While on a musculo placement recently, I was treating a 23 year old male who had undergone an ACL reconstruction. He developed subclinical septic arthritis 8 months post surgery and had to have his knee drained twice in a matter of days to reduce the swelling. He presented to physio with a hugely swollen knee and decreased range of motion with low pain levels. I started him on an ex program including cycling as a gentle ROM ex. The first time he did the bike with me in physio, he didn’t complain of any pain or altered sensation. However the next session when he rode the bike, he complained of some dull pain and numbness in his anterior tibials, calf and the sensation travelled further down into his foot. The patient was quite vague and disinterested in this pain and I wasn’t sure whether to take much notice of it, though I was querying circulation/nerve compression issues.
To be safe, I asked one of the physio’s to come in and have a look to give a second opinion. She was shocked at the size of the patient’s knee, she did a quick assessment and then got yet another physio in for a third opinion. The third physio also did some assessment and agreed that it was likely there were some claudication issues present and instructed me to write a letter to the patient’s orthopaedic specialist immediately suggesting an MRI be carried out for further investigation and to closely observe the patient’s claudication signs.
After all that, I was very glad that I had checked with the physio the extent of the issue, and in future will be more comfortable with asking for second and third opinions to ensure the safety of the patient.
This is a fantastic skill to develop as a student, all you need is one clinical situation like this to realise that the biggest and best resource we have as clinicians, is each other.
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