KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: Puffy the Knee Slayer on November 24, 2016, 08:06:03 AM

Title: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on November 24, 2016, 08:06:03 AM
So for those who haven't read my fat pad thread, I've had FPI and PFMT for over 8 years.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=66643.60

In October this year I had a botox injection into the tensor fascia lata and a steroid into the lateral femoral condyle, to switch off lateral muscles and get the glutes and VMO working again.

After the steroid I had terrible pain and stiffness under the LFC site and couldn't bend the knee. This lasted about 48 hours and I thought was post-steroid flare up.

However it's now been nearly 3 months and I have developed terrible pain on that side, just above the fibula going down the bone, over the last week.

It doesn''t hurt when walking or at rest, but if I put weight on it either on the upright bike or cross trainer I get really bad pain after less than 10 minutes and have to stop. The recumbent bike hurts also but the pain is less. Walking on the treadmill at a gradient is fine.

It also hurts on stairs and is worse going down stairs.

It feels like a sharp pain pressing on the bone.

Have told the physio and he's tested for pernoneal nerve and sciatica and it isn't either of those.

He tried kinesio taping on the outer calf and has done trigger point therapy on my glutes, and asked me to try out a gym session to see if these helped. They haven't.

It's another 3 weeks before I see him again.

Am doing various physio exercises to strengthen glutes and medial quads. These don't hurt though quad and glute stretches involving bending the knee back might not be helping.

Does anyone know what this pain might be, and if it will go away? As I seem to have swapped one problem for another.

Thanks.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on November 24, 2016, 06:48:23 PM
Hi Puffy,

We both have had our fair share of soft tissue injuries to the knee that are hard to get right again! I am limping more than I ever have been even after all the physiotherapy sessions, 3 ESWT sessions and 5 cortisone injections with 3 of the 5 done during the year 2015. I will refuse to have another injection around the patella tendon as I do not want to risk having it rupturing! 

We both know our knees better than any of the professionals out there as we have to live and manage with restrictions on what we can and cannot do on a daily basis. Your symptoms sound similar to mine with PFS causing all the aggro and frustration that limits our physical activities involving running.

A diagnostic arthroscopy is an option but a big risk and gamble that it could make your knee problems worse rather than better. Scar tissue is the main concern that can ruin the whole knee joint once it has established fully! It always the last resort after all none invasive treatments have failed.

Sorry not to be more upbeat and positive in response to you’re posting, good luck with what you decide to do next.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on November 24, 2016, 07:34:43 PM
Hi Nick,

I am sorry you are worse than ever after all the treatment. You have been through a lot with your knee and trying to get it all sorted with various specialists and treatments. I will also refuse further cortisone.

As this is a new pain that has only come on after the steroid into the Lateral Femoral Condyle I am thinking I would push for a new MRI rather than diagnostic arthroscopy.

It is possible a change in biomechanics has caused this new pain but it might be something else and I want to be sure, if it does not go away.

The knobbly protrusion on the lateral side, below the knee joint, don't know what it's called, is sore to the touch.

I have been icing it and keeping off it though it is ok walking just not bike, cross trainer or stairs.

I just think they are going to say the pain is nothing to do with the injection, and I think it is, as in over 8 years of knee pain I have never had this before.
Title: Re: Pain under knee, lateral side above fibula?
Post by: minka on November 30, 2016, 06:53:58 PM
Hi you have a collapsed arch on your foot I see if the arch of the foot collapsed inward it will cause all sorts of problems to the knee joint if you are using arthose in shoes are you sure this is not the problem as they are incorrectly fitting on that leg are you also favoring the better leg when walking
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on December 03, 2016, 07:51:07 AM
Hi Minka,

Yes you are right my other leg is compensating, my orthotics are the right fit. I can understand what you are saying, however the pain on the lateral side, as I said, has only come on after the steroid injection into the lateral femoral condyle, therefore I really don't think it is to do with compensation issues or the orthotics.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on December 17, 2016, 11:23:06 AM
So am still having this pain.

Saw the physio who has given me a stretch to do, he thinks the problem is the nerve rather than the joint as he said if the problem was with the bone it would hurt when he presses on it, and it doesn't.

He thinks the consultant may want to image the lateral side, either by MRI or ultrasound. There is nothing on my previous MRI to indicate problems in this area, and indeed have not had pain there until the steroid injection into the lateral femoral condyle.

Will wait and see if the stretch helps, am seeing OS in new year.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on December 30, 2016, 07:23:41 PM
Pain had improved a bit, then attempted a short run (as was told to try running by physio, to check if botox has improved anterior knee pain), which was fine during.

After though, any attempt to go forward on forefoot with knee bent - cross trainer, stairs = pain.

Also even on recumbent bike, painful, and also felt at one point my joint got stuck in bent position which was scary, makes me wonder if it it could be a lateral meniscus tear but I don't have any other symptoms and my quads are working fine?

Don't think the running caused this as I had the lateral pain before physio said to try running.

No idea what it could be, am seeing OS next week so will have to wait and see. In the meantime rest, ice and upper body work only  :(

Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on January 03, 2017, 05:06:31 PM
Hi Puffy,

Happy New Year, good luck with your consultation, hopefully he spots something that is a straight forward fix none invasively. It best to avoid running again until you have seen your OS as you could cause permanent damage! I was last able to run in January 2013. I am missing it a lot if you are passionate about running long distances, we are both keen on being physically active again.

My physio told me to live with the knee pain and suggested going to the pain clinic and yours is telling you to run! The physio after my AIR surgery in July 2014 made me do too much PT in once session that could have ruined my knee even more? Sport physiotherapist are better in my experiences, the one I trusted 100% is now living in the Middle East. It is now a gamble which one I can trust fully.

Feel like a broken stuck record as every year I say this is the year I will finally sort out my right knee? lets hope 2017 is successful for us both in sorting out our knee problems.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on January 04, 2017, 09:14:26 PM
Hi Clarkey,

Happy New Year to you also and thanks for your reply.

Have seen the OS who did a thorough clinical examination but was unable to replicate the pain, as I explained to him it only comes on when I am doing activity, putting weight through a bent knee.

He has no idea what the problem is so has referred me for an MRI, and says if there is inflammation it will show up there.

I am not thinking of running again until the results are out and I know exactly what I am dealing with. However as the pain seems to wax and wane I will probably have to aggravate it on purpose before the MRI just to make sure it shows up whatever it is. But given how it is this will not be too difficult and acheived just by walking up some stairs!!!!

I really don't know what it could be. I managed 4 minutes on the cross trainer today before giving up in pain. Can't even do recumbent bike. The pain moves around but is all on the lateral side and feels like something - vein, nerve, ligament?? - is getting caught somewhere and being stabbed through the bone with a knife and then twisted round.

I think it is to do with the steroid into the lateral femoral condyle, I wish I had never had it.

Yes I miss running too, and other things like kickboxing and not being able to skate.

I really hope we will get our knees sorted this year, am proper fed up and sure you are too.

I think your physio does not sound very helpful to put it politely. That is the sort of thing they might say to an 80 year old with arthritis not someone young who wants to be active! But I also had a useless previous consultant at a different hospital who pretty much said the same thing - "we all get aches and pains sometimes" wtf

Meanwhile, coming soon to kneegeeks...Fat Pad Impingement - 9 years and counting!!!!
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on January 10, 2017, 04:34:06 PM
Hi Puffy,

My right knee pain is similar to yours as the pain comes when I am weight bearing, I have no pain or discomfort while sleeping during the night. As soon as I lift anything heavy or squatting down straight away get intense anterior knee pain. A knee does not need to massively become swollen to have a knee problem any fluid in the knee and minimal swelling is a sign that the knee is not happy.

I am now thinking that the Registrar suggesting to realign the kneecap performing an 'osteotomy' might actually work that is a major surgery to endure that is a daunting prospect. It's well worth the risk if it puts less strain on my right knee and hip. I can then move on and apply for a job position as a Playworker for autistic young people. 

As you well aware there comes a point when one has to be assertive in a polite but firm manner to get the treatment that will hopefully be beneficial improving your quality of life. I will go for a 1 mile walk before my MRi scans to flare up the knee and hip to increase a positive result.

Hopefully this time round our MRI scans come back positive clearly showing a mechanical problem inside the knee.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on January 10, 2017, 08:36:29 PM
Hi Clarkey,

When you say osteotomy do you mean the TTT?

It is a big step but if it resolves the problem then maybe worth it. I was also offered this but opted to try the botox first.

Clearly your knee problem is not just affecting your sporting activities but your choice of career so is a big impediment.

My fat pad is still swollen though doesn't seem to be pinching as much and the kneecap is tracking much better, but whatever they did on the lateral side they have messed me up.

I really hope the MRI shows something they can clearly see and fix, and wish the same for yours.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on January 11, 2017, 06:07:51 PM
Hi Puffy,

Knee osteotomy is a different type of procedure to TTT surgery that is done if you are prone to regular knee dislocations with a shallow trochlear groove. A knee osteotomy does sound very similar to TTT surgery. I know this after speaking to my sister who is an orthopaedic nurse about TTT surgery.

Link below is a good interpretation of 'Knee Osteotomy'

http://www.kneesociety.org/web/patienteducation_osteo.html

A link from the Birmingham Royal Orthopaedic Hospitalon 'Tibial Tubercle Transfer' where I go for consultations and had my two surgeries.

http://www.roh.nhs.uk/patient-information/general-patient-information/biopsy/144-tibial-tubercle-transfer/file

Lets hope that our MRI scans show up something this time round so we finally know what we are dealing with. Good luck.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on January 19, 2017, 07:32:14 PM
Thanks for the links, that does explain the difference really well.

Will an osteotomy affect muscle balance?

I got my MRI date, it was meant to be the same date as yours but I changed it as it was first thing in the morning and I need to go to the gym beforehand. So now am having it first week in February.

Someone at my gym thought it was strange that I am deliberately trying to aggravate it before the MRI  but this is in fact what some of the private OS's tell you to do.

Yes I hope both our MRIs show what is wrong and that these are fixable. Luck to you too.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on February 01, 2017, 08:44:42 PM
I have had my MRI scan today.

I went to the gym beforehand but only managed 8 minutes on the cross trainer before the pain got too much and I had to stop. I really hope that was enough to inflame it so that whatever is wrong shows up on the scan.

Am really worried that nothing will show up on the scan and then the choice will either be to live with it and do no weight bearing cardio, or have a diagnostic arthroscopy (assuming they offer this).

I have rested it for weeks before today's scan and whatever the problem is hasn't got better with physio and rest, as evidenced by todays foray onto the cross trainer.

There was a bloke at my gym chatting to me today about it, I thought he was being friendly but the second time this has happened basically he wears shorts and when he gets onto the bike his manhood pops out of the opening!!! I don't know what to do, whether he is aware of it or not!! He should be wearing undershorts, really.

I am not going to say anything to him as I am too embarassed. I think I will ask someone else I know there to have a word with him. I would like to give him the benefit of the doubt that he does not realise this is happening but it is also possible he might be a perv :o
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on February 02, 2017, 08:53:12 AM
Hope the MRI gives you some answers :)

Ugh to the guy at the gym. I'd perhaps ask a member of staff to have a word, say they've had several complaints, so you remain anonymous. They have the duty of care to their members
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on February 02, 2017, 04:16:03 PM
Hi Puffy,

I totally agree with Vicky to report it to one of the staff members at the gym! He might not realise what he is doing is highly impropriate behaviour that is not acceptable practice at a public gym. Male changing rooms and showering area is the safe place to do this if there are facilities available at your gym.

Hope you have better luck with your MRI scan results of your hard to fix knee problems then I did. Good luck in what ever is decided as the next course of treatment.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on February 19, 2017, 01:32:03 PM
Am due my results this week. I mentioned this to someone who said "Hopefully it will show nothing is wrong" and seemed amazed that I actually WANT it to show something is wrong.

Of course I want it to show something is wrong - how else will they know how to treat it?!

I think she thinks I have some minor pain and they are sending me for an MRI just to reassure me everything is fine and that it will get better by itself. Rather than that they know something is wrong and are sending me for the MRI to find out what it is and how to treat it, because it very clearly isn't getting better by itself!

Very strange attitude.

At least I know people on Knee Geeks understand.

Anyway, we shall see.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on February 19, 2017, 01:45:44 PM
Good luck, hopefully it shows something that can be addressed conservatively by a good physio and home exercise programme :)
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on February 20, 2017, 07:05:08 PM
Hi Puffy,

You are right us KneeGeeks understand each other while others think we are barmy wanting to have a positive MRI scan in order to have a treatment plan set in place in a none surgical way. This would be the ideal scenario if it cures or eases your knee pain and discomfort. There nothing more frustrating not knowing how to go about treating a long term knee problem when you have a MRI scan result coming back negative.

I am still surprised that my right hip MRI came back positive that I was not at all expecting to happen. I thought it would be the other way round that my right knee MRI would show up a new problem. Hip problems are similar to knee problems having good and bad days. My mum was not sure if she should have her left hip replaced or not last year May when she had a good hip day. Turned out it was high time it was replaced when the OS said it was brittle when he removed her old hip.

Will have my fingers and toes crossed for you that something shows up this time on the MRI scan.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on February 21, 2017, 08:08:10 PM
They didn't find anything  :'(

I am gutted. I didn't even see the OS, my physio read the MRI and told me.

He said MRI still shows fat pad impingement but this is not more than anyone might have who is asymptomatic.

There's a slight lateral meniscal tear but it isn't sufficient to warrant surgery.

He's offered me a repeated injection of botox into the TFL. He said if I refuse this my only options would be surgical lengthening of the ITB or to try and convince the OS to do a fat pad debridement.

No exploratory scope was offered.

I know the pain isn't the fat pad, and I don't believe it's the ITB either, though he says there is still tightness on that side.

But I have to accept the botox otherwise they will probably discharge me! They are not even going to give me a new programme of physio, just a botox injection and carry on with the physio I've been doing - which isnt helping! The pain isn't even anywhere near where the ITB meets the LFC!

I can't believe they can't see what is wrong!

I am worse off now than before as I never had this lateral side pain before the steroid into the lateral femoral condyle.  :'(

I don't know what to do? Please help, I am very upset!
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on February 21, 2017, 11:00:45 PM
Hi Puffy,

Sorry to hear that the MRI scan results have not shown up anything new. I would also be upset if my physio told me my MRI scan results. I always thought that you have the rights to see your OS for the MRI scan result or a sports medicine doctor that read both my MRI scan of right hip and Knee. He was happy to refer me to both OS's. PT's can do a referral for an MRI scan and surprised that he gave you your results and not the Registrar, if your OS was is busy in clinic to go through the MRI images with you.

Do not have a fat pad debridement done or you will end up like me having to deal with AF that messed up my gait which has damaged my right hip. Fat pad trimming can cause you more problems post-op up then pre-op.

I can understand why you would want to go ahead with a diagnostic arthroscopy after all the failed attempts of conservative methods of treatment. The meniscus tear might be larger than 1st anticipated that might be causing the pain your are experiencing right now. MRI scans are usually very accurate with just a small percentage of patients where there is a problem that does not show up on the MRI scan images.

I am also tempted to go for a diagnostic arthroscopy, that is always risky, members on KG will say stay well clear! I would personally feel more at ease to going through with it. That just the way I am taking risks and a gamble. I then know I have tried every option available, there comes a point when something has to happen.

I would call your OS secretary or send an email that she will pass onto him. I did this when I was getting frustrated and upset. I got to see him at a private hospital funded through NHS Choice as he knew how frustrated I was getting from my email.

Good luck, hope you make some progress you have always been supportive on my post-op diary that helps psychologically knowing there are others out there that understand what you are going through.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on February 22, 2017, 07:46:52 AM
Hi Clarkey,

Thanks for your reply, it means a lot to know there are people on KneeGeeks who understand and are supportive.

I have got my MRI images and am sending off a request for the report today, which will take ages as they first send a form, then you have to make an appointment to show ID and collect etc

Am then going to try and see a private physio for an opinion. The one I see on the NHS is all right but he is part of the Botox study so think he is really pushing that.

I wish they would acknowledge the steroid into the lateral femoral condyle has done something it shouldn't have.

I do find it very strange nothing showed up as even my pes anserine bursitis showed up on the last MRI and the pain from that was nowhere like as bad as this lateral pain. They cannot leave me like this, I can't even do 8 mins of the cross trainer or upright bike without terrible sharp twisting pain.

Physio said the next availability for botox is quite soon so i doubt I will get to a second opinion before I have it. As the MRI still shows FPI I suppose it makes sense to have another go with botox but I don't think this will do anything for the lateral pain which, in spite of what he says, is nowhere near the ITB, kneecap, or anywhere else that has previously given me problems.

The clinic I attend has "Extended Scope Practioners" who are physios and it is not always clear who you are seeing, ie whether they are doctors or not. They do not say!
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on February 22, 2017, 09:44:48 PM
I have also seen an Extended Scope Practioner a while ago back in 2008 at Birmingham Royal Orthopaedic Hospital. He could tell there was problems with my fat pad and tried all the conservative methods before I had the surgery that I now know was a costly decision.

I had CT guided Botulinum Injection into my tensor fasciae latae or the thigh muscle on my right leg in the hope it would reduce my muscles that were super tight, it did help release some of the tightness. The knee pain remained, I then had the AIR surgery when it looked like a microfracture surgery on the one positive MRI scan out of five.

Extended Scope Practitioners (ESP) are specialist Physiotherapists or Occupational Therapists who work in an extended role alongside a Medical Consultant. If you are referred to an orthopaedic clinic you may be seen by an ESP instead of the Consultant or their Registrar.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=42784.0

I had the Botulinum Injection done by a 'specialist consultant musculoskeletal radiologist' who also reviewed my last two MRI scans that did not show up anything majorly wrong. A ESP must get a briefing from an OS and radiologist with the results rather than them going through the images alone.

It gets to a point when you accept anything that is being offered to you even surgery that many say avoid like the plague! If you have not tried you will never know if it will go the other way and be a success rather than a failure! This is what is getting to me right now. We are the ones that makes the final decision and gamble. If I was offered a diagnostic arthroscopy at my next consultation without asking first I would accept with never ending post-op none recovery.

I am sure you are now at the same stage as me contemplating on going ahead with a diagnostic arthroscopy surgery with some reservations of course, this is normal if you going through any type of surgery. It is not a pleasant experience to endure but when you desperate to make some progress you tempted to go ahead with it.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on February 23, 2017, 12:53:05 PM
I am not convinced surgery is the right way forward, I think they would just do a scope and say nothing is wrong or do one of those fake sham ops to shut me up!

Physio said the remaining FPI is no more than you might find on any person who is asymptomatic, but I am still experiencing pinching at the front of my knee.

My kneecap tilt has improved greatly with the botox but the rotation is still wrong, it is very obvious compared to the other knee.

This sharp pain on the lateral side is worse than all of that, heaven knows what they did, maybe when they gave me the steroid into the lateral femoral condyle the needle went in too far and hit a nerve or caused a bone bruise or the steroid weakened the cartiledge.

Anyway I will try another botox by the time they review me maybe if it is the lateral meniscus tear causing the pain it will have improved. I am not going to go on accepting botox forever though, will probably ask for a second opinion if this next treatment does not improve things.

I do not think their MRI scans are that accurate as they already told me I did not have a medial meniscus tear when a previous MRI from somewhere else showed that I did.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 07, 2017, 11:35:30 AM
OK having collected the MRI report I am thinking the physio downplayed things considerably?

Here is what it says:

"Intercondylar region: the ACL and PCL are in tact

Medial compartment: The medial meniscus appears intact. There is mild chondral thinning;there is no significant subchondral marrow oedema. The MCL is intact. There is minor pes anserinus paratendinosis.

Lateral compartment: There is a focal undisplaced short segment lateral meniscus tear involving the posterolateral horn, extending to the tibial surface, with the mild posterolateral gutter synovitis. There is mild chondral thinning. There is no significant subchondral marrow oedema. The LCL and conjoint tendon are intact. The popliteus tendon and remainder of posterolateral corner structures are unremarkable. The ITB is intact and does not appear to be significantly thickened.

Patellofemoral compartment: There is minor lateral patellar subluxation and overhang. There is an impression of borderline patella alta, with a shallow femoral trochlea demonstrating a truncated medial surface, as well as a dysplastic patella displaying a hunter's cap deformity. A TT-TG distance of 12mm is noted. The patellar tendon is lateralised, with significant underlying Hoffa's fat pad impingement. The quadriceps tendon is intact. The MPFL and lateral retinacular fibres are intact.

Other findings: There is a minor knee joint effusion. The popliteal fossa structures appear within normal limits.

Conclusion: Evidence of a subtle focal oblique tear of the lateral meniscus posterolaterally. Evidence of patellofemoral dysplasia, with suggestion of borderline patella alta. Significant superolateral Hoffa's fat pad impingement."


So I still have the pes bursitis, and the FPI and patella maltracking, and now a meniscus tear to add to my arsenal!

I would think the lateral tear could well be the cause of my lateral pain?? I don't mind if they can get it better by physio, but if it needs a trim I hope they are not trying to avoid offering me an op due to cost!
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on March 07, 2017, 12:41:45 PM
Sounds like a second opinion is called for, all those relatively minor things could be leading to accumulated pain, or referring pain around the joint, upsetting muscle balance and all sorts.  See if your GP will refer you (or pay to see a surgeon privately who could then move you to his NHS list?)

Unfortunately, degenerate meniscus tears tend to reoccur once they've been trimmed - if it's not causing locking or buckling, it's as well to leave alone (even insurance Co's are reluctant to fund menisectomies without biomechanical issues)

A lot of the things seem patella related, I'd still find a good physio (yours sounds a bit crap tbh - physios don't generally downplay pain and effect on QoL, that's what doctors / surgeons are there for ;) )
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 07, 2017, 01:12:31 PM
I think you could well be right. The letters I got copied from the hospital to the GP have inaccuracies in them, eg claiming that my last steroid was into the fat pad - it wasn't, it was into the lateral femoral condyle; also stating I said my new lateral pain was an ache - no I told them it was a sharp knifelike twisting pain.

Physio letter states there is no demonstrable explanation for patient's pain - erm???? As only new MRI finding is the lateral tear I would surmise that may well be causing the pain! But then they might have to admit the steroid did some damage?

I don't know if it is degenerative or not, maybe it was acute after the injection?

Anyway yes, definite plan to see private physio, will have to look into OS referral. There was one surgeon who looked promising and also has NHS clinic  - Mr Wills-Owen? - so maybe him.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on March 07, 2017, 01:17:55 PM
My surgeon is a top bloke, I'll PM details (NHS practice too)

Never heard of Willis-Owen myself
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 07, 2017, 01:50:01 PM
Thank you very much, Vickster  :)
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on March 07, 2017, 06:34:42 PM
I was going to see Mr Charles Willis Owen myself for a private consultation, he specialises in patella tendonitis that has had himself. He told me that ESWT has a high success rate that did nothing for my patella tendonitis.

http://www.kneeguru.co.uk/KNEEnotes/courses/lower-limb-overuse-injury-series-charles-willis-owen-frcs/tendinitis/patellar-tendinitis

He is also very much into long distant cycling as you can see on his YouTube account.

https://www.youtube.com/channel/UCyAbl6TaE2U9W9jIakz-U3Q

I read that he was based in London and moved down to Bournemouth on the south coast so he commutes less so he can spend more time with his wife and kids.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 07, 2017, 08:13:57 PM
Yeah looks like he is not in London anymore, don't blame him really.

I've made an appointment for a sports physio, first available in a couple of weeks. Maybe they can come up with a plan

Was chatting with a guy at my gym he said if you leave a meniscus tear it will just get bigger and the pain will never go away. He had a trim about 12 years ago and has been fine since, and he is older than me, so must have been around my age then? But maybe the NHS wasn't so restricted back then. I think they are trying to save money
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on March 08, 2017, 07:51:59 AM
Good luck with the physio :)
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 28, 2017, 10:22:27 AM
I am in the pits of woe atm. On Sunday I fell and sprained my left ankle. One minute I was walking along, the next on the ground and could not get up. A kind gentleman helped me up.

I've been to the minor injuries unit and got it x-rayed, there are no fractures, so I've been given crutches but told to get off them asap and start weight bearing or I could have permanent damage. To this end I have been given codeine (I can't take NSAIDs) to work through the pain.

They are also concerned if I hobble about for too long this will badly impact on my already damaged right knee, hopping about is not really good for it. The Doctor said it sounds like I have pre-existing ankle ligament instability from the sound of my fall, which means I will need to add more exercises to my already burgeoning physio repertoire. I fell while wearing orthotics and stability trainers so this is not a good sign. I wonder if all the focus on my right leg has meant any issues with the left leg have gone unnoticed.

I have had to cancel my follow up appointment with the sports physio for my knee this week as I cannot get there, a taxi there and back is far too expensive as it's quite a way.

I was due to have a second botox (Dysport) injection into the tensor fascia lata of my right leg next week but thinking I may have to cancel as I won't be able to manage the required physio anyway.

In addition have been having, prior to the ankle sprain this week, a lot of pain in my right toe which I think is the formation of a bunion due to my collapsed arch, in spite of regular physio and orthotics and motion control trainers.

I did have my assessment for my right knee with the sports physio last week, he said the main finding is that I have a very weak VMO, so he has given me some exercises to try and reactivate it and he was planning on trying EMS on it this week.

From his examination though, he said my fat pad was normal (!!) which I can't believe, and that the only thing he would concur with from the various investigations I've had, is the patella femoral osteoarthritis.

He also mentioned the brain receiving pain signals because it has become used to getting pain when I do certain movements, and that it needs to be retrained.

He hasn't actually watched me walk and didn't really mention much about the lateral pain I have been having. Anyway I will give him a chance for a few more sessions. I can still do the VMO exercises he gave me in bed while the ankle is healing but the exercises the NHS physio gave me I cannot do due to the left ankle and being unable to get down on the floor.

I will probably go nuts this week without the gym too. Just when things seem to be improving something goes wrong.

I hope that my left ankle heals normally unlike my right one which has permanent stiffness and of course that collapsed arch, which then led to the ongoing saga with my right knee.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on March 29, 2017, 01:00:39 PM
Hi Puffy,

Sorry to hear that you are now having further complications and setbacks on top of you knee problems. If you having problems with your foot and ankle an assessment by a foot and ankle surgeon might be beneficial. There many KG members with foot and ankle problems that has a negative impact of other joints particularly both kneecaps. My OS wants to try and see if an cortisone injection into my right hip helps ease my right anterior knee pain before doing a 3rd scope.

The fat pad can cause major problems as I have found out since having it trimmed and now looks likely will will have fat pad debridement surgery with fluid and scarring showing up on my latest MRI scan. It might have been best to left it as it was pre-op to scope #1! Would be weary and cautious before considering surgery to investigate the fat pad! I cannot reverse what happened, if I opt for a 3rd surgery hoping it shows up other damage missed out on the MRI scan.

I know how you must be feeling right now not being able to the gym, also upset and frustrated I cannot even jog at a slow pace or join in the football at the autism kids group that knocks my confidence as I cannot take part properly ending up not playing. Come onto KG anytime is helpful as we all understand while family and friends do not unless they have chronic knee problems themselves.

Hope your left ankle heals and can return to the gym again.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 30, 2017, 05:58:00 PM
Hi Clarkey,

Thanks for your reply.

I am really hoping this is just a normal ankle sprain and that with physio etc it will return to normal. Luckily I know the drill where ankle rehab is concerned as I did it all with my other ankle, only this time I know a good sports podiatrist who does mobilisations etc so once the ankle has settled and I can walk again will try and go up to see him. Hopefully he can prevent this ankle ending up like the other one. I think if I had known about him last time I would not have ended up with chronic ankle stiffness, equinus and a collapsed arch. My right foot is still pronating badly even with orthotics thus the bunion problem.

I do think I have probably focused too much on my other leg/knee etc and there is therefore probably some imbalance. I know however repeated sprains can lead to further problems and put one at risk of falls when they are elderly, so I will need to do what i can to strengthen the ankle now!

I hope that a cortisone injection will help your knee but I know you are keen to do the scope. I am not clear, are they offering you a further fat pad debridement? I do hope if you go ahead with a 3rd surgery it will be beneficial and not cause further issues like the others did.

I think it is frustrating the over specialisation, having to see a separate foot person and knee person etc, everything affects everything else but the knee OS has not even looked at my right foot/ankle.

Yes am frustrated not being able to do much and not getting exercise, I am like a border collie that way, won't be long before I start chewing the furniture. Once I am able to walk safely I will try and go to the gym for upper body work.

That must be really frustrating not being able to join in with the football, it sets one apart as different which is never a comfortable feeling. Can you manage goalie or something, I used to do that at school as there wasn't much running around involved and I was too rubbish to be a striker etc haha.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on March 30, 2017, 10:14:52 PM
Hi Puffy,

I am sure your ankle will heal up nicely with a good physiotherapist and podiatrist, your right knee is becoming an ongoing saga by focusing your attention on it. It restricting your daily routine and lifestyle, you have given a good interpretation of border collie not getting enough exercise. I always had a flat stomach when I was able to do long distance running now have some flab around the stomach that I know would soon go if I was back to jog again 9 miles before my fatal slip on black ice in January 2013.

I got a call this morning there has been a cancellation this coming Tuesday to have my right hip x-ray guided injection, it was a pleasant and daunting surprise but glad to get it over and done with. I would not have a cortisone injection into my right knee again, I will have a think about fat pad debridement after hearing the horror stories from KG members. If the right hip cortisone injection has no positive impact on my right knee I would have a diagnostic arthrocopy in the hope it shows something else that the MRI scan missed out on.

I do go in defense or be the goalkeeper at the autism kids club but not very well as at times I need to run out to save or kick the ball then of course an easy goal and target to score. The kids seem to be understanding and taking my place if they see me limping to kick the ball.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on April 12, 2017, 07:47:50 PM
I saw the sports physio and he has given me some further exercises to do for the ankle, mobilised the joint, and says I am clear to go to the gym and do upper body work or cycling (or rowing, except my knee doesn't like that).

The bad news is that something must have set my knee off when I saw him, maybe the theraband crossover exercise for strengthening the ankle?

As when I left after a short walk the terrible lateral side pain in my knee started again, especially bad on stairs but even just walking hurt.

I did go to the gym today but could only do upper body work, the joint is too painful to try cycling or even some abs exercises. The knee is hurting particularly when bending and by the time I got home the only way to walk was to lift my hip up and drag it straight legged!!!

This is exactly what happened after my steroid injection, I cannot believe it is unrelated as the NHS OS clinic claims. They will never accept liability but I just want to know what it is and how it can be sorted out  :'(

Clarkey: am glad your injection went ok as I think I read in your journal and I hope it gives you some relief. It's good that the kids at your club are understanding of your knee problem, I am sure they appreciate a good support worker as you are.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on April 12, 2017, 11:42:16 PM
Hi Puffy,

I am sorry you are still having pain and discomfort that might have been made worse after you had the cortisone injection. I have never really benefited from the 5 cortisone injection into my right knee, it is  the same with my right hip pain after coming back after helping out at under 8's autism holiday club. It can be extremely frustrating if you are not able to make progress and unable to do things you once could do without any problems.

I chatted to a playworker that is well respected with many years experience, he was shocked and surprised that I have not been employed yet after 2 years of volunteering. I can handle a service users with challenging behaviour doing one to one since December. A well respected playworker told the Manager I am really good with the service user and should have be given a paid job by now. If they still say I cannot be employed should complain to The Director for disability discrimination, they already have two male Aspie Playworkers. Have done nearly 6 months one to one at the Saturday club that a paid playworker would be doing without pay! They are taking advantage of me at this stage making do a paid job for free.

I am great with young people of all ages and naturally gifted getting on well with youngsters on the autistic spectrum. Seem to have a natural bond being autistic myself can relate to them better. Sorry to flood you posting with my own ups and downs! I know how supportive you are that I should be given a opportunity to help and support young people on the autistic spectrum.

Hope your knee pain can be sorted out soon to put an ending to the never ending long winded saga.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on April 14, 2017, 09:40:54 AM
Clarkey: Due to cuts a lot of charities are now offering voluntary positions that would previously have been paid roles, if unemployed for a period it is hard to get paid work unless one has volunteered first to prove ones worth and dedication, people are expected to work for free after graduating etc.

If your role has clear progression, ie that volunteers do go on to be paid staff, and this has not happened in your case, then it could be discrimination yes. 2 years is a long time and they know you are interested in a paid role. It's wrong of them to take advantage of you especially as it sounds from your other posts like you are more suited to the role than some of the paid staff.

How did the group interview go?

As for my knee, I have had enough. I want them to trim the lateral meniscus, I can't bend my knee without pain, I have been doing physio for months and the slightest movement sets it off again, I can feel something twisting and getting caught, I think it is the meniscus, what else could it be? I know there are risks and surgery should be the last option but when I cannot even walk without terrible pain then enough is enough, it is ridiculous. I think their steroid either weakened the meniscus or the needle pierced it.

I know they are just going to say botox will help, how is that going to help a torn meniscus it won't. And they don't do surgery unless it is unstable or locking. I cannot live with this forever, it is madness for them to think I can. This is worse than the fat pad pain, at least I could walk with that. 
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on April 14, 2017, 10:01:07 AM
Get your GP to refer you for a second opinion. I'd ask to be referred to SWLEOC in Epsom where lots of the top SW London knee specialists operate on the NHS :) If you want to speed up the process, get the second opinion privately

Good luck :)

Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on April 14, 2017, 09:08:07 PM
Hi Puffy,

Despite all the pre-warnings that with many KG members saying stay well clear from having any surgical procedures in the hope it will ease some of the knee pain and discomfort. There comes a time when enough is enough being cautious and weary to go ahead with surgery, religiously going by the results of a positive MRI scan to go ahead with surgery.

It's your body and your choice what you would like done and we both know that going through surgery is daunting and frightening. If it putting a mental strain on your health and well being as well as physical health. After going through conservative methods of treatment without any success then you have the right to have surgery, you are giving your consent fully aware of the potential risks and dangers surgery can have if the kneecap is operated on.

Do how your body and mind feels and go for a meniscus trim to put your mind at ease by going for a 2nd opinion. I also feel that due to cutbacks the OS's are less likely to go for surgery, when it ends up more expensive for NI insurance contributors after months, weeks or years on unsuccessful none surgical treatments and numerous consultations on the NHS. I knew something was not wrong after scope #2 of AIR and that conservative methods has made any difference to improving my pain, discomfort and limited mobility restrictions.

I agree with you that cortisone injections do more harm than good causing even more complications. It always hard to prove that the cortisone injection you had caused the cartilage tear. I have had 5 in total with 3 done in 2015, this might have caused the increased joint effusion that shown on on my MRI scan done in January 2017.

I did not like the group interview last week Friday! I was not allowed to say I am already a volunteer for 2 years to pretend that I just met the manager and team leader for the very 1st time. This made me more anxious and insecure that showed in the group of 6 other candidates, I am not sure if I came across ok, someone autistic likes to be open and honest and struggle if we cannot say the truth. Hiding the truth made it daunting and challenging and was not my usual self.

I raised my concern with a leader I known throughout the 2 years that allowing me to do one to one with a service users that can suddenly hit other service users at club. I dealt well last week Saturday when he suddenly hit a young person on his head! I was firm and fair taking him for time out alone in another room till he was calm again.

My Team Leader said they have to look at you from a clean slate how I did during the group interview rather than looking at the 2 years volunteering I done so far. Only 5 out of 20 making it through to the final interviews. If I am not one of the 5 I will write a letter of complaint to the Director who I have met twice. She thought I was a paid playworker and so did the parents when I helped out during their 21 years anniversary celebrations.

I might never run again long distances, what I would like now is being able to be more physically active. I attended the under 8's Easter holiday club on Tuesday and Thursday, I was not really myself, under 8's are physically and had to say to them that Nick cannot join as I have got a poorly knee when I really want to but physically but not able too, feeling anterior knee pain straight away if I try to increase my walking pace. I will not leave the clinic on 12/07/17, it is putting a hold on my dream job in life unless I am booked in for surgery at the pre-op clinic.

Do what you feel is best for your knee pain and discomfort, the risk of surgery is worthwhile once you reach deadlock with conservative methods of treatment and therapy options.

Good luck with whatever you decide to do next.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on August 09, 2017, 12:09:44 AM
So I have not been on here for ages, just to update have been working with a sports physio to try and resolve this issue.

He has got me back doing squats again which I haven't been able to do for years and some other glutes exercises which are very difficult to do but what I need as the stuff the previous NHS physio had given me was too easy and not moving me forward.

We are still stumped as to what the lateral pain is. Physio did at first think it could be ITB, but then changed his mind as the pain comes on when I am not actually doing anything, eg just sitting down. He wonders if the OS will order another MRI but I don't think so as I still havent had the second botox treatment into the TFL. Plus the first MRI didn't really show anything apart from a minor lateral meniscus tear and of course the neverending fat pad impingement.

I sprained my ankle again in June on holiday so put off the botox yet again, as I've had to do rehab for the ankle (which still isn't 100% yet).

Am due to see the OS again in October and I will keep the appointment regardless of whether I manage to have the botox or not by then, but not sure what to do, ie whether to have it or not.

I also have very bad bruising where I was foam rollering the ITB. I stopped doing it for a few weeks and the initial red and blue bruising has gone but I am left with black bruises for weeks now? Don't think this is normal and wonder if it has anything to do with the botox injection I had in that area.

My glutes are getting stronger but the lateral pain is still there, not all the time but when it is it is terrible. I just want to know wtf it is!!! It is nearly a year since I had the steroid injection into the lateral femoral condyle and the pain has not gone.

In addition current physio is leaving at the end of the month so I will have to get used to a new one.

Clarkey: read your post-op diary and as you said it was the last entry wasn't sure whether I could defile it with a reply or not! Congrats on getting the job, I'm sorry your knee problems are still affecting your work and I see you've decided to go ahead with another scope. I hope it gives you the outcome you are looking for, it's a tough decision to make as you say.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on August 09, 2017, 09:18:26 PM
Hi Puffy,

Sorry to hear that you have continuing ongoing problems with your knee and always tough when a physio you know and trust leaves and have to get familiar with a new one. I was 3rd time lucky with my MRI scan showing a significant finding to go for a 3rd scope. If my MRI came back not showing anything of a concern then I would have been told that I need to accept the way my right knee is as nothing else can be done conservatively and surgically. I would ask for another MRI scan as mine changed, December 2015 MRI scan came back without any problems where surgery would be beneficial. January 2017 MRI came back with a significant finding with grade 1 effusion with tenderness over the inferior pole of the patella with a positive fat fad impingement test.

Hopefully it will be the same for you that your next MRI comes back showing it is something concrete for your OS to work out what to do next to get your physical fitness back again doing sporting activities you are being deprived off right now. My fat pad impingement got worse over time with an increase in scarring, your meniscus tear might now be larger.

Cannot comment about the bruising it might be the side effects of the botox injection, maybe something to do with the blood circulation is the 1st thoughts that come into my head. Thanks for congratulating me on my new job as a Autism Support Worker for young people with high ability and higher needs is the correct term used when talking about autism. Was low and high functioning that was rather unfair and negative label tag.

It not my last post on my diary wish it was, made a mistake should have said an end to my 2nd post-op diary that is had been corrected. Starting my pre-pop to scope #3 once I got a date for the surgery. Now my right hip is playing up at the summer holiday club that clicks when I do the PT exercises, at least I have got a positive MRI scan 1st time round with something to work on for my OS if PT fails to improve the hip pain. It's the clicking that concerns me the most, will see what my hip OS says when I see him in December after PT sessions.

Good luck trying to find something significant for your OS to work on, nearly gave up hope with 2 out of 5 of my MRI scans coming back positive. Hopefully your next MRI shows something this time round.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on August 09, 2017, 11:27:23 PM
Hi Clarkey,

Sorry your hip is now troubling you again, had thought the injection you had into it had helped or did I get that wrong?

As my last MRI was in January I very much doubt they will offer me a new one, especially as the last time they saw me they said the botox was the treatment for my lateral pain and I have not had the second treatment yet. I can try asking for another one but I think they will say no.

I am back under podiatry once more as my toe pain - bunion stemming from the collapsed arch - is getting worse. So maybe faulty biomechanics are making the knee worse as well, will have to see if i need a new prescription for my orthotics. Am hoping it can be managed conservatively, I really don't fancy bunion surgery, but it is very painful even walking a short distance and wakes me up in the night throbbing.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on August 10, 2017, 09:40:12 PM
Hi Puffy,

Worth asking your OS for another MRI scan, a lot can change over a 7 month period. Bunions are very painful and crippling, toes and feet are extremely sensitive. Stubbing your toe is bad enough so can understand how painful it most be coping with the daily with pain and discomfort from the bunion. Hopefully will not need surgery to remove the bunion, if you do it a straight forward common procedure, the thought of going under that's a daunting prospect.

My right hip cortisone injection done in April is now wearing off, fully aware that having clickey joints as long as it not painful and uncomfortable. When I rotate with my hip extended can hear a loud clunk that does not feel pleasant. MRI showed up a small labrum tear, hip impingement, joint effusion and bilateral cam lesions. Guessing the cam lesions is causing the clunking when rotating my hip at a certain angle. Worse case is surgery to smooth out the cam sucket and repairing the labrum tear if PT exercises does not improve the pain and discomfort. Early intervention is better in the long run to stop the hip wearing out too quickly.

I am not going to do the last two weeks at holiday club want to rest up my knee and hip as I am on my feet all day, will stick to the Saturday Club, no more holiday clubs joints cant take it, could make things worse rather than better and have learnt the hard way already overdoing by running too much before my knee in injury occurred.

[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on August 17, 2017, 12:00:14 PM
My physio seems to be mystified by what is causing my problems. He did a fat pad test which he says is negative, yet I can still see a bulge compared to my left knee and still getting anterior knee pain. Also think doing leg press, which he recommended at very low weight, has aggravated the old FPI anterior knee pain.

As I can squat over 90 degrees he doesn't think my lateral pain is ITB, it also comes on when I'm sitting down which to me sounds like PFPS except it is solely on lateral side and is sharp twisting pain not the ache of PFPS.

Was reading somewhere that PFPS is meant to resolve within 6 weeks of physio treatment - HAH.

I think that current physio has helped somewhat with the lateral pain, in that it is not flaring up as much as before, and he's got me back to doing 7 mins on the cross trainer, pain free, whereas before I could not do over 3-4 mins without the twisting pain.

I see podiatry in September for biomechanical assessment, and then OS in October.

I still haven't made a decision about having the botox treatment but I best do it soon as if I go back in October and haven't had it they will probably discharge me.

My hunch is that my lateral pain is the meniscus rather than ITB, based on the feelings of getting stuck, twisting etc

I can ask for another MRI but I very much doubt I will get it.

Was hearing now you only get 3 NHS physio sessions and if you need more you have to go back to the GP, am grateful I can afford private physio for now but this whole knee problem has cost me so much and still isn't resolved.

@Clarkey - sorry to hear of your ongoing hip problems in addition to the knee, this is the problem,we end up with multiple issues as a knock on effect. I hope the PT helps so that you do not need surgery on your hip as well as your knee.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on August 17, 2017, 02:18:28 PM
Could you perhaps get a consult with Clare Robertson at Parkside? I realise she is quite expensive but is a recognised PF expert. Fresh pair of eyes is always good :)
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on September 02, 2017, 04:43:02 PM
Have now seen the Podiatrist. My xrays show that my toes are only 12 degrees of deviation - the threshold for a bunion is 15 degrees - therefore surgery is not an option at this stage and may even make things worse.

The podiatrist feels that with all the goings on with my knee, my biomechanics have probably changed and therefore the best way forward is to address the issue with physio. Therefore he has recommended a sports physio. I have no idea how much this is going to cost as their website has no info on fees for self-paying clients - so I suspect it will cost the earth. Have emailed them to find out.

Podiatrist has also recommended Hoka trainers, which should take the pressure off my toe. Will have a trip down to Run and Become to try them out.

He's said my xrays show that my left toe is actually worse, even though I'm getting more pain in the right toe, thus he thinks the issue is more biomechanical than to do with the level of deviation.

He has given me an open appointment with the option of having an MRI scan on my toes if the physio doesn't help, but says even if the MRI shows inflammation my only options at this stage will be injections. He's told me there really isn't a way to stop bunions getting worse, but they can be fixed when they do get worse. He checked my orthotics and doesn't think I need a new prescription.

He's also said he'd wait and see the physio before making a decision about having another botox treatment into the TFL for my knee, so will have to postpone my OS appointment again.

In terms of the lateral pain, am now able to do 10 minutes on the cross trainer, credit to the other sports physio I was seeing (who has now left), he has helped. Can also feel my glutes are much stronger and working more effectively. But still having anterior knee pain and lateral pain has not gone altogether, though it is not as bad.

@Vickster, I would consider Clare Robertson if all else fails but really she is pretty unaffordable atm. I'll probably try this new person the podiatrist has recommended, they do gait analysis so should be able to see where my function is failing. If it doesn't work I will probably need injections for my toe as it is very painful and I'm unable to take anti-inflammatories.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on September 03, 2017, 09:18:37 PM
Hi Puffy,

Shame you are not based in the Midlands region of the UK, The Birmingham Royal Orthopaedic Hospital has an excellent team of physiotherapists and extended scope practitioner that each have special areas of interest. There must be some good PFPS physiotherapists on the NHS at your nearest orthopaedic hospital or unit that do both NHS and private.

Might be a silly suggestion have you ever tried reflexology that will not cure the pain just ease it slightly and at the same time make you feel more relaxed. Also beneficial for other heath related injuries and problems.

https://tennenttechnique.blogspot.co.uk/p/foot-pain-and-reflexology.html

Still waiting for a date for scope#3 like to know soon so I can plan ahead, the Saturday Autism Club that starts again next week Saturday be nice to tell my leader a date, should be next month but might now be November or December with the NHS under budget and overworked.


[email protected]
Title: Re: Pain under knee, lateral side above fibula?
Post by: Jose831avalos on September 05, 2017, 06:08:24 PM
Work on hamstring
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on September 17, 2017, 12:45:49 PM
I've now seen the new physio, he is very stern and a bit scary tbh in direct contrast to the last physio but seems to know his stuff. Also the new place is quite posh and has a personal training gym attached to it where lots of very fit people are. It's quite intimidating.

He says I have classic PFS and that no surgery will help, he has seen 2 people who had the ITB lengthening op and were not any better. He does not think botox will help me either as he says I am too flexible rather than too tight. He said the NHS does not give as thorough assessment as he does (not strictly accurate in my case but anyway) and are just offering the op as they have not got the time. I don't think so as they are trying to avoid giving me a scope.

Anyway he has given me some new exercises to do, which have to be done in order, at the gym (which may be a pain given how busy it gets, getting hold of the equipment to do them in order etc). He says recovery from PFS is a long hard road. I expect that means it will be costly.

I tried the Hoka trainers and could not find one pair that fit properly, they are too narrow for my wide feet, one pair made my right toe feel better but my left toe worse, another pair was lovely cushioning for my feet but made the lateral knee pain worse etc. Even men's sizes were too narrow. I need to find something that has stability but also decent cushioning for my painful big toes.

@Jose, yes I have been working on hamstrings, along with everything else.

@Clarkey, have not tried reflexology but with having to pay for physio shouldn't think I could afford both. Hope you get a date soon for your scope.

I am due to see the OS in October, I would rather postpone the botox and have it there as an option if this new rehab programme with the sports physio does not work out, but I don't know if they will agree to that, they may discharge me instead.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on January 11, 2018, 01:22:44 PM
I saw the OS this week, actually saw the consultant. It did not go very well. He rushed me, did not really listen, talked over me etc and I felt so flummoxed I did not present my case very well. I normally have someone go with me but they were ill so I had to go alone.

The upshot of it is that I have been discharged from the OS clinic as they feel there is nothing that can be done for me surgically, but I have been referred back to the NHS physio who runs the botox clinic, to be assessed for further botox if I want it, and that I can discuss with the physio if I want to put it on hold.

The OS refused to comment on the lateral pain I've had since the steroid injection into the lateral femoral condyle in 2016, saying that he can't comment as he did not give me the injection.

He examined me but it was short and perfunctory and I got the impression he just wanted to shut me up and discharge me. I'd already told him the pain is not replicated on examination and only hurts with activity. He asked me what the pain felt like and when I told him it seemed to me he did not believe me.

He seemed overjoyed I'm seeing a private sports physio and agreed with his opinion even before he had examined me  - just think he was thrilled to discharge me.

After my consultation I had to fill in a survey on how he did, but I had seen the receptionist reading previous patient's surveys after they handed them in, so didn't feel I could be honest that I was not happy at all with the consultation.

My current sports physio does not feel surgery will help though he is neutral about the botox. He feels my problems stem from hypermobility rather than tightness so all the usual treatments like ITB lengthening and botox will not really help. I am carrying on with him for now though had a setback after he got me to do split squats which just aggravated the anterior knee pain, so he has taken me back to goblet squats.

I am really upset that no one at the NHS clinic will take responsibility for what their injection caused or do anything about it. But I know from experience it is totally pointless complaining, they all just back each other up and obfuscate.

Some weeks ago the private sports podiatrist suggested the lateral pain has been caused by them catching my popliteus when they injected the LFC. He did some manipulation which has helped a bit but it has not got rid of it.

I don't know, I am so fed up of the whole thing, I don't really know what to do.

It is January 2018 - 10 years of fat pad impingement. And now over a year of lateral pain too.

Happy *%&@~#£!* new year  :'(
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on January 11, 2018, 07:08:44 PM
Hi Puffy,

Sorry, you are not making any progress with your ongoing knee saga! I suggest that you get a GP referral to Birmingham Royal Orthopaedic Hospital that takes on patients nationwide do not have to live in the city of Birmingham or surrounding counties. Dr Bhogal I highly recommend a Consultant in Sport and Exercise Medicine at the sports injury clinic. He has a great portfolio as a team doctor for the England Cricket Team that have just lost the ashes badly.

http://www.roh.nhs.uk/about-us/our-team/item/dr-b

The staff at the hospital are fantastic and would see Dr Bhogal 1st before seeing an OS, he will know what to do and which procedures to try out first before considering surgery. I had ESWT and x-ray guided cortisone injection for my patella tendonitis and now having patella decompression surgery this coming Tuesday 16th January. He also found I had a labral tear in my right hip by doing a full gait assessment.

Good luck, don't give up hope, I thought Tuesday would never arrive a year ago after all the setbacks finally making progress. I am sure you will once you find someone that sympathetic and understanding towards you ongoing knee problems.

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Title: Re: Pain under knee, lateral side above fibula?
Post by: Alina on January 30, 2018, 10:34:16 AM
Hello!!!

My mom has been suffering from severe pain in her knees and some other joints. The pain that you have mentioned here, here experience is pretty similar. Different people are suggesting different things. There are some people who are worried it is arthritis where as others are suggesting it to be dengue. She also has quite high temperature. Someone suggested a pill  (https://justdoc.com/medicine/caripill-tablet-carica-papaya)which kind of worked for a while. However, both the pain and the high temperature returned after a few months. I am considering her taking to the hospital if things do not improve. Any advice would be very helpful. Thank you.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Vickster on January 30, 2018, 11:29:52 AM
Definitely take her to a hospital to see a specialist. I don’t know what country you are in but a musculoskeletal specialist rheumatologist would seem a sensible place to start.
I wouldn’t wait to get her seen. How old is she? What pill did someone recommend? Was it a doctor?!
Title: Re: Pain under knee, lateral side above fibula?
Post by: Puffy the Knee Slayer on March 11, 2018, 10:49:08 AM
I've since been reassessed for the botox injection. The NHS physio claims I am still tight on the right hand side and that they have treated people with hypermobility with botox and still helped them.

He is also now saying that the lateral pain is the ITB bursa. This is the first time he has mentioned it, so I asked him what the treatment for that would be and he said....yep you guessed it, botox.

He says I have tried lots of physio and it has not worked so I need to add something to the mix and botox is it. But as he heads up the botox study he is not impartial.

Anyway he has left it open for 6 months, which is the maximum he can do, for me to decide.

Meanwhile have progressed with my sports physio, though my current setback is insomnia. Sports physio says do not even return to see him until I sort this out as the knee rehab will not work if I cannot sleep.

A few weeks ago I had an internal job interview and wore normal shoes for a couple of hours, within a short period of time I had terrible anterior knee pain. My physio says that this is not due to my collapsed arch and he thinks the problem is with my balance, and he now wants to focus on the lower leg so he has added some bent knee calf raises to my programme and I am doing weighted step ups to a high step now as well. Still continuing with the dreaded lateral band (monster) walks.

Oh, and I did not get the job :( I had thought I had done well in the test and interview, had gotten very positive feedback and encouragement from supervisor, but the job went to an external candidate. Very disappointed.

Glad the snow and ice is over, was afraid hobbling about in walking boots that I'd slip and injure the knee again. The boots are not as stable as the trainers, but better slight pain from non-motion control shoes than agony from a fall.
Title: Re: Pain under knee, lateral side above fibula?
Post by: Clarkey on March 16, 2018, 05:02:06 PM
Hi Puffy,

Sorry that you are going through a rough time at the moment with so many setbacks and personal obstacles with lack sleep are bound to get you down on top of all your other worries. Finding a job and an understanding employers are hard to find nowadays. Just filled out my PIP application form, my gardening jobs around my neighbourhood cannot be carried out this year. Want to make sure I recover well from my 3rd scope and not jeopardising it by doing too much manual work on top of my right hip impingement.

You are entitled to claim benefits for your physical and mental health needs and should not feel bad when applying for Employment and Support Allowance (ESA) that I will be looking into as my PIP application is likely to be rejected. All my friends on the autistic spectrum claim ESA, think you can only do 16hrs a week that would be the maximum I could manage with the state of my right knee and hip till it starts to improving.

Thanks for reading my post-op dairy and the 4 likes was a nice surprise :)

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