Just told I have major arthritis in my right knee

[alaskamom]

hello everyone,

I am new here. 

This nightmare started on September 4th when I woke up and my knee was swelled up like a basketball.  Actually my whole right leg was swollen, with the knee being the worst.

I went to the ER, and they did an ultrasound looking for blood clots because of the swelling being in my whole leg. No blood clots were found and I was sent home with pain meds and told to see my general doc.

I got into the general doc on Tuesday, September 7th.  He put my knee in an immobilizer and told me if there is swelling and pain in my knee in a week to come back. To stay off my knee as much as possible and apply ice  as much as possible.  He also gave me an antiinflamatory and more pain pills.

A week later I went back, he did an xray.  Said that no bones were broke, but that my bones weren't aligned correctly and that he suspected a sprained MCL.  He then put me in a knee brace with hinges, told me to wear it for 6 weeks and to come back after the six weeks if I still had pain.

Well still had pain this week so went back on Wednesday.  He ordered an MRI, thinking that maybe something was torn.

He called me today with the results. He said he had good news and bad news. good news- Nothing is torn or damaged, will not need surgery. Bad News-- I have major arthritis in that knee and that most of the cartlidge behind my knee cap is gone.

He told me in the long run I need to lose weight.  In the short run I need to build up my muscles(quads) in my leg to support my knee better.  He wants me to walk at minimum 45 minutes a day. I asked him if I could ride a stationary bike. He said that is ok too, but he would rather have me walking.  He says a minimum of 45 minutes a day because 45 minutes is what burns the glucose, and anything past that burns fat.

Does this make sense?

I don't see how I am going to walk that much on this knee.  I am usually somewhat active. Went camping in July and did alot of walking and all it did was cause my knee to swell and be painful.  How am I suppose to walk that much every day and not have my knee swell up and cause me even more pain? 

I understand the losing weight part. I am somewhat overweight and I know that is more strain on my knees. I realize that.  But I don't see how I am going to exercise that much and not end up in pain, swelled up like a basketball again, and be sitting on the couch with ice on my knee all over again.

Any advice out there?  Should I go and see an ortho doc?  A physical therapist?  Are there special exercises I can do to build the quadraceps?   I feel kind of left in the dark by this doctor. 

Any help, or responses would be greatly appreciated.

Thanks

[alaskamom]

oh thought maybe I should give a little more history.

I am 43 years old.  Back when I was 18 I had my left kneecap dislocate while I was dancing. Was told I would probably have it happen again, but it never has.

In 2007 I fell on the ice and my right knee swelled up. They did an MRI saw no tears or damage and they ended up sucking the fluid out of my knee, and the pain subsided.

I have had my right knee swell up off and on if I do a lot of walking. But usually a couple days of rest and ice bring it down and it is ok again.

I have always had some pain in my knees ever since I was a teen. Especially when going up and down stairs.  I also have had the "crackling" noises in my knees when I bend them since I was a teenager.

But this time, it has been pretty bad as far as swelling and pain. The pain just seems to linger on. At first when it was swollen it was just a steady ache. Now that the swelling has gone down alot, I am having sharp pains mostly on the inside of my knee and right below the knee cap, kind of in a moon shape.  Sometimes the pain is just a sharp burning pain that brings me almost to tears. 

I don't like to take the vicodin that was prescribed because I just don't like that "drugged" feeling. But sometimes the pain is so bad I don't have a choice.

If things aren't torn in there and surgery isn't needed, then what?  how do you get this pain to subside?

[dm]

First off, an MRI isn't absolutely the end all answer. They've been known to miss things, or flat out be wrong. A lot depends on the skill of the person reading it, the scan quality, etc. You've been seeing a GP, so he's relying on the MRI report alone to decide how to treat you. I've had my orthopedic surgeon see stuff on my MRI that the radiologist didn't, and his findings were borne out in surgery, with photos to prove that my "inconclusive" MRI was wrong.

If the problems don't improve in another few weeks, with some reasonable exercise, and some effort at trying to lose a few pounds (diet modification is gonna be your best option here, methinks, like portion control, cutting out high fructose corn syrup, etc) then I'd ask for a referral to an orthopedic surgeon for a consult, and take the MRI films with you when you go, since that's the first thing the ortho will ask for. There may be something on the films that got missed, or the OS may be able to help settle things by giving you a cortisone shot in the knee and help settle the inflammation, at the minimum, so that you can exercise easier. Also, if the shot helps a couple months, and the symptoms return, that in itself is a diagnostic tool that indicates that something's going on the films didn't catch. That happened with me.

See what you can do to get the swelling down. Stick with the stationary bike for exercise for now. Unloaded, aka non-weight-bearing exercise is going to be easier on the knee than walking aka weight-bearing exercise. Walk if you feel you can, but take it in 15 min increments, and ice, ice, ice, with the knee elevated heart height or above, to reduce swelling.

Quadriceps exercises.... straight leg raise- sit on bed or floor with legs out in front of you, bend good knee 90deg, tighten quad muscles of "bad" knee to hold leg straight, lift heel up off bed/floor 18" and hold for count of 10, then lower. Repeat 10 times. rest 2 min, repeat cycle. Trick here is to tense quads before picking up leg, it's a sequence of events, tighten thigh muscles making sure leg is completely straight, then lift. another exercise - quad set - get a rolled up hand towel, fold and roll into a 3-4" diameter roll, place under bend in knee. Tighten quads, pressing knee down into towel roll, hold for 10 count. relax. repeat 10 times. rest 2 min, repeat cycle. Do NOT allow heel to lift off of bed/floor when doing the quad set exercise. The goal is to press knee down, not lift heel up.

The more of the quads exercises you do the better. Start out with 2 sets of 10 at a time, once the last reps start getting easier to do, add a 3rd set.

You can work on exercises for your calf muscles like repeatedly going from flat foot to tippy toes, standing with feet shoulder width apart. This helps balance etc too, and work the opposite side of your shin too, by rocking back on your heels and raising your toes/ball of foot up as far as you can while standing on your heel. Of course, hold onto a heavy chair or counter edge while doing stuff like this so you don't fall over.

there's a whole section on this board dedicated to knee exercises, these are just a few that I thought might be applicable to you that might not be too painful, yeah, I know there's discomfort with most anything right now, but you know not to do things that cross that line between exercise related discomfort and true pain of something not right.

You could get a physical therapy referral for a couple visits, to get set up professionally with a home routine, which might not be a bad idea if you can get the referral.

hope the input helps. Be careful with what you decide to do so you don't hurt yourself more.

[alaskamom]

Thanks dm for your reply!  I very much appreciate it.

I did get my MRI report in the mail today.

There are a few things in it that I don't understand. This is what it says:

There is no apparent meniscal tear. The anterior and posterior cruciate ligaments are intact. No marrow signal abnormality within the distal femur or proximal tibia. There is no significant joint effusion.

The extensor mechanism is intact. There is cartilaginous irregularity of the posterior patella and of the articular femur abutting the patella. There is sclerosis and subchondral cyst formation of the articular patella. The medial and lateral collateral ligaments are intact. There is some subcutaneous edema along the medial aspect of the knee.

Impression: Moderately prominent cartilaginous thinning and irregularity and osteoarthritis of the posterior patella.

No apparent interanl derangement.

No significant joint effusion.

No marrow signal abnormality.


OK, so I get that nothing is torn.  But what is sclerosis and subchondral cyst formation of the articular patella. 

and what is cartilaginous irregularity of the posterior patella and of the articular femur abutting the patella.

I am assuming those are two biggest problems, am I correct?  But not sure exactly what they are.  Is it as simple as my GP said " You have major arthritis and the cartilage behind your knee cap is pretty much gone".   OR is there more to it than that.  His explanation seems pretty simple compared to the big technical words in the MRI report, or was he just dumbying it down for me?

Thanks for the exercises. I did start doing the leg lift off the bed, and I can tell that my quad got real weak with that brace on. My leg just shakes as I am holding it up.  But will keep working on it. 

If I do any decent amount of walking on it, my knee aches for the rest of the day. (just grocery shopping gets me aching).  Hoping that will get better with time and use again.

But if things don't improve I do plan on going to see an ortho surgeon. 

thanks again for your response. If there is anyone out there who can explain the technical words in my MRI report to me, I would greatly appreciate it.

Thanks

[TwoBadKneesUSA]

I'll post the links where I got the info too, so you can have a look.

A subchondral cyst is a fluid-filled sac that extrudes from the joint, consisting of thickened joint material (mostly hyaluronic acid, a substance found in normal joint fluid that serves to lubricate the joint).
http://osteoarthritis.about.com/od/osteoarthritissymptoms/f/subchondralcyst.htm

Subchondral sclerosis is defined as increased bone density or thickening in the subchondral layer. This often occurs with progressive osteoarthritis and shows up on x-rays as abnormally white (dense) bone along the joint line.
http://osteoarthritis.about.com/od/osteoarthritisdiagnosis/f/subchondral_bone_sclerosis.htm


"what is cartilaginous irregularity of the posterior patella and of the articular femur abutting the patella."
Basically the cartilage is damages on the back of the kneecap and the part of the thigh bone it is closest too

The good part is the ligaments and menisci seem fine.  Does not diminish your pain though.  If the kneecap is your problem, you may be a candidate for a patellofemoral joint replacement.  It would replace the worn parts of the kneecap and femur.  I know first hand how much this kind of OA can hurt.  Good luck with your journey.  Any strengthing exercises you can do will help, the weaker the quads get it seems the more pain there is.

Milly