Lets discuss Bateluer's knee

[SociallyChallenged]

For patellofemoral pain, an MRI is not the most useful thing. If you had a torn meniscus, then sure. But you'd see the same decrease in joint space on the MRI as x-ray for the patellofemoral joint. Even if you don't do the MRI, the orthopedic surgeon will almost 100% grant you a prescription for PT if you request it. Give the office a call. They'll get you a scrip.

 

[alkemyst]

Well, put it this way. If I was able to have my MRI w/ contrast (Arthogram) two years ago, they would have identified the torn labrum and skipped the PT and anti-inflammatories that only helped the symptoms short-term.

If one even has to come out of pocket, it's $2,000 well spent.

Personally, if anyone knows much about exercise; they can do most of a traditional PT cycle themselves.

 

[SociallyChallenged]

Well, put it this way. If I was able to have my MRI w/ contrast (Arthogram) two years ago, they would have identified the torn labrum and skipped the PT and anti-inflammatories that only helped the symptoms short-term.

If one even has to come out of pocket, it's $2,000 well spent.

Personally, if anyone knows much about exercise; they can do most of a traditional PT cycle themselves.

A shoulder is a very different obstacle than the patellofemoral joint. If the ortho suspected meniscus damage, hemarthrosis, tumor, whatever, the MRI would be the way to go. However, the patellofemoral joint doesn't have any of this. It has articular cartilage and possible plicae (that aren't even well viewed in MRI, I don't believe). It's a completely different structure. For the shoulder, there's a TON of stuff that can't be visualized on x-ray that can be on MRI - labrum, muscles, tendons, capsule, etc. The PFJ is a little bit more limited in structures.

The issue with PFJ is that it isn't solely an exercise treatment. It should be (ideally) a lot of hands on. Patellar maltracking can be caused by having weak hip external rotators and abductors (which someone can exercise), but it can also be due to tightness of the lateral structures of the knee. That tightness requires soft tissue work, joint mobes, etc. We also assess for patellar deformities and femoral deformities that may be contributing so we can estimate the potential effectiveness of PT. PTs don't (or shouldn't) just do exercise. And there's a lot of research on given exercises directed toward activating certain patterns, muscles, etc that people don't realize. Status post labrum repair, I understand why you have that viewpoint because most of PT is just getting back into moving and strengthening yourself. With a chronic issue like patellofemoral dysfunction, there's a lot more that has to change.

 

[Bateluer]

A shoulder is a very different obstacle than the patellofemoral joint. If the ortho suspected meniscus damage, hemarthrosis, tumor, whatever, the MRI would be the way to go. However, the patellofemoral joint doesn't have any of this. It has articular cartilage and possible plicae (that aren't even well viewed in MRI, I don't believe). It's a completely different structure. For the shoulder, there's a TON of stuff that can't be visualized on x-ray that can be on MRI - labrum, muscles, tendons, capsule, etc. The PFJ is a little bit more limited in structures.

The issue with PFJ is that it isn't solely an exercise treatment. It should be (ideally) a lot of hands on. Patellar maltracking can be caused by having weak hip external rotators and abductors (which someone can exercise), but it can also be due to tightness of the lateral structures of the knee. That tightness requires soft tissue work, joint mobes, etc. We also assess for patellar deformities and femoral deformities that may be contributing so we can estimate the potential effectiveness of PT. PTs don't (or shouldn't) just do exercise. And there's a lot of research on given exercises directed toward activating certain patterns, muscles, etc that people don't realize. Status post labrum repair, I understand why you have that viewpoint because most of PT is just getting back into moving and strengthening yourself. With a chronic issue like patellofemoral dysfunction, there's a lot more that has to change.

Would PFJ and Plicae also have a lot of knee joint cracking when I crouch and rise?

An MRI would run me about 200 bucks, after insurance. But if it likely won't show anything related to the PF, then I'd rather not drop the money.

I've also gotten some swelling, inflammation, or tendinitis on the tops of my feet, just above the big toe. That started in early August, after a number of hot yoga sessions. And didn't go away after 3 weeks of abstaining. Bah. I have a heavy racing schedule this fall/winter.

 

[SociallyChallenged]

Would PFJ and Plicae also have a lot of knee joint cracking when I crouch and rise?

An MRI would run me about 200 bucks, after insurance. But if it likely won't show anything related to the PF, then I'd rather not drop the money.

I've also gotten some swelling, inflammation, or tendinitis on the tops of my feet, just above the big toe. That started in early August, after a number of hot yoga sessions. And didn't go away after 3 weeks of abstaining. Bah. I have a heavy racing schedule this fall/winter.

Patellofemoral dysfunction is probably the most common cause of "knee popping" with any knee movement. Like I said, if the doc too suspect patellofemoral joint dysfunction, then it's not really worth your while to get the MRI. It just won't show much, other than inflammation and fluid stasis.