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Doctor John MD
Doctor John MD, Board Certified MD
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My daughter has an injury from an inflatable water slide on

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My daughter has an injury from an inflatable water slide on July 20. Basically, she came down the large drop, her leg went into a small tear from a manufacturing defect, and her leg went into the liner clear up the thigh, and then continued ripping this heavy gauge vinyl for about 5 feet until she finally came to a reinforced stitched area, and it spun her body violently around in the opposite direction...while her leg was still inside this liner. Ambulance came, took her to hospital, they diagnosed Knee sprain. We saw ortho the next day, she had massive hematomas all up and down her leg, we went into 2 Mri's and an arthrogram about one week later...none showed any tears. We started PT. 2 months later, She is still complaining of pain,especially behind her knee and right above it in the back, and her PT has noticed severe hyperextension, with a very dramatic visual snapping back as she walks. She is still swollen, still unable to completely bend her knee against her thigh. The pt believes her Hamstring is involved. To complicate matters, she was diagnosed recently with a connective tissue disorder called Ehlers-Danlos, which makes her prone to this kind of thing. We are at a loss. Currently, our ortho has her in a hinged full leg brace, locked at 30 degrees, to try and give those ligaments a chance to heal, but it's constantly slipping down her leg, despite her having to retighten and lift it every few steps. We are frustrated and don't know what to do.

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This is Dr. John and I will be helping you today. I am a primary care sports medicine doctor with over 20 years of experience.

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Answers here are for education and information only.

Sorry to hear about her injury and the rough 2 months both her and you have had as she rehabs.

when was she diagnosed with Ehlers-Danlos? After the knee and leg injury or before?

Customer: replied 1 month ago.
Thank you. It's been a wild ride. I'm worried that the MRI"S missed something due to the inflammation. Our ortho confirmed that it's also not good for seeing stretching of the support systems. She was diagnosed on July 11th, the accident happened on the 20th.
Customer: replied 1 month ago.
The day of the accident, the ER put her in a full straight leg brace. A couple of weeks later probably, we called our ortho and requested a hinged brace, as she was starting her school year, would be on her feet most of the day walking between classes, and that brace kept slipping down. They switched her to a hinged one that goes about 8 inches or so above and below her knee. It would slide as well, but not near as bad. She has continued to wear that one until this last week, when we saw our ortho again to inform him of the hyperextension, and thats when he put her into another full length brace, but this one is hinged, and has the capability to dial it to different degrees and lock it at that position. However, it is nonstop slipping down, so she is still able to straighten out her leg. He mentioned at that appt that if this option didn't work, they may decided to cast her.

MRIs are very good at looking for tears of ligaments, tendons and muscles. They can also pick up inflammation as I'm sure your Ortho has pointed out. However, since an MRI is done with the leg in one position, its not a great test for looking at function of the joint, etc. Usually we depend on physical exam and a careful history to determine functional deficits.

With any musculoskeletal injury, there is a "retraining" of the brain-nerve-muscle complex that needs to happen (which physical therapists are quite adept at), but it does take time for the patient to unlearn some of the compensation patterns they have picked up post-injury and retrain the original movement patterns.

Additionally, her ED diagnosis (assuming she was diagnosed with the hyper mobility type of ED) means that her body will have a more difficult and challenging time with the rehab as well.

I would think of it as the difference of learning to walk again on sand versus learning to walk again on a sheet of ice. Its not impossible and she'll slowly make progress.

She is only 8 weeks out from the initial injury, and if we say that the first two weeks were impacted by the significant swelling and bruising, she has really only had 6 weeks to allow those ligaments to heal. Realistically, she may need 12 weeks or more to fully heal the ligaments.

And then followed by restarting physical therapy after she is out of the brace or cast.

And obviously, if the new brace doesn't fit properly and keeps slipping down, she is not getting much benefit out of it.

Customer: replied 1 month ago.
it is type 3, hyper mobility, same as mine. We are overwhelmed by it all, and the idea of casting scares us, but we feel like we've kinda exhausted our other options.

I can understand that dealing with her diagnosis and now knee injury can be frustrating and draining.

I think I would have you look at potential casting as hopefully a quicker way to get her healed up, especially with the brace problems she currently has.

Customer: replied 1 month ago.
We have another ortho appt tomorrow to address the issues with the new brace, so we're unsure of what tomorrow holds for her. Can the casting soften her bones in that leg, or create other issues,besides the expected stiffening that PT would need to remove?

Short term casting should not cause any significant bone issues. The stiffening of the knee and muscle atrophy would be biggest issues. What's interesting is that in patients that are immobilized or casted, if they exercise the opposite limb, they do not lose as much muscle mass in the immobilized leg as patients that don't do any exercise in the unaffected limb. So that would be something to talk to the PT about if Ortho does decide to cast her.

Customer: replied 1 month ago.
as what point does surgery start to be discussed to retighten any structures? 12 weeks, 6 months, etc? My worries are that no matter how much PT, even as consistent as we are with it, will tighten them back up to proper structural stability,especially considering the diagnosis we have of EDS.

depends on the Ortho, but in general, would at least immobilize for 6 weeks and then 8+ weeks of focused PT before any discussion of surgery. Surgery also difficult due to her EDS, so would want that as last resort. But I think you're still at the beginning of her healing process, and she may do very well with the longer term bracing/immobilization.

Customer: replied 1 month ago.
I hope so. Surgery would be our absolute last resort. Thank you for your assistance.

You're welcome and glad to be able to help you today!

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