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Author Topic: Opinon on Medial Knee Pain  (Read 775 times)

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Offline ContinentalOp

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Opinon on Medial Knee Pain
« on: April 06, 2011, 10:02:28 PM »
My girlfriend has been immobilized for about a month now.  The medial compartment of her left knee is giving her a lot of pain when she puts any load on the knee.  She can aggravate it more if she does particular twisting motions.  If she doesn't put any load on it, it's sore.  Furthermore, there's pain in the first few degrees of motion when bending her knee.  Conversely,  there's pain in the final few degrees of motion when extending the knee.  There's no acute pain when the knee is fully flexed.  There's no clicking, no popping, and no locking of the knee. 

Let me give a little history.

At the start of this history, my girlfriend was 27 years old.  For most of her life, she lived in warm environments.  For work, she moved to Cleveland, OH in 2009.  In late 2009, she slipped in the shower and hit her knee.  The knee was fully bent when she hit it.  There was no swelling or bruising after the hit.  In fact she claims there was no pain at all.  This is the only trauma her knee has undergone.

Over the next year she did notice some minor aching in the medial compartment of her knee, but very insignificant.

During that year she became more active than at any other time in her life.  She was using a gym a couple times a week, doing some aerobic classes, using some of the cardio machines like an elliptical.  Sometimes her knee would ache a bit, but she was unsure if it was attributed to the exercise or the cold weather.  In late 2010, we took a 2 month hiking trip across the National Parks of the western United States.  We hiked 10+ hours a day and 7+ miles a day.  Some of these hikes had 700+ foot elevation gains and descents.  For most of the hikes, she had no pain at all.  Occasionally at the end of a grueling day she would have minor discomfort ( < 1 on the pain scale ).

We returned to Cleveland in October of 2010.  Starting in mid-November she ran about 30 minutes a day for about 3 weeks.  In mid-December when the weather became cold in Cleveland, she noticed some pain the medial compartment of her knee.  At that point, she stopped all activity.

A couple weeks later (January 2011) we went to visit her family in China.  We started the trip in Shenzhen where it was very mild, around 65 Fahrenheit on a daily basis.  We were walking and sightseeing for 6 hours a day.  At the end of the day, she would have some pain in her knee, but again nothing major, around a 1 on the pain scale. 

Then in February 2011 we went to her hometown in China which was very cold.  Around 30-40 Fahrenheit.  Slowly her knee pain got worse.  At the start she could walk 6 hours a day without pain.  Then 5 hours  without pain.  Then 3 hours without pain.  And the level of pain was slowly increasing.

In mid-February 2011 we went back to Shenzhen where it was in 65 Fahrenheit.  She could hardly walk without pain.  We got her some crutches.  The final part of our trip was to Thailand (early March 2011) where she walked everyday with crutches.  She couldn't put any load on the knee without pain.  But it felt better than when we were in Shenzhen.  In Thailand it was in the high-80s to 90s (Fahrenheit).  While we were there we went to an orthopedic surgeon.  Through a physical examination he couldn't find anything wrong.  He suggested an MRI, but we had to leave before we had a chance to get it done. 

In mid-March 2011 we flew back to the United States and the knee just went crazy.  She got an effusion in the knee.  It hurt constantly.  She couldn't move it without pain.  We got an MRI and scheduled an appointment with some doctors.

We saw a very good orthopedic surgeon who only does knees.  The MRI showed a fissure in the knee, but no apparent tear.  The MRI also showed she has a lateral discoid meniscus but the doctor doesn't believe it to be an issue.  He's not seeing anything mechanically wrong in the knee.  But he does say the knee is "pissed off".  Everything is inflamed and in an "angry" state.  He's not sure why it's not calming down even though she had not been load bearing on the knee for 5 weeks at that point.  He wants her to do physical therapy which she's undergoing now.  She's got another appointment with the OS in 2 weeks.  At that point, if nothing has calmed down, he's thinking about arthroscopic surgery.

We also saw a rheumatologist.  He doesn't think she has any auto-immune disease which would perpetuate the inflammation in the knee.  She has no joint pain (or pain for that matter) at all anywhere else in her body.  He drained some fluid from her knee and it was perfectly clear.  He gave her a shot of cortisone which improved it about 10-15% but she still can't load bear.

It should be noted when we got back, she had some pain in the other knee.  It had a very small effusion, but in the following weeks it's gotten better.  Currently it doesn't hurt her at all.

Also it should be noted that she has patellar tendinitis, but this pain is completely separate from that.

Just looking to get any thoughts. My girlfriend thinks it's from overuse from a combination of events: the running, the walking in cold weather, etc.,

I'm leaning towards a meniscus tear.  She's been off her leg now for about 5 weeks without any signs of improvement.  From what I've been reading, apart from PVNS (so far two of the diagnostics for PVNS have been negative, clear knee fluid & the MRI), the only thing which won't heal by itself is a tear.  One radiologist thought there might be a tear on the MRI but it's not clear. 

Has anybody experienced a 5+ week recovery from an overuse injury?