Pain under knee, lateral side above fibula?

[Puffy the Knee Slayer]

So for those who haven't read my fat pad thread, I've had FPI and PFMT for over 8 years.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=66643.60

In October this year I had a botox injection into the tensor fascia lata and a steroid into the lateral femoral condyle, to switch off lateral muscles and get the glutes and VMO working again.

After the steroid I had terrible pain and stiffness under the LFC site and couldn't bend the knee. This lasted about 48 hours and I thought was post-steroid flare up.

However it's now been nearly 3 months and I have developed terrible pain on that side, just above the fibula going down the bone, over the last week.

It doesn''t hurt when walking or at rest, but if I put weight on it either on the upright bike or cross trainer I get really bad pain after less than 10 minutes and have to stop. The recumbent bike hurts also but the pain is less. Walking on the treadmill at a gradient is fine.

It also hurts on stairs and is worse going down stairs.

It feels like a sharp pain pressing on the bone.

Have told the physio and he's tested for pernoneal nerve and sciatica and it isn't either of those.

He tried kinesio taping on the outer calf and has done trigger point therapy on my glutes, and asked me to try out a gym session to see if these helped. They haven't.

It's another 3 weeks before I see him again.

Am doing various physio exercises to strengthen glutes and medial quads. These don't hurt though quad and glute stretches involving bending the knee back might not be helping.

Does anyone know what this pain might be, and if it will go away? As I seem to have swapped one problem for another.

Thanks.

[Clarkey]

Hi Puffy,

We both have had our fair share of soft tissue injuries to the knee that are hard to get right again! I am limping more than I ever have been even after all the physiotherapy sessions, 3 ESWT sessions and 5 cortisone injections with 3 of the 5 done during the year 2015. I will refuse to have another injection around the patella tendon as I do not want to risk having it rupturing! 

We both know our knees better than any of the professionals out there as we have to live and manage with restrictions on what we can and cannot do on a daily basis. Your symptoms sound similar to mine with PFS causing all the aggro and frustration that limits our physical activities involving running.

A diagnostic arthroscopy is an option but a big risk and gamble that it could make your knee problems worse rather than better. Scar tissue is the main concern that can ruin the whole knee joint once it has established fully! It always the last resort after all none invasive treatments have failed.

Sorry not to be more upbeat and positive in response to you’re posting, good luck with what you decide to do next.

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[Puffy the Knee Slayer]

Hi Nick,

I am sorry you are worse than ever after all the treatment. You have been through a lot with your knee and trying to get it all sorted with various specialists and treatments. I will also refuse further cortisone.

As this is a new pain that has only come on after the steroid into the Lateral Femoral Condyle I am thinking I would push for a new MRI rather than diagnostic arthroscopy.

It is possible a change in biomechanics has caused this new pain but it might be something else and I want to be sure, if it does not go away.

The knobbly protrusion on the lateral side, below the knee joint, don't know what it's called, is sore to the touch.

I have been icing it and keeping off it though it is ok walking just not bike, cross trainer or stairs.

I just think they are going to say the pain is nothing to do with the injection, and I think it is, as in over 8 years of knee pain I have never had this before.

[minka]

Hi you have a collapsed arch on your foot I see if the arch of the foot collapsed inward it will cause all sorts of problems to the knee joint if you are using arthose in shoes are you sure this is not the problem as they are incorrectly fitting on that leg are you also favoring the better leg when walking

[Puffy the Knee Slayer]

Hi Minka,

Yes you are right my other leg is compensating, my orthotics are the right fit. I can understand what you are saying, however the pain on the lateral side, as I said, has only come on after the steroid injection into the lateral femoral condyle, therefore I really don't think it is to do with compensation issues or the orthotics.

[Puffy the Knee Slayer]

So am still having this pain.

Saw the physio who has given me a stretch to do, he thinks the problem is the nerve rather than the joint as he said if the problem was with the bone it would hurt when he presses on it, and it doesn't.

He thinks the consultant may want to image the lateral side, either by MRI or ultrasound. There is nothing on my previous MRI to indicate problems in this area, and indeed have not had pain there until the steroid injection into the lateral femoral condyle.

Will wait and see if the stretch helps, am seeing OS in new year.

[Puffy the Knee Slayer]

Pain had improved a bit, then attempted a short run (as was told to try running by physio, to check if botox has improved anterior knee pain), which was fine during.

After though, any attempt to go forward on forefoot with knee bent - cross trainer, stairs = pain.

Also even on recumbent bike, painful, and also felt at one point my joint got stuck in bent position which was scary, makes me wonder if it it could be a lateral meniscus tear but I don't have any other symptoms and my quads are working fine?

Don't think the running caused this as I had the lateral pain before physio said to try running.

No idea what it could be, am seeing OS next week so will have to wait and see. In the meantime rest, ice and upper body work only 

[Clarkey]

Hi Puffy,

Happy New Year, good luck with your consultation, hopefully he spots something that is a straight forward fix none invasively. It best to avoid running again until you have seen your OS as you could cause permanent damage! I was last able to run in January 2013. I am missing it a lot if you are passionate about running long distances, we are both keen on being physically active again.

My physio told me to live with the knee pain and suggested going to the pain clinic and yours is telling you to run! The physio after my AIR surgery in July 2014 made me do too much PT in once session that could have ruined my knee even more? Sport physiotherapist are better in my experiences, the one I trusted 100% is now living in the Middle East. It is now a gamble which one I can trust fully.

Feel like a broken stuck record as every year I say this is the year I will finally sort out my right knee? lets hope 2017 is successful for us both in sorting out our knee problems.

[email protected]

[Puffy the Knee Slayer]

Hi Clarkey,

Happy New Year to you also and thanks for your reply.

Have seen the OS who did a thorough clinical examination but was unable to replicate the pain, as I explained to him it only comes on when I am doing activity, putting weight through a bent knee.

He has no idea what the problem is so has referred me for an MRI, and says if there is inflammation it will show up there.

I am not thinking of running again until the results are out and I know exactly what I am dealing with. However as the pain seems to wax and wane I will probably have to aggravate it on purpose before the MRI just to make sure it shows up whatever it is. But given how it is this will not be too difficult and acheived just by walking up some stairs!!!!

I really don't know what it could be. I managed 4 minutes on the cross trainer today before giving up in pain. Can't even do recumbent bike. The pain moves around but is all on the lateral side and feels like something - vein, nerve, ligament?? - is getting caught somewhere and being stabbed through the bone with a knife and then twisted round.

I think it is to do with the steroid into the lateral femoral condyle, I wish I had never had it.

Yes I miss running too, and other things like kickboxing and not being able to skate.

I really hope we will get our knees sorted this year, am proper fed up and sure you are too.

I think your physio does not sound very helpful to put it politely. That is the sort of thing they might say to an 80 year old with arthritis not someone young who wants to be active! But I also had a useless previous consultant at a different hospital who pretty much said the same thing - "we all get aches and pains sometimes" wtf

Meanwhile, coming soon to kneegeeks...Fat Pad Impingement - 9 years and counting!!!!

[Clarkey]

Hi Puffy,

My right knee pain is similar to yours as the pain comes when I am weight bearing, I have no pain or discomfort while sleeping during the night. As soon as I lift anything heavy or squatting down straight away get intense anterior knee pain. A knee does not need to massively become swollen to have a knee problem any fluid in the knee and minimal swelling is a sign that the knee is not happy.

I am now thinking that the Registrar suggesting to realign the kneecap performing an 'osteotomy' might actually work that is a major surgery to endure that is a daunting prospect. It's well worth the risk if it puts less strain on my right knee and hip. I can then move on and apply for a job position as a Playworker for autistic young people. 

As you well aware there comes a point when one has to be assertive in a polite but firm manner to get the treatment that will hopefully be beneficial improving your quality of life. I will go for a 1 mile walk before my MRi scans to flare up the knee and hip to increase a positive result.

Hopefully this time round our MRI scans come back positive clearly showing a mechanical problem inside the knee.

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[Puffy the Knee Slayer]

Hi Clarkey,

When you say osteotomy do you mean the TTT?

It is a big step but if it resolves the problem then maybe worth it. I was also offered this but opted to try the botox first.

Clearly your knee problem is not just affecting your sporting activities but your choice of career so is a big impediment.

My fat pad is still swollen though doesn't seem to be pinching as much and the kneecap is tracking much better, but whatever they did on the lateral side they have messed me up.

I really hope the MRI shows something they can clearly see and fix, and wish the same for yours.

[Clarkey]

Hi Puffy,

Knee osteotomy is a different type of procedure to TTT surgery that is done if you are prone to regular knee dislocations with a shallow trochlear groove. A knee osteotomy does sound very similar to TTT surgery. I know this after speaking to my sister who is an orthopaedic nurse about TTT surgery.

Link below is a good interpretation of 'Knee Osteotomy'

http://www.kneesociety.org/web/patienteducation_osteo.html

A link from the Birmingham Royal Orthopaedic Hospitalon 'Tibial Tubercle Transfer' where I go for consultations and had my two surgeries.

http://www.roh.nhs.uk/patient-information/general-patient-information/biopsy/144-tibial-tubercle-transfer/file

Lets hope that our MRI scans show up something this time round so we finally know what we are dealing with. Good luck.

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[Puffy the Knee Slayer]

Thanks for the links, that does explain the difference really well.

Will an osteotomy affect muscle balance?

I got my MRI date, it was meant to be the same date as yours but I changed it as it was first thing in the morning and I need to go to the gym beforehand. So now am having it first week in February.

Someone at my gym thought it was strange that I am deliberately trying to aggravate it before the MRI  but this is in fact what some of the private OS's tell you to do.

Yes I hope both our MRIs show what is wrong and that these are fixable. Luck to you too.

[Puffy the Knee Slayer]

I have had my MRI scan today.

I went to the gym beforehand but only managed 8 minutes on the cross trainer before the pain got too much and I had to stop. I really hope that was enough to inflame it so that whatever is wrong shows up on the scan.

Am really worried that nothing will show up on the scan and then the choice will either be to live with it and do no weight bearing cardio, or have a diagnostic arthroscopy (assuming they offer this).

I have rested it for weeks before today's scan and whatever the problem is hasn't got better with physio and rest, as evidenced by todays foray onto the cross trainer.

There was a bloke at my gym chatting to me today about it, I thought he was being friendly but the second time this has happened basically he wears shorts and when he gets onto the bike his manhood pops out of the opening!!! I don't know what to do, whether he is aware of it or not!! He should be wearing undershorts, really.

I am not going to say anything to him as I am too embarassed. I think I will ask someone else I know there to have a word with him. I would like to give him the benefit of the doubt that he does not realise this is happening but it is also possible he might be a perv

[Vickster]

Hope the MRI gives you some answers

Ugh to the guy at the gym. I'd perhaps ask a member of staff to have a word, say they've had several complaints, so you remain anonymous. They have the duty of care to their members