The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: bruisedkneecap on January 14, 2005, 03:18:28 AM

Title: Bruised knee
Post by: bruisedkneecap on January 14, 2005, 03:18:28 AM
I fell on my knee on pavement in November while working out of state.  I had x-rays but nothing broken.  I saw an Ortho surgeon and he gave me Celebrex for a couple of weeks to take down the swelling and the knee did get somewhat better.  I kept walking 2-3 miles per day but at a slower pace than I had been doing.  I stopped all jogging, step aerobics etc.  I do not have much pain when walking as long as the surface is flat.  I have pain sitting and sleeping.  This Ortho surgeon thought I might have a torn meniscus.

I am home now and had an MRI and it appears that I have a very bad knee bruise and it is not healing.  The new Ortho surgeon told me that I should stop the walking and go to physical therapy to get a home therapy program.  He told me wear thick sole sneakers as much as possible and absolutely no high heels.  

Has anyone else had this problem and if so what did you do to get better and how long did it take? I have been in pain for a long time and will really miss exercising even if it is only walking. Thanks
Title: Re: Bruised knee
Post by: Heather M. on January 14, 2005, 08:20:23 AM
Do you have a copy of your doctor's notes--this would likely be dictated by him and then typed up by his assistant or a service after each of your appointments.  Your file would also include any results of x-rays and diagnostic testing.  These are important because you need to get the actual medical phrases your doctor uses to describe your condition.  A 'bone bruise which isn't healing' could be many things--a chondral defect, which is when a chunk of the cartilage that coats your bones is gouged out or worn away in a small, readily identifiable way.  Or it could be a condition called OCD or osteochondritis dissecans (did I spell that right?  It might be dessicans, but I'm not sure--sorry).  OR, a 'bone bruise' could result in such trauma that the area actually begins to die--this is called osteonecrosis.  So as you can see the layman's term 'bone bruise' is not really very helpful, because each of the conditions described above has a different treatment plan.

I urge you to get your records or call your doctor and get the actual diagnosis--ugly latin words and all!  Then you can post the results here, as well as carry out research using the search engine on this site (as well as the Net in general).

To give you an idea of the kind of information out there--much of it in easy to understand language--here is a link that describes what a chondral defect is.  I'm not sure if this is what you have, but it's a good anatomy lesson.  Basically, a chondral defect is an area in the knee joint (on the back of the patella in my case) which has had the cartilage wear away.  So it looks like a lesion or a scab, kind of comparable to a skinned knee.  How much pain and the amount of time rehabbing is really an individual thing.  It depends on your history, the location of the lesion, how deep it is, and a couple of mystery characteristics that no one really understands.  The truth is that some people have very deep chondral lesions that are widespread through the joint--this is osteoarthritis--and they feel relatively little pain and discomfort.  Other people have shallower or less numerous lesions, but they feel pain that is nearly crippling.  And other people fall somewhere in between these two extremes.  It really is a matter of physical therapy, supportive care, anti-inflammatories, lifestyle changes like reducing impact activities and losing weight (this is a tough one!  I'm working on it....).  And luck, apparently!  A positive attitude certainly can't hurt, and I believe it does a world of good.

So do some digging to find out your exact diagnosis.  Usually, a radiologist who reads the MRI will say whether they believe a lesion is OCD or necrosis or 'merely' chondral damage or chondromalacia.  Getting the results of your MRI reading can clear up a lot of things, but they should always be combined with your doctor's notes.  Sometimes the orthopedic surgeon disagrees with the radiologist, and this would be indicated in your files.  

Then, once you have a potential diagnosis, look up the terms and read posts here written by people who are facing the same thing.  You should get lots of information and support here.

Title: Re: Bruised knee
Post by: Heather M. on January 14, 2005, 08:20:34 AM
Following is a web page that explains about chondral defects, another that talks about a potential treatment for areas of damaged bone (microfracture technique), and another on patello-femoral syndrome in general.  This last is something that you are usually born with, and many people never have symptoms from their poor knee mechanics.  Others like me have trouble as soon as we take on our adult frame and do things like intensive sports that stress the knee (my PFS problems started at age 13).  Finally, there is a small group of people that develops lots of problems and altered knee mechanics as a result of a serious blow or injury to the knee.  Usually this means  patellar tilt or weak VMO (the inner part of your quads), causing mal-tracking of the kneecap, which can cause chondral wear.  Or the patient can have a direct blow as in a car accident where kneecaps meet the dashboard (ouch!), which causes pain and swelling, which can acutally make the muscles around the knee shut down to protect the joint from further pain.  Then it becomes a self-perpetuating problem that has to be resolved with very creative physical therapy and supportive care (anti-inflams, bracing/taping, ultrasound or iotophoresis, etc.).

I know I've thrown out a lot of terms, but as you read you will become familiar with them and the pieces will start to fall together.  And with a good understanding of your condition, you can work together with the doctors and PT's to devise a treatment plan.

Finally, here is a great page with an overview of the causes of patellar pain.  Read through this page, and also the other links on this site--go to the 'for patients' link on the left side of the page and hold your cursor over the drop down menus that appear.  For example, this other link discusses chondromalacia.

...and this one goes over physical therapy to alleviate knee pain and strengthen the muscles around the joint.

There is a lot of information out there--hope I haven't buried you.  But it is important to learn these terms and understand what the problem is inside your knee, and what you can do to rehab effectively.

Title: Re: Bruised knee
Post by: casey2291 on January 14, 2005, 06:53:27 PM
Hi there.  I can feel your frustration as I too have a bone bruise.  I know how annoying it can be to feel like it is not healing and also being told to limit your exercising is just as annoying, particularly if you were very active like myself.  Not to mention that you have been in pain for several months.  Like Heather said, looking at the term "bone bruise" isn't really going to help you, especially if you are searching on the net for information.  I spent way too many hours searching on the net for information regarding bone bruises and found little to nothing.  I think Heather gave you some great info.  I wish that I would have had some of that info when I was doing my research months ago.  

From my understanding bone bruises can take a long time to heal.  I have actually seen three surgeons regarding my case and one OS that I saw told me that it could take up to six months for a bone bruise to heal.  My new OS who I saw last week is a knee specialist and she told me that she wasn't really sure if there is a difference between a bone brusie and OCD.  And I guess that it can at times be hard to tell the difference between the two particularly if it has not affected the cartilage yet, as in my case.
In my case I injured my knee over eight months ago and unfortunately none of the conservative treatments have worked for me.  I went to physical therapy, took the anti-inflammatories, had a cortisone shot and have stopped exercising.  I was told last week to wait yet another month to see if any healing occurs naturally on its own.  And, then I will be getting a new MRI at the beginning of Feburary.  If there have not been any changes then she will operate and perform the microfracture surgery.

It is so frustrating to wait, but I think the conservative treatment is worth it, even if it doesn't end up working for you.  The recovery time for the surgeries that correct problems such as ours is not short.  From the research that I have done, most are looking at 4 to 6 weeks on crutches and at least three months or more before you are back to impact activities such as sports.

Keep me updated as to how you  are doing.  It is nice to have other "bone bruise" folks to talk with.  I hope that your knee begins to feel better soon!!

Also, if you really want to exercise, ask your OS or PT about biking or swimming.  I was told that I could do either of those.  
Title: Re: Bruised knee
Post by: KarenS on January 14, 2005, 07:44:55 PM
I am recovering from bone bruises in both knees (the right worse than the left). I was also getting radiating pain into my shins and ankles on days that were particularly bad. It took 3.5 months to get to the point where I could function somewhat around my own house (never mind exercising! I don't see myself going back to that for a couple more months, and I, too, was VERY active). My husband had to take a lot of time out of work to help me (I have two small children, ages 2 and 4, to take care of, and I could barely tend to myself!). My mom and dad live close by, thank goodness, and they helped me a lot, too.

It's been 4.5 months right now, and each day I find I can do more and more without pain. Actually, my knees feel *great* right now -- I don't even need to ice them anymore. Yaay! :) I'm just left with the weird ankle/shin sensation, and even that seems to be lessening with time. My OS said he's seen bone bruises take anywhere from a month to close to a year to completely resolve -- everyone's different. He prescribed 800 mg. of Motrin 3x/day, and pain medication for days when I just couldn't stand it. I found that any amount of PT made me feel worse, so I focused on resting and LOTS of ice.

The good thing about bone bruises -- if that's truly all you have going on in there -- is that you will not do any damage simply by going about your day to day activities (nothing strenuous, of course).

As for saying your bone bruise "isn't healing," well, I'm surprised that an OS would say that after such a short time. There's no way of "seeing" that the bruised bone is healing, so all you can do is wait and see how things progress over time. My best advice would be not to do *too* much research about your condition, as you can drive yourself bananas doing so (trust me!). Sometimes things just take a good deal of time to heal, and overanalyzing it can sometimes be detrimental to your mental state!

I really feel for you, because I've been through my own personal hell since the beginning of last October, but I finally see the light at the end of the tunnel...and it's getting brighter by the day. ;)

Good luck, and keep us updated on your progress!
Title: Re: Bruised knee
Post by: bruisedkneecap on January 16, 2005, 11:40:19 PM
Thanks for all the encouraging replies.  :)  I have a copy of the OS notes and the MRI report and I do have medial femoral condyle abnormal marrow edema due to a contusion (when I fell), medial femoral condyle focal osteochondral defect, due to my contusion.  The good news is that I do not have any meniscus injury and no other internal derangement.

The OS said it was not getting better because I had been exercising too much.  I did go to physical therapy and they gave me a home program for both knees.  They told me (like many of you told me) that this may take a long time to completely heal and for the pain to go away. The OS and Therapist told me to wear thick sole sneakers as much as possible and that daily activities are okay to do and swimming is okay too in addition to the exercises.  Absolutely no high heels.  I will go back to the OS in 8 weeks but I may have pain for 3-6 months.  

I am not happy about cutting back on exercise for that long and will try to find a place to swim every day.  Thanks everyone for the information and words of encouragement- let us hope all of us with bruises will continue to improve.