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Knee reinjury in physical therapy

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scott knighton

Junior Member
Do I have a malpractice case? What should I do?

I am from the state of Alabama. In June 2006, I hurt my Left Knee. I went to the Doctor. He performed a MRI on my Knee. He told me he needed to perform, “a Knee Scope on my knee because I have some broken cartilages in my Knee”. I said, “no problem”. The surgery was performed on July 18th at 0800am. The 18th and part of 19th my knee hurt. My Knee stopped hurt the 19th and was feeling fine with normal range of motion with no problem. I am a firefighter, LPN nurse and a paramedic, By the 23rd of July, I told the fire department by early August if it ok with the doctor I might be able to come back to work. On the 24, I went back to the doctor and he told me I might be able to go back to work that time. He said I needed,” to start some Physical therapy”. And for me to go across the hall and set up an appointment with the therapist. The therapist got me in his therapy room. He explained the exercises that I needed to performed at my home.
He set up an appointment for the 26th a Wednesday to perform Physical therapy. I came for my appointment. The morning of the 26th my knee was feeling fine with no pain or swelling. His assistant made me executed an exercise which causes me to suffer severe pain. I broke out in hot flashes, started to sweat profusely even in an air conditioner environment. My knee swells up to a basketball. I was bed ridding for a weekend. Now, August 29th I can not walk without crutches a month later.
Back to July the 28th a Friday, I confronted the Therapist with a memo with what happen to me. I was on my crutches. He told me that he,” does not tell me how to fight fires and do not tell him how to do Physical Therapy.” On the 27th, the doctor was told by me that my leg is in pain and by the Physical therapist told him also.
I scheduled an appointment with the doctor for Monday July the 31 and gave him the same memo I gave the Physical therapist and show him the exercise the therapist wanted me to perform. Which I will explain the Exercise later in this posting. The doctor told me that he, “do not think that the exercise reinjury my knee”. I asked him,” do you think I need another MRI.” He said, “it will not show anything different. Just make another appointment in 5 to 7 days with me” I said, “is there anything you can do now? Can you give me a Corticosteroid shot?” The doctor said that he “can give me a corticosteroid shot and drew some fluid out of my knee”. This was the first he looked at my knee that appointment. He withdrawn some fluid and said to me, “your knee is infected and we need to admit you into the Hospital” I was admitted for 3 days and gave me around of antibiotics. My control infection doctor put a peg line in my arm. And they are having a home health care nurse coming to my home. She is monitoring me and giving my home IV antibiotics. This is where I am now.

The exercise that I did on the 26th of July was “side steps with constricting rubber band around both of my ankles. The Physical Therapist wanted me to go 8 to 10 feet one way then back to my original point 4 times I only did the exercise 3 times because it became painful. ” After I did this exercise I was in severely in pain and could not walk. All the exercise that the therapist could have me perform, she had to choice this one- just a week out of surgery. Side stepping without a constricting rubber band would have been a challenge and lot better then with a constricting rubber band. I can’t believe that exercise was any good for a injure knees.
 


pattimelt

Member
I am NOT a lawyer NOR a doctor

but if you have an infection in your knee, it is NOT because of Physical Therapy. Especially that exercise. Physical Therapy would not cause an infection.

I have had my knee scoped 4 times, and I have performed that exercise so much I could do it in my sleep(and probably have).

If you've read anything about Barry Bonds, they did a scope on him, and then he got an infection in his knee, too. It's NOT because of therapy, but it does happen to SOME people. Barry Bonds was on IV antibiotics, etc, too, so you're in good company.
 

lealea1005

Senior Member
Physical Therapy strengthening/stabilizing exercises are appropriate for knee surgeries. They do not cause osteomyelitis (or any other infection), it was undoubtedly already brewing but hadn't presented itself. As I'm sure you know, from being an LPN, infection is a risk of the surgery and could have been caused by a multitude of reasons. Risk of infection was probably indicated on the informed consent you signed before having the surgery.

Swelling and pain at the surgical site is not totally abnormal post-op.

Once the infection presented itself, your Orthopedic doc acted appropriately and swiftly to admit you for IV antibiotics and now you are being followed by an Infectious Disease specialist and home monitoring....all appropriate and within the standard of care.

I hope you continue to heal well and you're back to work soon, but remember recovering from an osteo, not to mention your surgery itself, takes time. In the meantime, have you looked into FMLA?

Good luck!
 

panzertanker

Senior Member
scott knighton said:
Do I have a malpractice case? What should I do?

I am from the state of Alabama. In June 2006, I hurt my Left Knee. I went to the Doctor. He performed a MRI on my Knee. He told me he needed to perform, “a Knee Scope on my knee because I have some broken cartilages in my Knee”. I said, “no problem”. The surgery was performed on July 18th at 0800am. The 18th and part of 19th my knee hurt. My Knee stopped hurt the 19th and was feeling fine with normal range of motion with no problem. I am a firefighter, LPN nurse and a paramedic, By the 23rd of July, I told the fire department by early August if it ok with the doctor I might be able to come back to work. On the 24, I went back to the doctor and he told me I might be able to go back to work that time. He said I needed,” to start some Physical therapy”. And for me to go across the hall and set up an appointment with the therapist. The therapist got me in his therapy room. He explained the exercises that I needed to performed at my home.
He set up an appointment for the 26th a Wednesday to perform Physical therapy. I came for my appointment. The morning of the 26th my knee was feeling fine with no pain or swelling. His assistant made me executed an exercise which causes me to suffer severe pain. I broke out in hot flashes, started to sweat profusely even in an air conditioner environment. My knee swells up to a basketball. I was bed ridding for a weekend. Now, August 29th I can not walk without crutches a month later.
Back to July the 28th a Friday, I confronted the Therapist with a memo with what happen to me. I was on my crutches. He told me that he,” does not tell me how to fight fires and do not tell him how to do Physical Therapy.” On the 27th, the doctor was told by me that my leg is in pain and by the Physical therapist told him also.
I scheduled an appointment with the doctor for Monday July the 31 and gave him the same memo I gave the Physical therapist and show him the exercise the therapist wanted me to perform. Which I will explain the Exercise later in this posting. The doctor told me that he, “do not think that the exercise reinjury my knee”. I asked him,” do you think I need another MRI.” He said, “it will not show anything different. Just make another appointment in 5 to 7 days with me” I said, “is there anything you can do now? Can you give me a Corticosteroid shot?” The doctor said that he “can give me a corticosteroid shot and drew some fluid out of my knee”. This was the first he looked at my knee that appointment. He withdrawn some fluid and said to me, “your knee is infected and we need to admit you into the Hospital” I was admitted for 3 days and gave me around of antibiotics. My control infection doctor put a peg line in my arm. And they are having a home health care nurse coming to my home. She is monitoring me and giving my home IV antibiotics. This is where I am now.

The exercise that I did on the 26th of July was “side steps with constricting rubber band around both of my ankles. The Physical Therapist wanted me to go 8 to 10 feet one way then back to my original point 4 times I only did the exercise 3 times because it became painful. ” After I did this exercise I was in severely in pain and could not walk. All the exercise that the therapist could have me perform, she had to choice this one- just a week out of surgery. Side stepping without a constricting rubber band would have been a challenge and lot better then with a constricting rubber band. I can’t believe that exercise was any good for a injure knees.
Did you have a legal question?
What you have described, while painful and problematic, is a possible risk associated with surgery. PT did NOT cause septic arthralgia.
 

ellencee

Senior Member
scott knighton said:
Do I have a malpractice case? What should I do?

I am from the state of Alabama. In June 2006, I hurt my Left Knee. I went to the Doctor. He performed a MRI on my Knee. He told me he needed to perform, _a Knee Scope on my knee because I have some broken cartilages in my Knee_. I said, _no problem_. The surgery was performed on July 18th at 0800am. The 18th and part of 19th my knee hurt. My Knee stopped hurt the 19th and was feeling fine with normal range of motion with no problem. I am a firefighter, LPN nurse and a paramedic, By the 23rd of July, I told the fire department by early August if it ok with the doctor I might be able to come back to work. On the 24, I went back to the doctor and he told me I might be able to go back to work that time. He said I needed,_ to start some Physical therapy_. And for me to go across the hall and set up an appointment with the therapist. The therapist got me in his therapy room. He explained the exercises that I needed to performed at my home.
He set up an appointment for the 26th a Wednesday to perform Physical therapy. I came for my appointment. The morning of the 26th my knee was feeling fine with no pain or swelling. His assistant made me executed an exercise which causes me to suffer severe pain. I broke out in hot flashes, started to sweat profusely even in an air conditioner environment. My knee swells up to a basketball. I was bed ridding for a weekend. Now, August 29th I can not walk without crutches a month later.
Back to July the 28th a Friday, I confronted the Therapist with a memo with what happen to me. I was on my crutches. He told me that he,_ does not tell me how to fight fires and do not tell him how to do Physical Therapy._ On the 27th, the doctor was told by me that my leg is in pain and by the Physical therapist told him also.
I scheduled an appointment with the doctor for Monday July the 31 and gave him the same memo I gave the Physical therapist and show him the exercise the therapist wanted me to perform. Which I will explain the Exercise later in this posting. The doctor told me that he, _do not think that the exercise reinjury my knee_. I asked him,_ do you think I need another MRI._ He said, _it will not show anything different. Just make another appointment in 5 to 7 days with me_ I said, _is there anything you can do now? Can you give me a Corticosteroid shot?_ The doctor said that he _can give me a corticosteroid shot and drew some fluid out of my knee_. This was the first he looked at my knee that appointment. He withdrawn some fluid and said to me, _your knee is infected and we need to admit you into the Hospital_ I was admitted for 3 days and gave me around of antibiotics. My control infection doctor put a peg line in my arm. And they are having a home health care nurse coming to my home. She is monitoring me and giving my home IV antibiotics. This is where I am now.

The exercise that I did on the 26th of July was _side steps with constricting rubber band around both of my ankles. The Physical Therapist wanted me to go 8 to 10 feet one way then back to my original point 4 times I only did the exercise 3 times because it became painful. _ After I did this exercise I was in severely in pain and could not walk. All the exercise that the therapist could have me perform, she had to choice this one- just a week out of surgery. Side stepping without a constricting rubber band would have been a challenge and lot better then with a constricting rubber band. I can_t believe that exercise was any good for a injure knees.
I'm going to disagree with all answers given so far. The exercise you described is not an appropriate initial exercise but is an advanced exercise. An injury, such as tearing apart a surgical repair is known to be a cause of infection as it creates the opportunity for opportunistic infections to develop. That being said, damages (award for) would have to pay for the litigation and provide a sum to the plaintiff. Your damages may not justify a lawsuit.

A PEG tube is a feeding tube that delivers nutritional products into the intestines. A PICC line delivers medications and fluids into a large vein. Major difference.

LPN stands for Licensed Practical Nurse. Saying LPN nurse is like saying "ATM machine". (and God help us, I see signs with "ATM machine"!)

EC
 
Last edited:

panzertanker

Senior Member
ellencee said:
I'm going to disagree with all answers given so far. The exercise you described is not an appropriate initial exercise but is an advanced exercise. An injury, such as tearing apart a surgical repair is known to be a cause of infection as it creates the opportunity for opportunistic infections to develop. That being said, damages (award for) would have to pay for the litigation and provide a sum to the plaintiff. Your damages may not justify a lawsuit.

A PEG tube is a feeding tube that delivers nutritional products into the intestines. A PICC line delivers medications and fluids into a large vein. Major difference.

LPN stands for Licensed Practical Nurse. Saying LPN nurse is like saying "ATM machine". (and God help us, I see signs with "ATM machine"!)

EC
I understand your disagreement, however I don't think the time-line supports it:
Surgery 18 July 2006
PT 26 July 2006
Admission 31 July 2006 (what is described as septic arthralgia)

Your thoughts?
:) (where ya been, anyway?)
 

lealea1005

Senior Member
Just a thought re: LPN nurses**************...waaaaayyyyy back in the olden days when I was in training to be a nurse (1979-1983), the LPN students lived at the hospital and worked a shift along side the RN's before or after their classes. Maybe the OP referred to "peg line" because they were trained pre-PICC? I try not to belittle what education/knowledge they may have. LPN training now is a lot different....and OP is also a paramedic/firefighter. I think they were just trying to make the point that they weren't totally unknowledgable.

Checked with MD & PT co-workers who all agree that, although a post surgery tear could cause the infection, the exercises were appropriate for the OP's post-op period.

Have a good one!:)
 

panzertanker

Senior Member
lealea1005 said:
Checked with MD & PT co-workers who all agree that, although a post surgery tear could cause the infection, the exercises were appropriate for the OP's post-op period.

Have a good one!:)
Did you give them the time frame of 3 days to set-up the infection? Not my area of expertise, but seems too fast for a 7 days post surgical knee to get as infected as OP states in just 2 days post injury....I will call one of my ortho friends and inquire to his thoughts.
 

ellencee

Senior Member
panzertanker said:
I understand your disagreement, however I don't think the time-line supports it:
Surgery 18 July 2006
PT 26 July 2006
Admission 31 July 2006 (what is described as septic arthralgia)

Your thoughts?
:) (where ya been, anyway?)
Throw in the inflamation factor and the scenerio is more realistic. As for the post about the exercise's being appropriate, not if it was the initial exercise and we have no info about inpatient PT.

Anyway...where have I been? deep into education, as a student and as an instructor. I'll stick with acute care specialist, thank you! I learned my lesson well! :D

EC
 

lealea1005

Senior Member
OK, ellencee, you're right.....i guess we assumed there was some kind of inpatient PT before discharge. :eek: So then there's the question of whether he/she was sent home with exercises and, if so, were they properly instructed on how to do them.

As for the infection.... there could have been some contamination during the surgery. The OP signed a consent which would have indicated infection was a risk of the surgery.

Have a good weekend!
 

panzertanker

Senior Member
lealea1005 said:
As for the infection.... there could have been some contamination during the surgery.
Have a good weekend!
That was/is my inclination as well......b/c the OP said:
scott knighton said:
He set up an appointment for the 26th a Wednesday to perform Physical therapy. I came for my appointment. The morning of the 26th my knee was feeling fine with no pain or swelling.
I felt that the PT injury (and if they were truly initial exercises, they were too advanced) allowed dissemination of a surgical infection....Either way, OP may/may not have a case - but the recovery will probably not bear the cost of initiation of a lawsuit.
 
B

butterscotch

Guest
The use of rubber bands on your ankles for Physical Therapy is not only unusual but it makes no sense. The point of the therapy is to regain extension as soon as possible after trauma of surgery. The image from OP description of PT is that he had full weight bearing on the operative leg without the benefit of normal protective shift to the unaffected leg.

Septic arthritis is not a common complication of arthroscopic knee surgeries as
it occurs in less than 3%. The treatment, as you described by your physician sounds appropriate.

The most important thing for you is to continue with atbs as ordered. The infectious disease physician is the professional to monitor your progress.

You have not completed your history with this complication of your surgery/PT to determine if you have damages, malpractice, blah blah blah.

Additional things you might do while re-cooperating is to contact your insurance company and ask if a second and third opinion would be covered by insurance. Your insurance company may have a risk manager or legal nurse consultant. If so ask for that contact and discuss concerns about physical limitations following this surgery. I encourage you not to discuss potential action as you do not want to compromise your care. If your records are to be summoned, that action will be and should be taken by a professional person.

I have included a website that does a very nice explanation of arthroscopy (redundant?):

http://orthoinfo.aaos.org/booklet/view_report.cfm?thread_id=8&topcategory=knee

I want to clarify the misinterpretation of nursing credentials being confused with atm machines. The use of a title in the nursing profession is a reflection of the educational preparation and the duties permitted by the state board of nursing.

LPN, Licensed Practical Nurse
RN Registered Nurse
BSN Bachelor of Science in Nursing
MSN Masters in Science in Nursing

The use of “nurse” followed by their certification is the most appropriate way to identify their level of education in the field of nursing.

The ATM machine is interpreted as "automated" machine. I believe a description of an "AT machine" would be confusing. But that's me.
 

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