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Author Topic: Fat Pad Issue  (Read 988 times)

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Offline jennR

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Fat Pad Issue
« on: November 25, 2008, 03:37:50 AM »
 :'(Hey there,
this is my first time posting.  I  am a 28 year old mother of three very active boys who are the age of 5, 3 and 1.  So I have no time to be in pain.
Here is my story:
Four years ago I was injured at work by a child during a soccer game. At the moment that my left foot ( my dominate) came in contact with the ball one of my students came around from behind me to steal it. He and i made contact causing him to fall from my left side. When he was falling to the black top i reached for him causing my knee to shift to the right and popped.  I was sent for a workers comp case , I recieved an x-ray and one session of PT.  OOOOH, did that help!  Not!!! . Any way the pain lasted for several months and went away totally until now.  I believe I have reinjured or caused a very simular injury about 12 weeks ago I was showing off in a tipsy stupper and I jumped from about a six foot drop to my feet.  When I woke the next day I was in so much pain, causing me to have trouble walking.   I went to my family DR who sent me to my OS.  My OS sent me for x-rays and an MRI which surprisingly came back normal with some unclrearness. So He sent me for three weeks of PT which did not help.  Now 12 weeks into the pain, I was sent for another MRI with the die injection.  OUCH! The doctors forgot to tell me that I would not be able to walk on my own. I just was not expecting so much pain.  My knee was injected at the joint and was filled with 1/3 of a cup of the die.  Expected to walk to the MRI machine, which I tried to do, however I stumbled to a chair realizing that I was in no shape to walk the hospital halls to the MRI room. The pain for the injection was intence.  And of course this MRI reading had nothing new to tell us although it did rule out damage to tendants. Thus, causing him to diagnose me as having a fat pad issue.  "WHAT You, think my knee is over weight?!?" was the first that crossed my mind.  I left the office today thinking this guy is insain. So I started my search the web for any info on fat pads,several hours in tomy search I found out that this is a common injury.  And sadly, it looks like it's not a quick fix.

My symtoms include:  
 Pain, tenderness under my knee cap,  my knee seems to give out at times.  The pain wakes me up at night so I'm rolling from one side to another.  stairs, bending at the knee, kneeling, standind or sitting with out moving my knee causes me pain as well.  mild loss of knee extension,clicking in the anterior part of the knee.The pain is well localized to the front of the knee or to the side of the patella tendon.
The pain is usually sharp and can last for several hours or days once provoked.
Going up and down steps or squatting will aggravate the symptoms.  NO SWELLING has occured.

IF you have any suggestions for me on hope to eliminate some of the pain and some exercise methods that may strenthen my "FAT PAD" I would be greatful.
Thanks,
Jenn

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Re: Fat Pad Issue
« Reply #1 on: November 25, 2008, 05:46:19 PM »
Hi jenn,

Welcome to the fat pad club which I been part of since October 2007 when I fell onto the pavement while jogging and not been able to jog since. I finally had an MRI scan in July 2008 and and as yours did the scan came up as normal with no damage to the ACL or meniscus but did find swelling and fluid around the fat pad. I 1st went to a Osteopath and it did not help me, I then did some PT and it still did not help, I then had 4 ultrasound therapy at my local PT Centre and it did not help at all. I now will see the PT at the hospital on 3rd December and says I will get an cortisone injection into the fat pad by an OS to see if they can reduce the swelling. I have swelling mainly at the bottom of my kneecap thats never gone down since my fall.

I get pain mainly on the lateral side of my knee and also get clicking and catching at times and sudden sharp busts of pain but only last a few seconds not days like yours but do feel pain and discomfort in the knee most days. Not always but at times when going down step get the sudden spurts of pain and my worse pain I get sometimes is so intense that the pain goes from my kneecap up the side of my leg to my hip.

I work as a Greenkeeper and when I doing a lot of manual work aggravate the fat pad and get the sudden sharp pain more. Most of the time its a dull ache towards the bottom of the kneecap.

I go to the gym 3 times a week and if the pain not to bad go on the cross trainer and excercise bike but if it hurts too much stop straight away. My PT said dont carry on if you are in pain. The best option is swimming as you not putting to much stress on the knees. I not sure if stetching helps or not but can find a good PT and ask him/her what excercises to do and how long you should be doing ot for.

What about a scope has an OS said the knee needs looking at inside or did he/she suggest to strengthen the leg muscles as one OS suggested to another member on this this boad but can tell you now it wont help as I been doing PT now for 6 months almost and its not improved my fat pat problems.

I hope you get the treatment you need soon and find an understanding OS that knows about problems with the fat pad, feel to free to PM me if you want with regards to the fat pad as I am sure you like to know how others get on with thiers on this board.

Nick :) {2008} :)
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline plantgeek58

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Re: Fat Pad Issue
« Reply #2 on: November 25, 2008, 07:30:30 PM »
Hi Jenn,
Well, you probably know from your Internet search that fat pad inflammation is usually caused by a patella that is tilted downward so that the bottom tip of it digs into and irritates the pad. The pain stems from the fact that the fat pad is very well innervated by the synovium. The key to getting it under control lies in shifting the position of the patella so that it is no longer causing the irritation. When I was having problems with this, my physical therapist showed me how to tape the knee in a V pattern that keeps the bottm of the patella up and away from the pad. That works for a short time, but the tape does sometimes stretch and lose its support. You also have to frequently remove and re-do it. If it's left on too long, it sticks too tightly to the skin and getting it off becomes a painful ordeal.
A more lasting solution would be a knee brace with a J-shaped support around the knee cutout. You can get your OS to script that and insurance should cover the cost.
PT does sometimes help with the problem, too, but the exercises need to be targeted to the correct muscles. The position of the patella is most influenced by its connection to the VMO on the medial side and the IT band on the lateral side. People who have patellar tilt usually have a tight IT band and a weak VMO. Exercises targeted toward strengthening the VMO and getting the IT band to loosen up can pull the patella into a more normal alignment and take pressure off the fat pad. It can sometimes be difficult to build up strength in the VMO, though, so you have to be patient and be diligent about doing whatever exercises you're assigned. Friction massage across the ITB is usually the best way to loosen it up.
If all else fails, surgery can be performed arthroscopically to either shave or remove the fat pad altogether. My OS took care of the problem when I had to go in for a meniscus tear procedure and I haven't had a recurrence since. 
Hang in there, Jenn. This may not be an easy fix, but it's not hopeless.
Terre
RK 7/04 part. m. menisc., plica resect., MF
    3/05 part. m. menisc., open OATS
    1/07 part l. menisc., MF, patellar chondroplasty
    9/08 MF
LK 11/04 & 8/06 part m. menisc.
     7/07 LR, patellar tendon debrid., part m. menisc.

Offline jennR

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Re: Fat Pad Issue
« Reply #3 on: November 26, 2008, 05:00:11 PM »
Hey Terre,
Thank you so much for you advise. I just wanted you to know that I do have the J brace that you were talking about.  It's Okay, I was sized by me PT, the sizre is correct but do to my job an my constant up and downs i seem to have a lot of trouble keeping in the correct spot. So I do a lot of pull ups thorugh out the day.  I started at the gym to strenthen my legs. I spent much of my time taken it easy on the bike nad focus on my quads and glut.  It really seemed to agravate my knee so i'm poppen the advil. However thanks for your time and advise.
JennR