Author Topic: Sharp pain on medial side - nothing on MRI  (Read 349 times)

Offline cgw1981

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Sharp pain on medial side - nothing on MRI
« on: July 17, 2017, 06:15:40 PM »
I've been having anterior (left) knee pain for almost a year now and I'm beyond frustrated with my OS, so just looking for any thoughts/input on what might be going on or what can be done.  I'm 35 and exercise regularly, and haven't had any major knee issues in the past (although I do recall left knee pain at different points playing sports or running in high school.  I started having awful pain behind my kneecap and loud grinding last fall.  X-rays were fine (the Dr did point out that my patella is pulled laterally and tilted) and MRI didn't show anything major aside from mild chondromalacia.  I did 8 weeks of PT and ended up having a cortisone shot, which provided about 3 weeks of relief.  I ended up taking a break from my regular exercise routine to just give it time to heal, but every time I have tried to resume activity, the same symptoms come back and are becoming worse.  About 6 weeks ago, I also started having a sharp pain on the medial side of the same knee, which got much worse over the next few days.  I went back to my OS and ended up seeing one of the other doctors in the office, who suspected a meniscus tear and sent me for another MRI.  Over the next week, the pain kept increasing and the knee started swelling quite a bit with any activity (even just walking to the printer in my office would be extremely painful).  When I went for my MRI results, my knee was very swollen (mostly over the medial side) and I let the doctor know how much pain I was in.  He said the MRI looked fine, aside from the same damage he saw before, insisted on giving me another cortisone shot, and basically said there is nothing really wrong and nothing that can be done.  This shot helped a bit for about a week, and I'm back to where I was - lots of pain, swelling, etc. that has gotten to the point that it's keeping me up at night.  It's definitely worse when my knee is bent (even a little) - enough that driving more than short distances is almost impossible.     It doesn't always hurt a lot *during* activity, but by the end of every day, I end up with a very swollen knee, with almost constant sharp/stabbing pain on the medial side.

I have a follow up appointment in another week, but I'm tempted to try to find a new OS because I feel like I'm wasting my time even going to see this one again.  Any thoughts/suggestions would be so appreciated.  I'm beyond frustrated.

Offline Geronimo

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Re: Sharp pain on medial side - nothing on MRI
« Reply #1 on: July 19, 2017, 04:17:26 PM »
Two things:

1. MRI is not 100%.
2. Make sure you get blood tests for RA, lupus etc.

If blood is ok and it doesn't get better you will need an exploratory scope.


Offline Clarkey

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Re: Sharp pain on medial side - nothing on MRI
« Reply #2 on: July 19, 2017, 05:44:22 PM »
Anterior knee pain could be a number of knee problems with PFS being the most common knee problem that the majority of the population. There could be an issue with the way your knee alignment that can easily be diagnosed with a CT scan of the knee that shows the bone density, if the knee angle is out of alignment if it out slightly out then strengthening of the muscle can reduce the pain. If the knee is out of alignment surgery is performed to realign the kneecap so it wears out less quickly known as osteotomy, it's a major surgery to go through using metal plates and screws.

I know from personal experiences with my right knee problems that soft tissue injuries to the knee are hard to spot as a problem on an MRI scan. It seems to cloud over what wrong behind the kneecap and problems with the plica are rarely spotted on an MRI. A good OS should be able to know if you have plica syndrome when doing a physical examination of the kneecap. The very 1st OS I saw back in 2003 said I could well have problems with the plica that can be removed during key hole surgery. At the time I thought it was an extreme way to deal with the knee pain and discomfort after having a negative MRI scan. Six years later in 2009 he was right all along and did have problems with my medial plica under another OS as he has now retired.

It's your decision if you want to take a gamble and risk going ahead with diagnostic arthroscopy that can lead to scarring inside the knee that once set in it is hard to get right again. It attacks the tendons and soften the cartilage. If you leave it untreated it can attack the knee causing early arthritis, more surgery can increase the scar tissue building making the knee more crippling. Just be aware that it could happen! I am more prone to scaring after surgery while others are more fortunate and do not scar up excessively. Having my 3rd surgery in the autumn removing the scar tissue for the 2nd time in 3 years of AIR surgery and decompression of the patella tendon.

I am not trying to put you off or scaring you, just pre-warning you in advance what could go wrong as a worse case scenario situation. If you go for a diagnostic arthroscopy it might be successful recovering from the surgery and given the all clear to be discharged from any further treatment.

[email protected]
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-hip 04/04/17 R-knee 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline cgw1981

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Re: Sharp pain on medial side - nothing on MRI
« Reply #3 on: July 19, 2017, 10:26:06 PM »
Thanks for all of the info!  There are definitely a lot of factors to consider, especially with the ongoing kneecap pain.  I'm assuming the most recent injection is still helping with the inflammation there (and that there really is no "quick fix"), so right now I'm mainly concerned with figuring out what is causing the swelling and sharp pain on the side of my knee and dealing with that.  Up until about 6 weeks ago, I had no swelling at all - now there's pretty much always some degree of swelling, increasing throughout the day and with activity.  And the pain is in such a specific spot - pretty much right at the joint line.  If it's not my meniscus, what else would cause sharp pain right there?

Offline cgw1981

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Re: Sharp pain on medial side - nothing on MRI
« Reply #4 on: July 21, 2017, 04:18:39 PM »
And the saga continues.  Yesterday after work I stupidly squatted down to turn the xbox on for my son, and on my way up I felt a really sharp pain right in the same spot on the medial side.  No pop or anything, just a really sharp pain, which progressed throughout the evening.  Within a few minutes I could barely put weight on it without more pain and it started swelling.  Lots of rest and ice last night and the swelling seems better this morning, but that side just feels really uncomfortable.  I can walk on it, but when I sit down or have it bent for a while, it starts to really hurt. I was going to cancel my follow up appointment Monday since I'm switching to a new dr, but I'm starting to think I should probably go just to see what they say.

Offline rigman06

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Re: Sharp pain on medial side - nothing on MRI
« Reply #5 on: July 24, 2017, 12:29:39 AM »
MRI'S are not 100%
Cortisone is overated
Honestly, I would find another OS, I tore my medial meniscus on my left side and had 2 differant arthoscopic surgeries. I've had ALOT of Mris done and was told that nothing was wrong. well guess what I just recently had a high tibial osteotomy and fasciatomy. this was all because my "other" dr's said nothing was wrong.

Offline Clarkey

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Re: Sharp pain on medial side - nothing on MRI
« Reply #6 on: July 25, 2017, 09:45:40 PM »
You know your knee best of all, can have all the experts out there telling you different things that can confuse you even more. Hopefully your OS came up with something when you saw him/her yesterday, pain and swelling does not happen unless there is an injury externally inside the kneecap. Cortisone injections is just a short fix fix numbing the pain ending up doing even more damage to the knee as you cannot feel the pain so much when pushing the knee too hard.

[email protected]
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-hip 04/04/17 R-knee 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline cgw1981

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Re: Sharp pain on medial side - nothing on MRI
« Reply #7 on: July 27, 2017, 04:46:53 PM »
Went to my appointment earlier this week and was told that I "must have sprained my MCL somehow" and to wear a brace when I work out.  Um....that doesn't even make sense.   I've been taking it easy for a couple weeks and trying to rest it a bit, which seems to be helping.  I'm going to test it tonight with a relatively "knee friendly" workout and see how it feels after, then hopefully set up an appointment with a new OS soon.

Offline Clarkey

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Re: Sharp pain on medial side - nothing on MRI
« Reply #8 on: July 29, 2017, 10:09:57 AM »
Good luck with your consultation with a new OS, having a 2nd or even a 3rd or 4th opinion can be helpful but costly. Find a OS that deals with your specific knee related problems, they all have areas of specialist interest.

[email protected]
RK: PFS, P.T, maltracking & arthrofibrosis
Scope #3 scheduled October 2017
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-hip 04/04/17 R-knee 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

 

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