What do next? Knee pain with no cause?

[happydappy1]

Back in Feb 2013, I suffered from knee pain in both knees which gradually got worse. By November 2014, it was too painful to walk. I was referred for physiotherapy for a couple of months, which did not help.   

So I was then referred to a knee specialist. He thought it was a meniscus tear and sent me for an MRI.

However, the MRI scan shows that everything is fine.

The knee specialist said I am knock kneed so that might be causing the pain, but it can't be fixed. He also X-rayed my hip and found a small amount of arthritis. But he said that as I am 32 the arthritis can't be treated until I am older. I am surprised by the arthritis as I had a blood test for arthritis a couple of months ago, but it showed I was all clear.

The knee specialist said I should just take painkillers and see if the knee pain gets worse after a few months. He discharged me.

I am not sure what to do next. Lately, I have been getting a burning pain and so have tried ice packs, which stops the burning. But I still find it very hard to walk and have rarely left the house since November.

I am not sure what steps to take next. Any advice would be appreciated.

[vickster]

Just for information, there are two types of arthritis - there is rheumatoid arthritis which can be diagnosed by a blood test, it's an auto-immune disease where the body is almost attacking itself, causes joints to swell and get damaged.  Then, there is osteoarthritis which is seen on X rays and scans where the cartilage on the bones (the shiny stuff like on a chicken drumstick say) which can get damaged, either in a trauma or through wear and tear through impact and the bones not moving against each other properly and smoothly.  This is likely the issue in your case - is it in your knee or only your hip?

Have a read of this http://www.kneeguru.co.uk/KNEEnotes/primers/joint-cartilage-and-arthritis-primer

Why does the specialist say the knock knees can't be fixed, there are surgeries that can straighten the bones, there are also unloader braces that you can you to move the forces in the joint and offload the damaged part

As well as painkillers, physiotherapy can be helpful to get the muscles working well and keep the joints lubricated, having weak glute muscles, weak or tight calf muscles and even stiff ankles can all contribute to knee pain and physio to address these could help - try a new physio with knee expertise  

There are also injections that can help with the inflammation and lubricate the joint (called hayaluronic acid).  There's no concrete evidence, but taken in the right doses, supplements like glucosamine, chondroitin and fish oils can help (as long as you have no sensitivity or allergy to seafood or fish)

Are you in the UK?  Whereabouts?  I'd ask your GP to refer you asap to a tertiary orthopaedic centre (like the RNOH in Stanmore) or an expert in bone malalignment (like Adrian Wilson in Basingstoke).  If funds permit, you may wish to consider a private referral

Good luck

[happydappy1]

Thank you so much for your advice. It's great to have some options.

Why does the specialist say the knock knees can't be fixed,
He said he wasn't sure if the knock knees would cause the pain.

Are you in the UK?  Whereabouts?  I'd ask your GP to refer you asap to a tertiary orthopaedic centre (like the RNOH in Stanmore) or an expert in bone malalignment (like Adrian Wilson in Basingstoke).
I am in Lancashire UK. I'll ask my GP

Thanks again for the advice, especially about the physio and supplements.

[vickster]

If the knock knees have caused the arthritis then presumably they are responsible for the pain? Unless you had some sort of trauma or overuse injury which started it all off?

If you have arthritis throughout the knee and not just one compartment (usually the outside lateral one is affected with knock knees), then straightening the bones may not help as much as if the damage is in just one part of the knee...or do you mean the pain in the hip?  Perhaps you need a CT scan hip down to assess the full alignment if it's not clear from full leg X rays (problem is CT scans cost £££ and if on the NHS, the specialist may be less willing to do)

[happydappy1]

If the knock knees have caused the arthritis then presumably they are responsible for the pain? Unless you had some sort of trauma or overuse injury which started it all off?

I was doing treadmill and jumping jacks quite heavily before it all started. However, the knee specialist felt that wouldn't have caused it. But he also said he doesn't really know what is the cause.

If you have arthritis throughout the knee and not just one compartment (usually the outside lateral one is affected with knock knees), then straightening the bones may not help as much as if the damage is in just one part of the knee...or do you mean the pain in the hip?

The knee specialist did an xray of the knee but only found arthritis in the hip. The hip isn't hurting at all (it started hurting when he poked at it but that subsided).

I spoke to my GP this morning, but he said he doesn't want to do any referrals until he has had the knee specialist's report, which he should get in a fortnight. He is also skeptical that I would have arthritis in the hip at my age and wants to see the xray himself.  I am not too optimistic about this report as the knee specialist basically said that he doesn't know what is wrong and because of that he doesn't think any treatments are worth pursuing.

The GP also said to go back to doing Physio at home. I was originally told to stop these as they weren't helping (and the squat based ones were causing more pain), but I guess if I gradually ease back into them and avoid the really strenuous ones it should be okay.

I am looking into the private options, as if the GP doesn't come through I might have to go down that route. 

Thanks for all your help!

[vickster]

Squats aren't the best for knees, especially if there are any muscle imbalances.  Have you tried swimming as a non impact form of exercise or even pool walking and other gentle exercises in the water?  Might help.  Wall slides, clamshells and glute bridges are less impactful than body weight squats and target quite a few muscles.  Calf raises and step ups too, but avoid anything that is clearly painful, you should feel some stretch or muscles working but not obvious ouchy pain!


The specialist sounds a bit clueless, was he a consultant orthopaedic surgeon specialised in knees?  It is possible that an issue around the hips is causing knee issues too, but high impact gym work, especially if done with less than perfect form and with wonky legs can cause injuries

If you go down the private route, you'll still need a GP referral, with notes and imaging from the specialist

[happydappy1]

Thanks again for the useful advice! The squats advice is really useful, as when I used to go for physiothepry, they were fairly adamant about doing them even though they made my knees really hurt. (I stopped doing them for that reason, and also because it made it harder to walk).

Out of interest, are there any exercises that you recommend?

Also, I find that during the day I can only walk a few steps before it starts really hurting. However, at night I don’t get any sleep as they burn away in pain. I’m doing ice pack and taking paracetamol (I can’t take Ibuprofen as it causes me nose bleeds), but I was wondering if you might have some tips.

Thanks again for all your help. I genuinely do appreciate it!

[vickster]

The ones I listed above have always been given to me

The burning pain at night is quite typical of arthritis but other things too. Perhaps your GP could refer you to a rheumatologist specialised in musculoskeletal skeletal conditions, as perhaps orthopaedic surgery isn't the right specialism if nothing that can be fixed by surgery is showing up? Certainly another opinion from a specialist seems the next course of action of the current one isn't helpful. Also to another physio, no physio should be pushing you to do any exercise if it hurts, at least without modification. I for example due to really tight calves cannot squat with my feet flat, but I can more if I raise my heels

If not a simple case, you need the experts to think outside the box, and you need to find those with the experience to do that. Look at the CVs of the consultants at your local private hospitals

Can you ask the GP for some stronger pain killers to take at night like codeine or tramadol, they'll make you drowsy too which is a bonus.  They do have side effects like constipation but that can be managed, especially if only taking a couple of tablets a day

[happydappy1]

Good advice, thanks! 

[happydappy1]

Thanks for the suggestion about glucosamine. I have been having it for 5 days and I have noticed a difference, my knees feels stronger and I can walk a bit longer without pain.

Quick question: When walking or doing stretches, I sometimes hear a popping or creaking sound. It’s not all the time, but usually twice a day. Is that normal? I asked the consultant when I saw him, but he said he didn’t know. I thought I would double check with you!

I am seeing my GP, but I have to wait another week, as he wants to go over the consultant’s reports.

[vickster]

If the consultant doesn't know, I'm sure I don't if it doesn't hurt when it does this, I wouldn't worry, just normal joint sounds

Ref the glucosamine, did you check the dosing to get best effect?

Good luck with the GP

[happydappy1]

Ref the glucosamine, did you check the dosing to get best effect?
Yup, 1 a day. Out of everything I've tried this has been the best. Thanks again for the recommendation!

[vickster]

I meant how many milligrammes

[happydappy1]

It says:
Glucosamine 1247mg
(provided by Glucosamine hydrochloride 1,500mg)

Thanks!

[UK86]

Back in Feb 2013, I suffered from knee pain in both knees which gradually got worse. By November 2014, it was too painful to walk. I was referred for physiotherapy for a couple of months, which did not help.   

So I was then referred to a knee specialist. He thought it was a meniscus tear and sent me for an MRI.

However, the MRI scan shows that everything is fine.

The knee specialist said I am knock kneed so that might be causing the pain, but it can't be fixed. He also X-rayed my hip and found a small amount of arthritis. But he said that as I am 32 the arthritis can't be treated until I am older. I am surprised by the arthritis as I had a blood test for arthritis a couple of months ago, but it showed I was all clear.

The knee specialist said I should just take painkillers and see if the knee pain gets worse after a few months. He discharged me.

I am not sure what to do next. Lately, I have been getting a burning pain and so have tried ice packs, which stops the burning. But I still find it very hard to walk and have rarely left the house since November.

I am not sure what steps to take next. Any advice would be appreciated.

I'm not an expert but the advice given here seems quite shocking really. 

Firstly MRI isn't perfect, maybe it missed the problem. 

Secondly if you are badly knock-kneed the weight will not be distributed evenly across the joint and you will be putting pressure on certain areas more than others - to say they can't do anything about it is not true.

Finally I would have thought that treating anything early, especially arthritis, is a good idea.  Conservative measures and lifestyle changes could prevent further damage.

Can you request a second opinion?  Not being able to walk at age 32 is not normal.