On November 19th a Mr. T., a stone mason and plasterer, came into my office and asked we whether I could not give him something for his knee, which he said,” had water not.” He had been treated by me some time before for the so-called muscular rheumatism and wished to know if my remedies could do anything for his present condition.
Inquiry elicited the fact that this condition was of some weeks standing and that he had been under the care of an old school man for three or four weeks, during which time he had been treated by electricity in some form applied to the knee and, as this gave no benefit, he was put to bed with a plaster cast on his keen. Of course, the effusion was gone from the keen after this treatment, but returned as soon as he began to use it. He then came to me with the request or hope that my treatment would allow him to continue his work.
The patient is rather tall, angular, with “loose” or “flabby” joints. An examination found the right knee with the usual characteristics of effusion, but with no heat nor any history of heat in it.
The knee had never seemed as strong as the left knee, as showed by the fact that it would tire easier than the left when used in various ways in the work. He also reported two falls from a bicycle in which the right thigh had been injured, in one instance quite severely. Examination of the thigh found it smaller than the left one, the muscles were soft and lacking the tone necessary to proper action, while the ileo-tibial band was lax and unable to carry out its important function.
Though this condition was doubtless made worse by the use of the plaster cast, that alone did not seem sufficient to account for the state of the muscles and fascia. The site of the severe injury, which occurred a year or more ago, was marked by slight tenderness and hardened tissues.
The patient complained only of a feeling of weakness in the knee and an occasional “catch” on the outer side of the back of the knee.
It at once occurred to me that the trouble was due to an injury of a part that had never been strong and that the rational treatment was to increase the strength of the muscles and fascia of the thigh so they could hold the knee in proper position and give a proper tension to the ligaments surrounding it. To accomplish this, vibration and massage have been given on alternate days, omitting Sunday, for three weeks, and the results have been all that one could expect. The effusion has nearly disappeared, the muscle and fascia have increased in size and tone, the ligaments about the knee are increasing in tension, the sense of weakness is lessening, while the “catch” is rarely felt.
Treatment is given not only to the muscle of the thigh, but to the is given not only to the muscle of the thigh, but to the gluteal and lumbar muscles, while the lumbar and sacral nerves of the affected side are stimulated, as well as the inguinal glands. Apis, Arnica and Sulphur have been given internally and the patient instructed to restrict the use of his knee. AS foreman he was able to favor himself though there was an occasional walk of two miles to his home and, recently, a few days of hard labor.
Treatment was stopped because he yielded to the persuasion of his wife and used a liniment that made the parts around the knee so tender that he could not allow it to be touched. As I shall leave in a couple of days, the masseur will give daily treatment for a time and then, at intervals, as seems best. After a time, movements, passive and active, will be given for strengthening the parts and the ligaments about the joint may be given a light massage. This has been a very interesting case for me and if the results are what is promised it will cause me to suspect that the plaster cast is as useless in many cases of effusion where it is used as it is in the great majority of sprains.
