Overuse problems of the knee :

Bursitis Question..Heather M..can u help (again)? - - Posted by Heather (Heather), 1 November 2004

Hey everyone,

I had a TTT done Sept 2003 as a salvage procedure to correct patella baja, while it seems very sucessful, I still have pain over the turbercle area. It's on the medial side and it's almost like a bruise to the touch and it hinders almost every activity. It's becoming debilitating!

I had orginially gone back to my OS for this, he said possible bursitis. He gave me a cortisone shot, it helped. It flared up about 6 weeks later, he gave it another shot, this time it did not help as much, but I did have some relief.

We agreed that the screws from my TTT were most likely the culprit either causing the bursitis or causing the pain in general.

I had the screws removed August 2004. I had no pain since then really. I was doing good in my rehab routine and making some gains.

I recently had a bunionectomy which of course forced me to take time off from the knee rehab. I lost some of those gains, but now, with this pain level....I have NO hope of gettting any of it back!

I have a referral for pain management in the mail to me as I type this. It's really that severe at this point. My primary care doctor unable to understand my knee issues so when I asked for pain management again, he went ahead and gave it to me. I'm not sure what they do or if it would even help. I do know that my quality of life is going downhill again.    

Heather M,

I did a search on bursitis on this site. I found a lot of good info which you posted (THANKS!). One site in particular was medicinenet.com. I read over the different types of bursitis. Mine appears to be the 'anserine bursa'. I gathered this based on location  and the fact that stairs seem to be the worst for me.

The only thing is I'm not obese and that was a factor. I'm 5'6" 120 pounds. I'm not sure if all the surgical intervention I've had would make me a candidate for this type of bursitis or if it's totally out of the question because I am not overweight.

I have a call into my OS. I'm waiting for a return call of course. I'm not sure if my OS will want me to drive the 3 hours to see him or just try NSAIDS for a while before going up there.

Any one have any suggestions that help with this discomfort? I have vicodin for my workouts because my knee hurts so much but to be honest, it doesn't help it much. Ice only helps while it is applied. The second it comes off, the pain starts again.

It honestly feels like more like a bone bruise. I cannot touch the area without screaming. I do not have any inflammation or redness. It is warmer than the rest of the knee and in comparison to the other knee.

Any thoughts or comments are welcome.

Thanks,
Heather

   
Posted by hmaxwell (Heather M.), 2 November 2004

Heather,

I really think you need to be examined and x-rayed.  It sounds like you might actually have a bone problem going on.  Bursitis is painful, but I've never had it painful to the touch.  Sore, tender, bruised-feeling---sure.  But agony?  Not so far.

The things to consider would be burisitis, stress fracture, bone infection, non-union, neuroma or trapped nerve, bone chip or loose body, or scar tissue.  Also, patellar tendinosis (severe, recurring inflammation leading to tissue death/necrosis) would be a serious culprit given that you have/had patella baja.

Finally, though it doesn't seem likely since you can tolerate ice, you should consider testing for RSD or other nerve damage.  Maybe a neuroma, as I mentioned above.

One thing to try would be Lidoderm patches.  If you've got soft-tissue problems like burisitis, neuroma, tendinitis, etc., the the Lidoderm will likely provide almost instantaneous relief.  The patches are large sheets, and you can cut them down to size and slap them anywhere you want.  You can't wear them for more than 12 hours out of 24, so I use mine during the day.

I think pain management is a good idea, but only if you see someone familiar with the issues that long-term knee problems can cause--like a physiatrist or physical medicine and rehabilitation specialist.  Other people on this board see pain management physicians who don't have background in orthopedic issues, and I just don't think they're getting the best of the best--newest treatments and such.  Anyway, it's likely a PM doctor would take you off vicodin, as that's the first thing mine did--it's not intended for long-term use, and it's not very effective in some people (I'm one of them!).  The idea with pain management is to assume that the patient is going to have daily, intractable pain unless something surgical or curative is done...and most patients don't have that prospect.  So PM recognizes that the pain isn't going away.  THe idea is to reduce it as much as possible and improve the patient's quality of life.  The cornerstone of this is to take your pain meds on a regular schedule...not just 'when you need them.'  That's the most ineffective way of dealing with pain, because you are always chasing it.  Some people don't understand PM, and they think they will go and get enough of whatever painkiller that they can take it a couple times of day as needed.  But that's not what proper PM is.  So be prepared for that.  I fought it for several months, before I agreed to try things my doctor's way.  Within a week, I was taking half the dosage of meds but getting twice the relief.  I got these benefits just by going on a schedule.  It was very helpful!  I was able to do a lot with the PM program, and my PM&R doctor does pain management, acupuncture, and other alternative therapies.  She prescribes hot tubs (get them tax free and insurance pays for part!!), massage, pilates equipment, acupuncture, myo-fascial release, etc.  She got me my TENS unit and Lidoderm patches, which are mainstays in my daily arsenal.  So what I'm saying is that a good PM doctor does more than provides meds.  They look at the whole picture.

Hope this information helps.  As for the suspected bursitis, you've got to get it checked out by your OS.  And if you see a physical medicine and rehabilitation doctor or physiatrist for PM, have them weigh in on the subject as well.  Sounds like a lot of different things could be going on, and it will take some trial and error for you to figure out what it is.

Heather
Posted by bajalady (bajalady), 2 November 2004

Hi there,

Just had to jump in when I ran across your post.

Yes I bet it's pes anserine bursitis and it's horribly painful. Look at my history. I have the bursitis in both knees. Oddly the Maquet or TTT knee is not as bad, but it's quite painful to the touch and gets shooting pains. The other one which is baja and needs the same type of Maquet has the bursitis the worst.  

The pain is medial but can start in the center of your tibia probably real close to your TTT screw or where it was if you had it removed. It can also cause swelling. It hurts below the kneecap and it can hurt all the way around to the back of your knee. Feels like a bone bruise almost like you've been hit with a big hammer--over and over again.

Hamstring stretching is supposed to help some but there is really no great treatment for it. And it can be so bad it affects weight bearing. It's scary how much this kind of bursitis can hurt. I was also surprised at the diagnosis.

You've had so much trauma to your leg with all the surgeries and that is probably the reason the bursitis kicked up. Stretching is the only thing I know to do and try some ultrasound by a PT and massage to loosen up the tightness. They can show you some stretches. It's a hard area to stretch.

You might also be tracking too much to the medial side just a bit if they moved you that way in the TTT which I have to assume they did. It's called medial loading and it's common with a TTT. That squishes (ha, medical term) the bursa if you are not quite balanced.  

Callie
Posted by Heather (Heather), 3 November 2004

Heather M,


THANK YOU SO MUCH!!! You're always such a help and inspiration to me! I did get the call back from the OS, well his PA anyway.

He is "almost" sure it's a bursitis flare up. He wants me on NSAIDS 3x a day for about 7 days. If there is no relief then I'm supposed to get in to see him. So only time will tell and I'll keep you informed.

I appreciate the info on PM. I didn't really know what to expect and now at least I have an idea. I've heard that w/ PM that one is basically stuck on narcotic pain killers. I'm was hoping that wasn't the case!

The very first doctor I asked for the PM referral  (I have several docs on base I see for general care since my reular doc got stationed elsewhere) said that was all PM was and I remember reading your posts in the past and told that doctor that if the PM clinic knows what it is doing they can actually help. He didn't agree.

This last doctor...is the also the one who gave me the referral to see an outside OS after baja was suspected. He's a great doctor and he agreed with everything that you said. He said there is an excellent one local to me but it may be a bit to get in because they are busy. I'll wait, not a problem


Callie,

Wow! You described my pain and location perfectly. It really sucks! I've noticed that warm baths help somewhat. Heather M. mentioned hot tubs, I have one at our YMCA that I plan on using now. I already have the membership there so why not utilize all it's features?

I'm not sure about my tracking. I do know that if I lay on my side and I bend my knee as if I were running/walking, my kneecap slides and actually jumps. It also has a tendency to pop loudly towards the  medial side while walking. It's definitely jumping out of the groove. My OS thought that strengthening it would help stabilize it, but so far, no dice. I'm was supposed to tell him if it kept happening. I haven't told him yet. I just worry about needing that fixed.

I'll keep everyone posted and thanks again for the advice. I don't know what I'd do w/o all you guys!

Much Love,
Heather
Posted by pjays29 (pjays29), 3 November 2004

I hate the bursitus irriation the most.  I get it when I over use the bad knee.  Waking and moving is ok, standing is not.  When it flairs up, all you can do is ice, elevation, nothing, wait, calm down, get rid of it and start activity all over again.  Fortunately, I am having less of it and my knee seems to be settling down 6 months post surgery.  But I do hate that pain the most.

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