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GUIDE TO KNEE CARTILAGE INJURIES 25-1-06
Knees again? The Good Friday agreement seems to have a lot to answer for. As for young Stewart Downing, the provisional wing of the Irish College of Physiotherapists has struck again at Rockcliffe Park.
It seems that although big England stars can call our manager a cunt to his face, lesser players who can spell "can spell", and don't pay for sex, and don't kick off at the slightest provocation, and don't have a permanent angry scowl on their fat chav faces because the world shouldn't be so difficult when you're a millionaire - it's your right to have solid gold swimming trunks, so why won't shops make them?
Sorry, hatred tangent there, these lesser players seem to get their knees smashed in on the training ground if ever they do anything to upset Mr McClaren. What young Mr Downing did, one can only imagine, though demanding a pay rise every time the transfer window opens might have something to do with it. As a result he clearly got some sort of punishment beating and needs an operation on the cartilage in his knee.
Cartilage Trouble
You will of course remember quite clearly my prior explanation of the knee joint from a previous article. I know a few of you have printed out my previous work and taken it along to your nearest tattoo parlour and had it indelibly daubed upon your bodies. The name Scorpio has jumped into my head for some reason.
The tattooist's art has often puzzled me. When they are writing "Rooney luvs Lucy 4eva" on someone's skin, they never question the inkee that if they are not willing to commit enough to use the word "love" should they be writing this onto their bodies in a way that won't wash off, not even with Cillit Bang. The Lucy I was referring to incidentally was Lucy the oldest known hominid remains, not some interesting bit of gossip I alone was privy to.
So anyway, the knee joint. Basically one long bone sat on top of another with a few ligaments stopping it all falling apart at inopportune moments, such as every time you try to walk. Between the two bones are the menisci, two lumps of cartilage that stop the bones rubbing against each other. These act as shock absorbers and prevent you sounding like a bag of dice every time you cross your legs. When I say bag of dice, what I really mean is the sound made by one bone rubbing against the other when there is no cartilage to protect it. In medicine we call this noise "screaming".
To prevent this "screaming" we have two menisci, a medial meniscus on the inside of the knee and a lateral meniscus on the outside of the knee. By outside I mean away from the middle but within the knee joint, rather than hanging off the side of the knee like some rogue earlobe on a day-trip. This is why doctors use words like lateral, because it encapsulates the last sentence in one word not just to make us look all clever, absolutely no way. No really it's not, not even a little bit... alright it is, leave me alone.
But sometimes you just have to, fuck it if mechanics are allowed to do it to me with there talk of tappits and overhead cams and rear-view mirrors so why can't I ponce about a bit? I can stab you in the chest and make you feel better, I just choose to call it a tube thoracostomy so you don't run away when I call it stabbing you in the chest to make you feel better.
Back to the point anytime soon?
Each meniscus is a crescent shaped bit of cartilage, which to the ancients looked a bit like a moon, which is how it got its name in the same way that mental and menstrual did. The ancients often did things like this, which is why hysterectomy and hysteria sound similar because the ancients thought that only women were capable of going off their chump. Even today most women wish that man would realise women had feelings too. Whereas most men realise they hope to be feeling two women. But enough sexism, for that can only lead to the comparison between man-flu and bird-flu.
However speaking of the mentally ill and bird -flu, President Bush has stated that were there to be an outbreak of bird-flu in the US of States one of his first reactions would be to send in the national guard to help control the problem. Now, I don't claim to have any great expertise in the avian influenza A (H5N1) strain in humans, but I have some experience in the management of patients with less hip and sexy respiratory infections and I'm pretty sure that the patients aren't likely to benefit that much from being forced to form human pyramids in the bollocky buff whilst a bunch of slack jawed yokel office clerks point guns and big fuck off dogs at them whilst some retard from a gas station who has been allowed to carry a machine gun for fuck's sake takes photos and then takes them to fucking Kwik-e-mart to get developed.
Sorry, anyway crescent shaped cartilage, two bits in each knee. Each meniscus is crescent shaped when viewed from above, but is triangular when viewed in cross-section. This apparently helps with weight-load distribution and is all down to vectors and stuff and differentials and I don't know, ask a fucking physicist or mathematician or someone who cares. These provide nice smooth surfaces to allow fluid movements of the knee joint for running and jumping and free kicks and that.
So, anyway, cartilage trouble
So if you take a nice smooth surface then tear a hole in it, and the torn bit flaps about in the breeze then it kind of hinders free movement across that smooth surface. To demonstrate this, pop round your nana's house and tear a hole in the lino in her kitchen. The fact she will fall flat on her arse within a couple of days is actually not the best analogy but it keeps me in work and that's what matters. What you have in reality is a cut to an area of tissue that bears a lot of weight and has almost constant movement so it hurts a fair bit. Also it is being irritated and reopened a lot. So it doesn't heal particularly well due to this constant agitation. Couple this with the fact that cartilage has a piss-poor blood supply and you're in for a long run to recovery.
"Blood supply Vits" I hear you say, or more likely "bollocks to this shite I'm gonna go watch the dessication of that emulsion". Anyway, my point is many of you may have noticed when cutting one's face or hands there tends to be a lot of blood compared to say a cut to say the knee, this is due to these areas having a better blood supply. You may have also noticed, though admittedly it doesn't grab the attention like spurting blood, that these bits heal quicker. This may come as consolation if you should ever snap your banjo string, that, although you're sat in a corner of your bed screaming "don't even come near me woman!" holding a sock to your manhood as it vomits out blood like the spinny-head bird out the exorcist, it will be back in working order within the week. Not so cartilage, but given the last analogy who gives a tumbling toss about knees?
It's the point of the article SFB so less talk of bleeding pork-swords if you please.
Again, sorry, and more importantly sorry for starting this article the week of Downing's injury and not finishing it before he's back playing, well during the second half at least. My tardiness makes it kind of difficult to criticise any delay in recovery post-op by a 20 year-old millionaire who has bugger all to do all day except rest, gentle exercise and physiotherapy when a 35 year-old roofer has a reasonable chance of being back at work within six weeks. That unfortunately is the world of the professional footballer, where farting and following through can leave a 24 year-old with his arse in a sling for a month.
The treatment involves either leaving it and letting nature take its course no heavy impacts, swim a bit, take some painkillers. This has a not bad success rate, honestly, and I aren't just typing this because Patricia Hewitt has threatened to show me her arse if I don't do my bit to keep waiting lists down. The other option is letting an orthopaedic surgeon at your knee. These are the scary big rough men of medicine, rugby players to a man, who don't take kindly to namby-pamby footballer's injuries because it's a girl's game you see. Their anger can be attributed to the national library of orthopaedics burning down before they'd finished colouring all the books in. That's an in joke used by anaesthetists - fuck we're funny, funny fuckers in medicine and no mistake.
What they do is cut a hole in your knee and shove a camera in the hole, have a look round and then chop out the loose bits, which is as subtle as orthopaedics get, hence the jokes about them behind their backs. Not to their faces oh no, big bastards like I said. After the op the cartilage scabs over the raw edge heals over about six weeks and it's just a case of getting it moving again which is just down to exercise. Unfortunately the reason I never got round to finishing this article was an inability to think of a punchy enough ending.
Sorry.
Dr Vits is a real doctor and can find a lady's G spot nine times out of ten, or at least is probably able to and will prove it if he can get another ten women to sleep with him.
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