Plica issue, a nerve? Clean MRI report

[stillinpain72]

Can someone tell me if they think I may  have some sort of soft tissue injury or some sort of nerve issue going on...something that doesn't show on a MRI? The pain comes and goes seemingly at will. While it is consistently aggravated by running (usually pain level is closer to a 7-8 for the next 3 days, instead of a level of 5-6), the pain seems to be otherwise unrelated to activity. I can stop exercising for days at a time sometimes and then have a couple of bad days in a row 

I had a lateral menisectomy on the anterior horn of my lateral meniscus (about 20% removed) in September, 2010. I have had significant pain originating from what feels like deep within the joint, from that area where the portion of meniscus was removed. I have done my rehab quite religiously, had XRAys and 2 MRIs. The first MRI in May 2011 showed "superficial cartilage thinning and fissuring the lateral articular compartment". My doctor thought this was so minor that this really couldn't be what is causing the pain. He diagnosed me with ITBS and did a cortisone injection into the IT Band, which helped for about 3 weeks. Then, the pain came back as bad as ever. I had an XRAY which showed excellent joint space and no signs of arthritis. I had a second cortisone injection into the IT Band which helped a little, but not nearly as much as the first. I then had a 2nd MRI in January 2012, which showed absolutely nothing except the abnormal shape of the anterior horn of my lateral meniscus due to the partial menisectomy. There was not even any mention of the cartilage thinning and fissuring mentioned in my previous MRI, nor was there any mention of an inflamed IT Band or any other tissues. I am desperate to know what's going on.

Lately I have been reading about inflamed Plica, as these don't always show on an MRI, but it seems like most of the literature and issues concern the medial plica. My pain is all on the lateral side (although occasionally it extends across the patella). Does anyone have any other thoughts on what could be causing my pain? What kinds of things just won't show on a MRI, and what kinds of other treatments should I try? Any suggestion would be greatly appreciated. Thank you everyone!

[stillinpain72]

I should also add that I have had to basically give up running and skiing. I am 39 years old and otherwise in ery good shape. I do a lot of biking and elipticals these days. Thanks.

[captainruss]

still,

I am under the impression a very specific CT scan will only show plicas?  I am not sure, but you might want to look in the patellofemoral  threads.

russ

[aaa]

Hard to say, just my guess ..... running can sometimes lead to imbalances or tightness, which can start out without symptoms and then one day you just start getting pain and the symptoms start.

Its probably best, if possible, to see a PT who is experienced in treating runners who develop patella pain.  It is not an uncommon scenario.

Based on what you've described, at first what I would probably try is a foam roller over the IT band.  I wouldn't be surprised if that is very painful for you to do, at least initially.  Also, stretching the IT band might help.  Lastly, I would try a heel to butt quads stretch,  also known as  prone quad stretch, and see if you can get your heel to butt.   Possibly also try a little heat over the quads and then massage it gently with a tennis ball and see if you have some painful areas, especially on the outer quad.

If you have a lot of tightness doing the above, then you may have success with PT to strengthen other muscles that don't get as much work during running.

[stillinpain72]

Thanks for taking the time to respond Captain and YB. I'll give these suggestions a try! Truth be told, I haven't been doing as much of the PT exercises of late. I just googled and tried the prone quad stretch for the first time, and it seems pretty good. Thanks again!

[Clarkey]

HI There,

I had my medial plica and fat pad trimmed in November 2009 and my MRI scan came up normal and was getting sharp pain and catching on the lateral side of my right knee. When my OS was inside my knee he had to trim the fat pad and remove a inflammed plica. It took 18 months to fully recover from the surgery and starting to have problems again.

I had a cortisone injection pre op and post op and did not really help and had deep friction massage to break up the scar tissue and was still not helping. I then had something called IMS 'intramuscular stimulation' done on the NHS and it really help reduce the knee pain as the pain I was getting that was caused by nerve pain and by sticking fine needles into my back and muscle above my knee reduced the tightness around the muscles and this reduced the pain. I am due for some more IMS sessions as the pain has come back again and not surprised as I run 3 times a week and work as a manual worker so had a feeling the pain would return again.

You could try some IMS sessions to see if it helps or not and could also be some scar tissue around the portals and can have some deep friction massage done by your physio. As yb pointed out could be tightness around the muscles and IMS loosens the muscles so could see if it works for you.

nickwclarke2012@BhamUK