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Pain: Movie sign in TKR

Josephine

NURSE DIRECTOR EMERITUS
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The movie sign (pain in the knee with a prolonged period of sitting)

There are two leading theories for the movie sign.

1. while sitting we predispose our knee to change normal position so structures can impinge on a swollen and inflamed synovial lining

2. as we sit the knee's intra articular pressure increases, resulting in pain

Explanation:
Studies have shown that the knee is an extremely fibrotic and capsular entity, meaning it is contained in a tough, fibrous bag. When put in prolonged flexion we may impede venous outflow and increase arterial blood flow in to and away from the knee. This change in blood flow can increase the pressure within the joint as we sit.

(The complexity and fullness of blood supply to the knee can be seen in this image)

circulation around the knee joint.JPG



Treatment of the movie sign is more about prevention. It should be obvious the best therapy is movement and not sitting for long periods of time, for instance you should consider 40 mins to be a long time. So you need to get up and take a walk about every 30-40 mins, do stretches and simple exercises to get the normal circulation flowing again. Also have some emergency (crush the capsule type) ice packs and pain meds on hand.

But not really feasible in a theatre or cinema, is it? So if you find yourself subject to this phenomenon, then I would suggest you avoid such outings until later in your recovery.
 

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