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Author Topic: Knee pain since 2014, scans show nothing, 23 yr old  (Read 658 times)

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Offline user101

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Knee pain since 2014, scans show nothing, 23 yr old
« on: April 25, 2017, 01:07:37 PM »
Hi everyone,

I'm new here and fed up from not finding solutions.

Background: I'm 23 years old and in 2014 I was training for a half marathon. I ran between 10-15km per week just for fun and one time I was running and felt this nagging pain in my knee but I ignored it and continued running. I also did some stretches and pull ups on a metal bar and hung from it from my knees/legs. I ran a bit more and the pain was suddenly sharp. Half an hour later, I could hardly walk, an hour later I was in huge pain and I had to use crutches for 2 weeks. I couldn't bend or stretch my knee fully. At the end of these 2 weeks, one day I was sitting for a long period of time, studying, and when I got up, something felt like it "moved back into place" and I could suddenly use my knee, but with a lot of pain. The pain, as far as I remember, started on the "sides" of my kneecap and now it just aches under the kneecap and a bit behind the knee too, if I stretch it too much.

At the time I did an xray scan and an MRI scan, and found nothing. I went to an orthopedist who advised me to do some physiotherapy. I did it for a few months and it didn't help, and so far 4 professionals have all found nothing in my scans and just advised physiotherapy.

I've stopped running, I still do exercise but limited. When I cross my legs, it's only for a short time before it starts aching. It aches also when I sleep on my stomach with the knee pressing against the mattress. I'v been to a gym to train my knee muscles, but that seemed to make it worse so I stopped.
When I'm laying down I try and "pop" my knee (I can pop both but the bad one is harder to do so) since it gives me some kind of relief.

I don't know what I can do to get my knee fully functional again. Nobody seems to find any problem yet it still aches and gives me a dull pain if I stress it too much.

I've tried to give out as many details as possible. Thanks in advance for any advice.

Offline Vickster

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #1 on: April 25, 2017, 01:19:08 PM »
Can you find a specialist physio with focus and expertise in patellofemoral syndrome (aka runners knee), that's what it sounds like. Often no specific anatomical cause, or caused by muscle imbalance. You need to work on all the muscles from hips to feet and your core (source often higher up than the knees)

There's good info in the learning portfolio above

Might also be worth getting a new MRI or getting the other one reread just to check nothing like a meniscus tear has been missed
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Vickster

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Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Clarkey

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #3 on: April 26, 2017, 10:28:01 AM »
Hi There,

I was once was keen long distance runner and ignored the niggling pain while I was running thinking it will not do any harm to run through the pain! I have PFS and patella tendinitis due to overdoing it running a 9 mile circuit 3 times that is 45km in total. You are more sensible then I was by doing 15km over a week slowly building up the km's and running speed. I have not been able to run since January 2013 as I ignored the knee pain while I was running.

I greatly benefited seeing a Sports Medicine Doctor rather than going back to my OS straight away for the anterior that has reduced the knee pain and discomfort. It still flares up easily if I walk too long or do too much gardening work. A Sport Medicine Doctor will do a full gait analysis as other joint can have negative impacts on he kneecap. My right hip is also causing problems that could be straining the knee or vice versa.

A Sports Physiotherapist in my experiences over the years are better than standard PT's that are more focused and experienced getting you back to full physical fitness. Maltracking of the patella (PFS) when the kneecap is not aligned at the correct angle can be assessed fully by having a CT scan and also see how healthy the bone structure is.

Sometimes a cortisone injection might be given to see if it eases the pain and discomfort after PT sessions have failed to make any improvements. It works well for some patients and not so well for others. Cartilage tears can sometimes not show up on a MRI scan that can be picked up during a physical assessment that many OS's can fail to pick up on if they do not get the exact angle of the tear. The last option is a diagnostic arthroscopy to access the knee fully surgically. There is always a great risk and gamble having surgery as it increasing arthritis making he pain worse rather than better.

Good luck trying to reduce or stop the anterior knee pain, it takes a lot of time a great patience if you want to train for a half marathon that being hampered by the knee pain.

[email protected]
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 jackson7

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #4 on: April 26, 2017, 07:13:18 PM »
I would never trust a negative MRI ever again...or even a positive one (seen too many misdiagnosis).

I had 2 separate MRIs from different doctors and they both said nothing wrong.  I trusted them and continued trying to use my painful knee for a year after.  This caused me to get patellar tendinosis and put so much more strain on my other knee, it is now also chronically painful.  I finally got a diagnostic scope which revealed a torn meniscus...which had been shredding on my femoral cartilage.

If i would've ve been properly diagnosed at the beginning, l'd have about 75% less problems than i do now.  Maybe a CAT scan with dye will reveal the most?...or just get the diagnostic scope to be absolutely sure what's going on in there.
« Last Edit: April 26, 2017, 07:18:08 PM by jackson7 »
12/2015: slow speed bicycle crash
1/16: many x-rays & 2 MRIs only show tendinosis
3/16: bone scan shows uptake in all compartments
8/16: cortisone jab (no effect)
3/17: diag scope (part med meniscectomy, med fem chondroplasty, full synovectomy)
4/18: Pain finally diminishing. 65% function.

Offline Clarkey

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #5 on: April 27, 2017, 03:18:23 PM »
I am also cautious and sceptical towards negative MRI scan images that do not really pick up on soft tissue injuries to the knee as well as cartilage tears. Jackson your knee problems sound similar to my ongoing right knee injury. I have had two scopes so far, since scope #2 having problems with chronic patella tendinitis that no getting any better after over 18 months PT session and none invasive methods to try to reduce the inflammation.

I will now ask for a diagnostic arthroscopy as my right knee pain and limited mobility is far worse than it was pre-op to scope #1 and #2. I am fully aware and prepared for the risk involved that I could end up worse! It just added reassurance to put my mind at ease knowing I tried all the options available to hopefully ease the pain and discomfort.

I also had 2 separate negative MRI scans post-op, the 3rd one showed changes with increase joint effusion around the fat pad enough now to go ahead with scope #3. Right hip x-ray guided cortisone injection for impingement in the cam region was the last hope that it may ease the knee pain. It has not made any difference, I think that the hip problem is a result from not getting mt right knee treated in time.

It really frustrating in your case that the damage could have been greatly reduced if you had had a proper diagnoses for the torn cartilage tear in the 1st place! Too many OS religiously go by what comes up on an MRI scan. They should be listening and taking in how restrictive the knee problem is for the patient after PT sessions have failed to improve the symptoms and are in chronic pain, not able to take part in physical activities anymore.

[email protected]
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 Vickster

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #6 on: April 27, 2017, 03:31:36 PM »
To provide balance, I've had around 7 MRIs (both knees, hand, shoulder, foot, ankle) and they've all picked up issues which correspond to the symptoms. Part of it is down to the skill of the doctor reading / reporting and knowing what to look for following other examinations, patient history etc.  They are a diagnostic tool, to support or disprove a potential diagnosis...not really to help a doctor out who has no idea what's wrong.  With my hand, the specialist spotted a tiny fracture on one of the hundreds of MRI images, mainly because she knew where to look having prodded my hand to identify the exact painful spot - she wouldn't have known where to look otherwise!  IMO A good knee surgeon or physio should be able to diagnose a clear meniscus tear without an MRI, from history, mechanism of injury, symptoms, how respond to physio etc (not a GP or some generalist, an expert who knows exactly where to prod)!

I don't think they are as good if the symptoms are very non specific as with PFS or very diverse (i.e. lots of things could be the cause of the pain - I have a cartilage defect, more general arthritis, meniscus tears, any one of which or a combination could cause the symptoms - as could muscle imbalance, tightness, general anatomy/alignment etc). 

A diagnostic scope would no more identify the cause or cure the issues than the MRI - therefore I'm leaving well alone :) And the same is probably true for 90% of cases of non specific knee pain unfortunately - a scope is not a benign procedure, you have trauma, pain, you have to recover and do rehab... it carries risk as said (some of which can lead to life changing complications if for example nerves are affected).

Go see a physio or specialist who specialises in kneecap issues - not a general orthopedist or even a knee specialist with some other specialism - they'll hopefully be able to advise on possible causes and solutions (then you'll need to follow their advice) :)
« Last Edit: April 27, 2017, 03:53:51 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline user101

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #7 on: May 03, 2017, 09:31:31 PM »
Thank you to all who responded!

I just have a few questions.... First of all I'm a student which equals having no money. I want to get my full motion back so I've been trying to study all about patellofemoral syndrome and will implement exercises in order to fix this by myself. However, seeing as I don't have complete confirmation that I even have this (although, there aren't any other options actually) I was wondering how bad it would be if I did exercises and taped my knee as suggested, but in the end had no problem. I don't want to create any muscle imbalances or anything. Any thoughts on this?
(Sorry for an incoherence, I'm tired and English isn't my first language)

Offline Vickster

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #8 on: May 03, 2017, 09:59:22 PM »
You could have a read of Richard Bedards book Saving my knees which is about dealing with PFS. What country are you in? No access to public healthcare otherwise?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline user101

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Re: Knee pain since 2014, scans show nothing, 23 yr old
« Reply #9 on: May 03, 2017, 10:45:33 PM »
I live in Portugal and unfortunately nothing works unless you pay money for the private sector. (Otherwise I'll be waiting for months (year?))
I'll search around for the book, thanks!

Offline Vickster

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Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up