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Author Topic: Knee in severe pain, no explanation  (Read 19925 times)

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Offline knee always hurts

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Knee in severe pain, no explanation
« on: November 04, 2010, 08:51:15 PM »
After dealing with a severe inflammatory problem with my left knee for several months, which was never diagnosed, I was finally making progress, and by late August, I was actually feeling that my knee might have a chance of being normal again. But just as that problem was going away, a new problem started in a different part of my knee. All of the sudden, at PT, I started getting subtle sharp pains when doing step ups and squats. It was getting worse, so my physical therapist and I agreed that I should take a break. At first it seemed like it was improving, and although I was using a cane to climb stairs, I was walking without much pain. In the last few weeks, however, my knee has rapidly deteriorated. I started getting a lot more sharp pains in my knee when walking, and my knee had this strange sensation of emptiness.

Then, on Tuesday morning, I woke up in the middle of the night with pain severe enough that I had trouble falling back asleep. When I woke up in the morning, the pain was even worse, so I decided to go to the ER. I couldn't put any weight on that knee without experiencing severe sharp pains. On a scale of 1-10, I rated it as 8 or 9. At the hospital, the doctor decided to order an X-ray, but it came back clean. The doctor said that the joint space looked fine. He manipulated my leg, and I didn't hear any crepitus or feel any grinding sensations. I asked about an MRI, but the doctor didn't want to order it just yet. He prescribed naproxen and vicodiin, and while it seems to help, I am still in constant pain.

The pain is localized to the superolateral corner of the patella. I thought perhaps that my cartilage was just completely destroyed in that location, but the doctor didn't think that the problem is cartilage at all. He didn't suggest anything else, though. He just advised me to take the anti-inflammatory medication, continue to use crutches as needed, and suggested that it would probably start to improve.

What could possibly cause such debilitating pain in that part of the knee? As a result of being in pain for so many months, I've studied a decent amount of knee anatomy, and I can't figure out what could cause this level of pain in such a short period of time. I should mention that I've had an extremely low level of activity the last few months, so this didn't happen when doing strenuous exercise.

I haven't tried to bear weight on in the last couple of days, so it's possible that it has improved somewhat. But I now have this feeling of "fluidity" in my knee, and it doesn't feel much better than a couple of days ago. I should mention that there isn't any visible swelling, either. I'm really worried that something could be seriously wrong, but the doctor didn't see any cause for alarm.

What could it be?

Offline SqshPlr8

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Re: Knee in severe pain, no explanation
« Reply #1 on: November 05, 2010, 05:18:32 AM »
Geez man.  I am sorry to hear.    :-\

Has your insurance come through yet? Do you have an appt. scheduled?

Perhaps it is ultra-innervated, impinged synovium?   

Offline knee always hurts

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Re: Knee in severe pain, no explanation
« Reply #2 on: November 09, 2010, 10:51:43 PM »
A week has passed, and the medications given by the ER doctor haven't worked. I actually had to stop taking the naproxen because it was bothering my stomach. But I took it for 4 days and it did nothing. I still can't bear any weight on my knee without experiencing severe pain. It almost feels like there is liquid in my knee as well, but there is no swelling. My fear now is that my leg is going to waste away. I don't think I'll ever be able to bear weight on this knee again without surgical treatment. Should I go back to the ER or wait until my insurance is approved? I've read that it can take up to a month for that to happen. I submitted the papers about a week and a half ago, so I could still be waiting for 2 1/2 to 3 weeks, and then I have to make the appointment and wait even more. How long can I safely go non-weight bearing before it is a serious problem? I don't want to jeopardize potential treatment options as a result of severe muscle atrophy or cartilage softening. If I go back to the ER, I imagine they'll just give me more pain meds, which haven't worked, and that's it. So what's the point?

Offline kscope09

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Re: Knee in severe pain, no explanation
« Reply #3 on: November 10, 2010, 12:28:50 AM »
If you go back to ER what will they do?

I think if your having that much trouble it it then maybe you couldn't get any worse by having a scope.  What does the pt say about it?
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline knee always hurts

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Re: Knee in severe pain, no explanation
« Reply #4 on: November 10, 2010, 12:51:02 AM »
That's what I'm wondering. I imagine they won't do much at all. They suggested that I make an appointment to see a specialist, but the sheet I was given also suggested that I could return to the ER if needed. But if they're just going to give me more pain meds that aren't actually working, then what's the point?

I agree about the scope. If you've read any of my other posts, you know that I was willing to try a conservative route until the end of time or at least the limits of practicality if I thought it had a chance of working. It seems all but hopeless now so I'm resigning myself to the reality that surgery is in my future, with all its pitfalls.

I haven't gone to PT in over a month because of the insurance situation and because my knees were getting worse. They stabilized for a few weeks, and then my left knee got dramatically worse last week. I don't understand how my joint could be in such a disastrous condition since I didn't have any knee problems prior to Sept. last year, and I've never had a hard fall on them. I hope this pain is not the result of a chondral injury, but am having a hard time understanding what else might be causing it. Even though all knee problems are bizarre, I'm certain that all of us on this forum agree, I at least knew what the precipitating factors were with my other knee problems. I almost thought I was cured and then this problem started out of the blue at PT. And it happened in only a couple of months. Go figure!

Hopefully whatever this is, it ends up being something with decent treatment options. I feel like a complete fool for not getting my insurance situation dealt with sooner. Of course it's just my luck that my knee decides to go south just a few days after I apply for the insurance, yet long before I actually get it! It's agonizing not knowing what is wrong!  :'(

Offline kscope09

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Re: Knee in severe pain, no explanation
« Reply #5 on: November 10, 2010, 11:28:34 AM »
I'm not gunho for scopes believe me, my experience with arthtoscopy las tyear was not a pleasant one, but I might need one for the other knee sine the physios have thrown up their hands and said there's nothing more we can do.  When i first injured my right knee in feb 08 the thought of surgery was quite sickenning but believe me, 18 months later with much more medial pain and catching that drove me round the bend I was ready to cahcne it and as hard as it ahs been I don't regret it even if my plicas grow back and my chrondopalsty fails, at least i won't have that bloody fragment floating about anymore.

The thing is though, if you can't put weight on it now and it keeps getting worse it might be time for the surgical route.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline coral 251

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Re: Knee in severe pain, no explanation
« Reply #6 on: November 10, 2010, 12:21:28 PM »
Hi, sorry to hear of your pain problems,have you had a CT scan?,apparently this shows up problems more than just an xray,if not, may-be you should request one.
Hope you get it sorted,wishing you all the best.
             coral
23/03/10 displaced patella fracture 3 pieces right leg
26/3/10 had op,2 pins & figure of 8 wiring
full cast ankle to thigh 7 weeks.
18/5/10 cast removed xray showing hairline crack
26/7/10 walking unaided,full rom
31/10/2010.6 months post-op check,bone not healed,harware cant be removed

Offline surrender

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Re: Knee in severe pain, no explanation
« Reply #7 on: November 10, 2010, 01:25:34 PM »
Please keep us posted as to what you find out.  It will benefit this forum in case someone else finds themselves where you are.  We are interested in what happens to you  and want to encourage you.

cdubb

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Re: Knee in severe pain, no explanation
« Reply #8 on: November 10, 2010, 04:21:33 PM »
Dumb question and maybe I misssed in in reading through this, but it seems there is talk about having a scope done, but I don't see where you have had an MRI and an evaluation by an orthopedic yet?  Am I missing something? 

Offline knee always hurts

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Re: Knee in severe pain, no explanation
« Reply #9 on: November 10, 2010, 10:12:39 PM »
kscope09,

The first time I felt like I might eventually be on the surgical route, I felt sickened as well, especially considering that I've never had surgery for anything. But at this point, if they said hacking it off was a good solution I think I'd go for it.

coral251,

I think at this point the doctors will be ordering scans, as my condition has proved recalcitrant and is in fact getting worse. I certainly hope so, as I can hardly stand not having a diagnosis any longer.

surrender,

Absolutely, I'll keep everyone posted every step of the way. I'd love to know what the original problem was, and if I'm correct in thinking that it caused damage to something else.

cdubb,

No, not a dumb question at all. I asked for an MRI months ago and was refused. They wanted me to go to physical therapy. One doctor acted like I was nuts and that there was nothing wrong with me, another one told me that he "sees this 2 or 3 times a day". When I went to the ER, they gave me an X-ray, saw nothing wrong, and sent me home. In retrospect, I think if I was a little more persistent I could've secured an MRI before this point. But given the way I was treated, I honestly was hesitant to go back to the doctor. That was a big mistake. As soon as I get insurance, I'll be making another appointment to see an OS.

It's just my luck that another problem is emerging in my right knee. I can no longer bend it to an extreme of flexion without this severe dull pain in the general vicinity of where it has been sore. Can a week just go by without something else happening? Would it be alright if I climbed the highest tower and jumped off?  ::)

Offline surrender

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Re: Knee in severe pain, no explanation
« Reply #10 on: November 10, 2010, 10:22:40 PM »
I'm so sorry!  Sometimes I wish doctors could "feel" it 2 or 3 times a day.  Seeing and feeling are two different things!  Hang in.  Post often when you feel discouraged.  There is a solution and you will find it.  I'm sure you have searched the internet.  Does Knee Geeks have a section for contact with physicians via the site?  I might be wrong but I thought I saw that somewhere.  Anyone know what I am talking about?

Offline knee always hurts

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Re: Knee in severe pain, no explanation
« Reply #11 on: November 10, 2010, 10:35:57 PM »
It's probably going to be a month or more before I can get this looked at. And in the mean time, my left knee is completely and utter ruined, and my right knee is taking all of my weight, despite the fact that it is injured! I'm just hoping the the RK can hold out until then. I know that I can crawl and pull myself up to the toilet, so at least I won't need a bedpan! But otherwise, it will be breakfast in bed. I hope not!

I can't stand the way I was treated by the local hospital system. I'm looking at going to a doctor in Boston, but can't really start to move in that direction until the insurance situation is sorted out. I'm applying for Masshealth, which is the name for Medicaid in Massachusetts. Does anyone know if I would need a referral to see a specialist with Medicaid? I can make an appointment right now and send the bill after the insurance is approved, but only if it would otherwise be covered. If I needed a referral and didn't get one, it won't be covered. Maybe I should make some phone calls and find out. I really hate to think that I'm going to have to wait weeks before even making an appointment.

Complicating things further is that there are multiple plans and I'm not even sure which one I'm going to be on. This is a nightmare, folks. I know many of you are in Canada, Australia, the UK, or some other country with single-payer health care. I know there are problems inherent in every system, but what I wouldn't give to be in one of those countries right now!

Offline Snowy

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Re: Knee in severe pain, no explanation
« Reply #12 on: November 11, 2010, 06:35:15 AM »
Ack - so sorry to hear this. I know you've been wrestling with your ongoing problems for a while and were finally seeing some progress, so it seems especially unfair that this has happened.

At this point it seems like the best thing you can do is start making those phone calls and find out everything you can about the insurance situation. Are the wait periods mandatory, or down to paper pushing? If the latter I'd suggest the "polite pain in the ass" route - just call the company every single day, bugging them very nicely about getting everything through quicker. When I was referred for surgery here I was told that it would be a minimum wait of a year, more likely closer to two, before I saw an OS. I couldn't accept that, and a series of polite but very persistent phone calls eventually got me a consult six weeks after injury and surgery eight weeks after that. Sometimes the system fails, and you have to become your own advocate. It won't always work, but it's worth a shot.

Wishing you luck...you're in a tough spot, and I really hope you can find a way out of it.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline knee always hurts

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Re: Knee in severe pain, no explanation
« Reply #13 on: November 11, 2010, 06:49:47 AM »
I certainly hope I don't have to wait 2 years! My muscles and sinews will be reabsorbed into my bloodstream by that point!

The PPITA route might be what I end up having to do. "You can't let a 26 year old's leg waste away irreversibly, can you? Pretty please can I go to that surgeon?"  :'( :-* ;)

Offline Snowy

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Re: Knee in severe pain, no explanation
« Reply #14 on: November 11, 2010, 07:07:54 AM »
Don't panic too much - the two year wait is the down side of those single-payer health care systems that you mention. I live in Vancouver, which has some of the longest wait times in Canada. I'd pretty much accepted the fact that we were going to have to travel to Victoria and stay with my in-laws to get the surgery in a reasonable amount of time, but it was surprising how fast the PPITA route (love the acronym) got things happening once I committed to being really persistent with it. I'm also really happy with the OS I got as a result, which is a bonus.

It's probably fair to mention that I did pay for my own MRI (wait times are approx 6 months) just to get the ball rolling - I couldn't get the referral to the OS without it, and it seemed crazy to wait 6 months when four doctors had told me they were certain I had a completely ruptured ACL. It wasn't cheap, but I don't regret it - about a month ago I finally got a call from the MRI department saying they had a date for me, and I just laughed and told them I'd had the surgery in July and was well on the road to recovery. That's not to say I spent the money lightly, but ultimately your health is the most important thing and if there's a bit of strategic spending that can hurry things along, it's worth considering. (Budget depending, of course.)

I'm racking my brains trying to think of anything that could cause the level of pain you describe. My PFS sometimes felt like I had two rotten teeth in place of knee joints, but it never interfered with weight-bearing - even at its worst, I could take weight through the knees. It seems way too sudden and severe for cartilage failure. Some kind of really extreme synovitis, maybe? It might be worth trying some other NSAIDs...I found Naproxen pretty useless and got a lot more relief from Diclofenac. It might be worth going back to the ER just to get a different prescription to try.

Again, sending you well wishes...I'm so sorry this has happened to you, and really hope there's something that can help while you wait for the insurance to kick in.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA