Author: Foot Doc
Date: 1/23/2007 4:51 pm PDT
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DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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First of all, a fracture in that area, unless it involves the articular cartilage, with appropriate care, probably has a better long-term prognosis than a severe sprain. So what was your perhaps discounting of its seriousness as nothing was seen to be fractured should not necessarily have elicited the lesser concern you probably had when told that.
Sprains (other than pure avulsion sprains where the ligament may not tear, but the force of the trauma tears off a portion of the bone to which it is attached), are the stretching and sometimes tearing of ligaments beyond their normal capability. Sprains are graded according to the extent of damage to the ligaments involved, and treatment is dictated by the category or grade of the sprain.
Bone heals with new bone, and though a fracture might call for more acute initial treatment, once healed, the part is most often as good as new, providing that no articular cartilage had been damaged. On the other hand, ligaments, as with most of the tissues of the body, heal with fibrous scar rather than the tissue which was injured. In the case of ligaments, the function of which requires elasticity, healing with fibrous scar limits the elasticity of the ligament and thus its function, and does so permanently. For that reason, many patients who sustain a severe sprain of a joint where the ligaments are partially or completely torn, may never return to a function as good as was present prior to the injury, and the attendant increased instability of the joint can predispose to future strains.
There are a number of reasons why you might have restricted range of motion in the joint. Among those are that you may have sustained a fracture of the articular cartilage which was not noted on x-ray. You may have subsequently developed traumatic osteoarthritis. It is possible that their is a bone chip or loose cartilage in the joint. Fibrous tissue tends to contract, and it is possible that if the ligaments were torn, the fibrous scar has contracted sufficiently so as not to allow for a normal range of motion. It is possible that physical therapy was delayed for too long. It is possible that their were injuries to tendons which were not detected or addressed. But the above is completely supposition, and only a hands-on evaluation can determine the nature of your difficulties.
Where I practice, a physical therapist works under the prescription and direction of an attending doctor, and I would consider, at least where I practice, that it would be your attending doctor's purview and not the physical therapist to send you for a consultation. But I think that another opinion from someone is appropriate at this time. |
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