gain knee extension in this position.

Merry Christmas.

Doctorb

[chet]

Doc you musta been a terrapist in an earlier life.  ;D

[Magicman]

doctorb, every item that you listed is exactly what I am doing, all except the "sitting" thing. 

[Old Greenhorn]

Magic-

[clipped]

If all else fails, have someone sit on the knee.   Just kidding!  That's a joke ;D,......but placing a little pressure onto the anterior knee is just fine.  Some patients use the weight of the ice bag to help gain knee extension in this position.

Merry Christmas.

Doctorb

I have been following right along with MM's progress and watching his growth daily, but when I read that sentence above my butt and my abdomen both tensed into a knot instantaneously. I stopped reading and read the sentence again... twice. Only then did I read on a little further ;D. You had me going for just a long second there Doc, you got me good. Holy cow, if you could have seen what was going through my head in that split second. Yeah, you got me good.

[doctorb]

As long as Magic didn't take it literally, I'm good with that.  Glad I could increase your pulse rate for a few seconds.  Have a great Christmas!

[Magicman]

Some of the exercises that doctorb described above:


 
Extended leg supported by a folded pillow under my foot.


 
Then add a couple of pounds of weights.


 
And then to add additional misery, hang the "ice bag" containing 4 frozen 20oz water bottles over the unsupported knee.  After 15 minutes of this something has to have some relief. 

I am doing this plus the belt stretches plus the thigh tension and leg lifts several times each day.  My hope is that all of this pain is paid back with no pain after this thing heals.

[WV Sawmiller]

   Boy am I glad you posted that second picture with a clearer picture of your foot and sock. From the first one I was afraid you had leprosy or something in your foot. :D :D

[GAB]

Mr. Davis SIR:
You have my permission to back off on therapy today and enjoy the day.
Wishing you and every one else the bestest Christmas ever.
Gerald

[Magicman]

I am continuing to improve but very slowly now.  My flexion improved today from 135° to 137° and my extension is still below 1° but not to 0° yet.  The PT lady is still telling me that I ain't normal.  That most knee replacement patients struggle to get to 125° flexion.

All of my PT is now geared toward building and strengthening muscle not toward Range of Motion.