5/26/09: Week of NSAIDs and a brace…

It is 15 minutes before I am supposed to be escorted out of the prison by my preceptor. There is a patient with a knee injury to be seen. He has been grinning and bearing it for 5 days now. He was too much of a man to come in Friday, Monday was a holiday, and today is the first time there has been “sick-call” since his injury. Others are packing their things and making a dash for the door. I call him back and hear out his story:

“I planted my foot, but the rest of my body kept rotating. I heard a big pop, my knee came out of place and then it popped back in. I feel like my knee will give out when I am walking.”

So this isn’t going to be a simple cough and cold done in 10 minutes, is it?

This guy needs a thorough assessment and careful deliberation on the severity of his injury. I have 5 minutes to make it out the door with my preceptor or wait around until the next person can escort me out.

Decreased range of motion on the left. Pain on medial side. Anterior drawer and posterior drawer tests negative (no ACL / PCL involvement). Negative varus stress test (LCL is good). Positive valgus stress test on the left (MCL, not looking so good). Positive Apley compression test (looks like the meniscus is damaged too, good job!)

MCL is damaged and probably took a piece of the meniscus with it. Ok, so this guy needs an MRI to determine the extent of the injury. I’ll X-ray first to rule out bone involvement…

“What is the protocol to get an MRI done on an inmate?”

“You have to do a week of NSAIDs (ibuprofen), a brace, and then you can make another appointment.”

“…and if I have a strong suspicion of significant ligament damage?”

“week of NSAIDs and a brace.”

The look on this guys face was priceless when I told him the plan. He dealt with this pain for 5 days, but he didn’t deal well with being put off by the Federal Bureau of Prisons for a week. I handed him two 4” ace wraps (which wouldn’t do much of anything for a guy this size) because the staff member was running out the door and didn’t have time to look for 6” ace wrap or, more appropriately, a knee brace proper. You’re on government time, even in the medical world.

Net result: 1 likely torn MCL and meniscus injury of the knee, 1 X-ray, 2 flimsy ace wraps (designed for the knee of a 12 year old girl), and a script for meds that will probably just punch a hole in his stomach. Thanks Uncle Sam!