Advertisement - Hide this advert





Author Topic: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)  (Read 1178 times)

0 Members and 1 Guest are viewing this topic.

Offline twilitemoon

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Hello all.  ;D So, this being my first post, I'll explain why I came to this message board.
Beginning in high school, I began to experience pain in my knee. I never did anything about it, convincing myself that it was nothing substantial, and that the pain would subside eventually. However, the pain only intensified as I entered into college, and it was then that I sought the opinion of a doctor. The orthopedic surgeon took an X-ray of my leg, and told me that my patella was not alligned properly. He told me that I would need physical therapy so as not to further exacerbate the condition. Unfortunately, the only time they had alloted for physical therapy at the clinic was during that of my classes, so I was unable to go.
Since then, the pain has intensified, it now being four years since I last saw a professional. The pain is all around the kneecap, but the worst right under my kneecap, and then, following on both the right and left sides of it. Every time I flex my leg, there is a creeking sound and a click. Often, it feels as if my kneecap is not in place, and when I stand up, I can move my kneecap quite easily from side to side, unlike that of the kneecap of my right leg.
I've never been athletic, so whatever is occuring is not the result of running, etc, so, I'm not quite sure how to categorize it. I've gone to see a doctor about it, who took an X-ray, so I'm hoping it give me some feedback, because it's becoming quite excrutiatingly painful. I'm seeking advice from this board, because I am on a military base, and well, a lot of times, one has to cry bloody hell to actually get to see a specialist. So, if anyone has some advice, or a suggestion as to what it may be, I would be most appreciative. I am not looking for a definite diagnosis, but perhaps, some feedback on whether I should have received more than just an X-ray, or what I can do to ease the pain, or even, what the different potentials are for the problem.
Thanks in advance for any responses.  ;)

Offline cat

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1575
  • Liked: 0
Re: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)
« Reply #1 on: September 08, 2005, 02:46:17 PM »
Sounds like your patella may be subluxing. You really need to see a specialist and not just any OS. You need to see one that specializes in knees. In the mean time, do your homework and find out all you can. Here's a great link to start with. The course btw, is awesome!

http://www.kneehippain.com/patient/i_patellarpain.html

Good luck to you,
 ;D cat  ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline twilitemoon

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)
« Reply #2 on: September 08, 2005, 02:58:12 PM »
Thanks so much for the link, and for the suggestion. I wish it were that easy to just skip the general practitioner and see a specialist, but the way the military hospitals work, is that, regardless of what you have, you first need to see a your general doctor. Even more unfortunate is that we are stationed overseas, so I'm not able to consult a non military affiliated doctor.  :-[
Hopefully the X-ray will show something, so that I'll be sent to an Orthopedic surgeon, but, in the meantime, I am trying to do my own homework so that I can contest the general practitioner if he claims that I am 100% fine. This pain has become rather debilitating as of late, and I'm having trouble sleeping because of it. Therefore, thanks so much, once again, for the advice. Now I have a condition to reference next time I see him!  :D

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 10
    • Check out my photography!
Re: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)
« Reply #3 on: September 09, 2005, 09:53:39 AM »
Here's another good site explaining the catch-all diagnosis of PFS, which might be used in your case.
http://www.steadman-hawkins.com/pate/overview.asp

Also, the ability to move your kneecap extensively is called hyper-mobility or a hypermobile patella.  The problem with that is it's often associated with unnatural or very rapid wear and tear of the cartilage on the back of the kneecap.  This damage can range from 'just' at the level of cartilage (a problem often called chondromalacia or chondral defects or lesions) or it can even go through the cartilage and into the underlying bone--at which point it becomes osteoarthritis.  Now, this isn't as dire as it sounds, at least not necessarily.  We all will experience wear and tear of our cartilage--it's a consumible, meant to be used up in protecting the bones in the joint.  And there's no reliable, direct correllation between level of cartilage damage and levels of pain or disability.  So that's good news.

The bad news is that x-rays alone won't show damage to articular cartilage on the back of your kneecap or in other areas until it becomes very, very severe--we're talking bone spurs and bone on bone contact.  Theoretically, x-rays will show mechanical or alignment problems that are linked with cartilage damage...but only if the doctor orders the correct views.  It happens that some non-standard ones are required, including sunrise or merchant view and weight-bearing views and lying on your side with knees bent to 30 and 45 degrees.  These are part of a professional and very thorough knee x-ray series ordered by an OS that specializes in PFS problems...but often they are not ordered when someone who is not a surgeon or PFS specialist, when a traumatic injury (like a broken leg) is suspected, or even when the doctor is basically trying to placate a patient with a few diagnostic tests when the doctor really thinks the problem is something like 'growing pains' or some other nebulous non-diagnosis.  X-rays are relatively cheap and they actually are quite helpful in fully diagnosing knee issues...but they are only part of the equation--the rest involves a thorough hands-on exam by a knee expert and then correllating those exam findings with the symptoms the patient describes.  A general practitioner is not necessarily trained to do this, and many have been frustrated in their dealings with a health system that requires going through the GP (whose job is to control costs and/or who doesn't have the skill set to properly diagnose complex problems like PFS). 

I have no idea if that is what's going on with your GP at all, I'm just relating my personal experience.  If the x-ray views I described above weren't ordered (basically views with the specific goals of looking for patellar mal-alignment or serious underlying issues with the patellar mechanics), the x-rays may not be as helpful as they could be.  They should still be done, but you may get more information (and certainly more useful information) from an MRI.  ONce again, however, it's necessary to have the proper views ordered and to ensure that the doctor reading the MRI results knows what he/she is looking for (see the link Cat posted for Dr. Grelsamer's detailed info on MRI's and their limitations in diagnosing knee issues)!

Hope this information is helpful.  Also, you will want to visit the main kneeguru page and look up the information on the patella, here:  http://www.steadman-hawkins.com/pate/overview.asp

Heather

PS what country are you located in--maybe there is a great doctor that someone can recommend for you to see privately?  Just a thought.
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline twilitemoon

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)
« Reply #4 on: September 09, 2005, 11:22:49 AM »
Hi Heather, thanks so much for replying to my inquiry. I'm on a naval base in Japan, so, there are two problems with seeking out a doctor here: the language barrier, and the expense of Japanese hospitals. Further, my husband and I have only enough money to pay our bills and eat, ruling out my venturing out into Tokyo in search of a competent doctor.
As for the X-rays, I had three done. One being my bending my knees, while sitting down, the other being of my legs flat and straight out, and the third, where I was laying on my left side, my left knee bent at an angle, and my right knee over my left knee on the side. I'm not sure if those are the appropriate ones to issue, but I do know that in 2001, when I was seen by a Duke University specialist, he took multiple X-rays, and had them done on both my legs to compare and contrast. I am supposed to see my doctor tomorrow morning, but I'm not sure if I will this weekend, since I was too late coming home from work to schedule an appointment. Hopefully I'll be able to catch him tomorrow and talk about further procedures, because the pain is now keeping me awake at night.
My doctor is the only caring practitioner I've met so far, so I think that he'll be pretty inclined to schedule an MRI if nothing is positive on the X-rays. I wish it were easier to see a specialist, but it's not here. I do know that he asked me whether or not when I saw the Duke doctor he did anything more extensive than X-rays, and I told him the truth -- that he didn't, because he could see the misalignment on the X-ray. However, I wonder, even if I have misalignment of the patella, is that enough to fully diagnose what is wrong, and properly remedy the problem? That was in 2001, and right now, I'm in horrible pain, and it's getting worse each month.
I feel the most pain when my leg is straight, and less when it is bent. However, now, I have a constant throbbing pain under my kneecap, and my knee has been buckling when I apply too much pressure on it, simply because the pain can be quite horrendous.
What do you suggest is good to confront my doctor with? If I am armed with my own knowledge of what to do, then I think I stand a better chance at obtaining the proper treatment. At this point, I just want to be able to not be in such pain!
Thanks so much in advance for any more suggestions you may make, or anyone, and if there are no more suggestions, hey, thanks for the first ones! It's nice to find such a community on the web, especially when there is relatively little community on this base, and one can feel quite estranged at times. I'll post next when I see my doctor next.

Offline Natalie.D

  • SuperKNEEgeek
  • *****
  • Posts: 1090
  • Liked: 0
Re: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)
« Reply #5 on: September 09, 2005, 12:21:15 PM »
Hi there,

As has already been mentioned, you REALLY do need to see an orthopaedic surgeon, as the damage the maltracking is causing on the back of your kneecap is more than likely irrepairable so you obviously want to minimise this as much as possible, I had similar problems and did not get it seen to, I now have grade 4 (bone on bone) osteoarthritis because of the maltracking.  Firstly, whilst waiting to see if you can get referred to an OS, can you get referred to PT again?  Work really really hard on your quads etc to keep the knee muscles strong, this will help to keep the kneecap in place (hopefully), also ask your PT about McConnell taping - some people find it doesn't help whilst others, like myself, swear by it, if done properly, it can help to keep a mobile or malaligned kneecap in place - although this is just a temporary, short term fix and by no means corrects the problem.  Also, could you perhaps try wearing a knee brace in the meantime, that may also help.  There are surgeries to fix this type of problem, the most common ones being the TTTs which for many people have been a godsend and given back a quality of life they haven't had for many years.  Do some research on the TTTs so at least you can go to your doc with the knowledge of what is available for this type of problem.  Also check out the patello-femoral section on this board, you will find loads of info there too.  Good luck, I hope you manage to get an appointment soon and get this problem sorted.

Natalie.
Dislocations since age 12
Trochlear Dysplasia
Maltracking
Hypermobile
LR/MR-failed
TTT, LR, MR L knee 95-Success
TTT, LR, MR R 02-Success
Screws out
Partial tear ACL
Severe end stage OA
4 Debridements
Partial Meniscectomy
Failed Microfracture
11mm Defect LFC
Bone Spurs, Kissing Lesions

Offline twilitemoon

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Knee Problem for Several Years Now -- Seeking advice (any appreciated!)
« Reply #6 on: September 10, 2005, 11:26:36 AM »
Well, I went to see my doctor today, and the radiologist still has not finished reading my X-rays, so, I still am in the blind as to what is going on. I talked to my doctor about the potential of getting an MRI to rule out other associated injuries and the such. I wish I could see a specialist, but it's not possible.
As for the treatments, I'm not sure what I should expect. In 2001, I was told that the problem could be remedied by physical therapy, but, that was four years ago, and back then, my leg didn't creak, click, nor hurt every second of the day. I'm nervous, but, as I mentioned, want to be armed with an array of knowledge to talk to my doctor about. My husband has been thoroughly supportive, but he's gone almost all the time, since he is in the navy. Therefore, I'm on my own, and honestly, I don't want to spend the few times I have with my husband in frequent pain.
However, I did do what was suggested, and read through the forums, and looked at the websites, and it definitely has cultivated my knowledge of knee pain. Truly, thank all the posters for caring enough to help! As of right now, I will post again as soon as I hear about my X-rays.
However, if there are any people out there who have had a similar condition to how I am feeling, please post and tell me what it was and what the protocal was for treating it! Thanks!















support