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Author Topic: 4 months of pain without known cause (short version)  (Read 1167 times)

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Offline Celina1989

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4 months of pain without known cause (short version)
« on: March 16, 2018, 07:49:53 PM »
28 yo woman. knee pain around my kneecap for 4 months. Started by standing up from a chair (no trauma or injury recently) Had simulair pain earlier that day but after 30 min it was gone, could do everything again. Pain during walking, stairs, baring weight, pressure. Stiff by long times in same position (especially sleeping). Cortisone helped for a while but it came back. Atm not able to do my active job. Xray clean. Mri clean. Pt helped for ITband (probably by walking crutches) but no other improvement. Dayly RICE IT. 8 yo loose body in same knee. Advice please, exploratery scope?

Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #1 on: March 16, 2018, 10:05:48 PM »
Sounds like patellofemoral syndrome, for which surgery is almost never the answer. Find a knee expert physio, get a back to basics programme including stretches from core to feet, gait analysis eye and persevere. Avoid cortisone if the cartilage is healthy as it can damage chondrocytes in healthy bone surfaces

You can read about PFS here http://www.kneeguru.co.uk/KNEEnotes/primers/patella/patellofemoral-syndrome-pfs

And elsewhere around the forum if you search

Good luck
« Last Edit: March 16, 2018, 10:11:14 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 Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #2 on: March 17, 2018, 09:01:57 AM »
thanks for your reply Vickster. I googled for it in the first month of my kneepain but quickly thought It is not, especially cause it says it gradualy starts. For me this suddenly started.
 
I now did some more research in it first by searching this forum. The pain some unfortunate ppl go to here kind of equals mine. I have flat feet for which i have special soles (correcting a slight x leg with that as well). Ive been to pt 8y ago (with the loose body) as well as now. Both didnt mention PFS or anything related. Also my OS didnt. No dislocating of my kneecap and not the idea it moves different then my good knee. Also cycling with low resistance works fine for me, which is named on the internet as one of the provocing factors of the pain.

Since my injection worked of the pain is so bad i cant do my normal job. In fact i cant even do a short walk. If i go out of the house i need my crutches. I really miss walking my dog. I walked a lot before this started but besides that I was not very sportive.

Im just hoping arthroscopy can fix something and i finally can start to recover. But with not knowing what it is and no diagnostic tool finding anything im nervous they wont.

Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #3 on: March 17, 2018, 09:46:39 AM »
Up to you but Iíd persevere with Physio. Kneecap pain can come on suddenly. PFS isnít only duebti dislocstions, more commonly overuse and / or muscle imbalance.

They might find some minor cartilage damage or a meniscus tear although youíre young for degeneration. Has the position of your kneecaps been checked on CT? (Not MRI)

Good luck whatever you decide
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 Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #4 on: March 17, 2018, 06:11:25 PM »
Nobody ever mentioned the idea of a CT scan. I had a standing xray but no standing CT scan. Wonder if my local hospital got that option.
I think the fact that the injection  with anti inflammatoiry works shows that something is inflammated. And since its been better i think something is recausing inflammation. Would those injections works on other things as well?
I already got the surgery scheduled and did the preperation. So I think i go tru with it but feels like it is worth it to call my hospital monday and talk about the CT. Might be possible before the surgery.

Thanks for the reply again :)

Offline Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #5 on: March 29, 2018, 07:26:22 PM »
So today I had my surgery. Seconds after he got in my knee he said "ooh this is wrong". So I was kinda happy he found something. But the anesthesiologist immidiatly said that I better shouldnt have this. What seemed a part of my femurbone was totally exposed. Cartillage gone and as a loose body in my knee. He cleaned/ shaved it and then made some holes in the bone with a chondropick to hopefully get a new protective layer. It has been super painfull today. Not feeling well atm.

I havent googled anything yet. Will do some next days so if information is a bit odd im sorry for that. Just wanted to let you know what my outcome is. Advice is always appreciated!

Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #6 on: March 29, 2018, 07:37:44 PM »
Make sure you stay on top of the pain, take your meds on the dot as prescribed, even at night if you can. Microfracture is a painful procedure, it'll be sore for some while to come. As well as the meds, ice, elevate (support under calf and ankle, not knee). For sleep,  you may find it most comfortable to lie on good leg with pillow between knees

Presumably you're non weight bearing for a while?

Keep the blood flow going with ankle pumps to avoid clots (wear the compression stockings if provided)

I wouldn't google anything :) just follow the surgeon instructions especially regarding any physio exercises

All the best for a smooth and speedy recovery :)
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 Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #7 on: March 29, 2018, 09:02:23 PM »
wow that was a really fast reply! At the moment paracetamol, ibuprofen and tramadol. But this tramadol makes me very nausia and vomitting. They said its the max pain relief for home. As long as I dont move it its doable. I havent thought about night pain meds, might be a good idea. For now ill try to sleep the first nights on the couch but im a very bad backsleeper. Wont expect much of tonight anyways.

I wonder how long recovery takes, everywhere i read something different. I didnt get a brace (yet). Im allowed to gentle touch my leg on the floor. The OS calls it 50% weight baring with crutches. This is for the first 2 weeks and then i got to go to the OS for a check up.

Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #8 on: March 29, 2018, 09:10:42 PM »
Maybe donít take the tramadol if it makes you vomit?! Can you get codeine instead (or cocodamol/codydramol?)? What country are you in?

Alternate the paracetamol/tramadol and ibuprofen every 3 hours, only take the ibuprofen with food though
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 Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #9 on: March 30, 2018, 08:24:20 AM »
So after an aweful night i finally was able to call the hospital. The person I got on the phone was not very cooperative, she said I just need to go tru it and maybe use "supposatory" (not very convenient if you are barely able to move. I work as a nurse myself and in my hospital we work more with oxynorm en oxycodon so I told her about that. Then she would let my OS call me back so he just did. He is very friendly and cooperative and he agreed with oxynorm (and possibly oxycodon).

Also asked him about the weigh bearing. Since my damage is not on a spot you put direct pressure on im allowed the 50%. But he said he knows I won't barely walk first couple of days or a week.

So after a night with just a couple hours of sleep, threwing up another 6 times and lots of pain I hope today is better. I am going to try some crackers and bouiilon. If that is in I take my pcm and ibuprofen and then later when dad picked it up the stronger meds.

I am from the Netherlands. My super nice and experienced OS is Dr Boons but I doubt anybody here knows him.

In one to two weeks I got an appointment with him. He can prepare for a lot of questions.

Maybe one anybody can answer. I read this procedure only works for 3 to 5 years and can be overdone maximum twice. Is this true? Even in young people (im 28) and maybe it matters if it is on a non pressure surface.

Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #10 on: March 30, 2018, 10:32:34 AM »
My OS says that the fibrocartilage from a successful microfracture (or diy as in my case) lasts around 7 years if lucky, indeed mine has been breaking down for the last few years (right on schedule) and there's now more damage and to the bone beneath, and my knock knee is getting worse (I'm also overweight which won't help)

I'd be surprised if the microfracture can be done successfully more than once and then maybe need to look at more advanced biological repairs

A replacement is now my only option, but I'm avoiding any surgery for as long as possible!

Good luck, hope the new meds help
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 Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #11 on: March 30, 2018, 02:40:39 PM »
Feels like you are my guardian Vickster!

Im really pissed of the orthopedic policlinic. Called them a couple of times but even at 2:15 pm (first call 8:15, OS called back at 8:45) they didnt send the recipe to my pharmacy. Luckely my pharmacy was very wellwilling to help so after one call from m I could go get the meds (they still havent recived the recipe tho). My nausia is gone and I dont expect that oxynorm might give any nausia. Back to eating some things.

On the other hand a friend gave me a box with chocolat, biscuits and tea (not for today tho xD ). Made my day!

Doing just tiny movements on the couch might cause sharp pains altho walking to the toilet is going better then expected. Atm I won't put any wait on my right leg. Only comming to sit is really painful. Well I was already an expert in walking on crutches so thats my advantage.

My sister is going to send me a list of possible foods that might give a positive outcome. Wonder if anybody knows more about it? Experiences?

The anesthesiologist on the other said that glucosamine is crap, some dutch consumers program handled the subject lately so possibly tomorrow I am going to watch it back.

It is a bit of a disapointment that this fibrocartilage won' t last very long but 7 y is more then what I read tonight. Had the link from here somewhere. My OS couldnt really prepare me since it was unsure what is going on. Were you able to do everything afterwards? I like long walks, travelling and my nursing job and wonder if I can do all of it again. But if it is 7 y I would be 35 when i get a knee replacement :o, omg...

Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #12 on: March 30, 2018, 04:34:10 PM »
Why would you need a knee replacement because of a small defect? All of the compartments in my knee are now showing wear and tear and the big lateral defects is at least 2.5cm2. I hope not to need a replacement for at least 10 more years (I'm 45)

Don't worry about a knee replacement in the context of a small defect. You may have no further problems from it, was it caused by an injury?

In terms of food, the literature all suggests refined sugar is inflammatory, so stick to good quality meals

Glucosamine is unproven. However, Omega 3 is shown as helpful for joints, as is vitamin D

Oxynorm is a potent opiate, stop taking it asap. It'll bung you up too so long of water and fibre :)

Yes, I have a full time office job, I travel for work and holiday and since then most years I have cycled at least 3000km a year :) I'm not a walker really (try to do 9000 steps a day) I can't run or kneel, but I can row, cycle, crosstrain in the gym and I can swim

Try not to worry about it, overthinking is counter productive. Stop fretting, stay away from Google and concentrate on getting fit again :)
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 Celina1989

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Re: 4 months of pain without known cause (short version)
« Reply #13 on: March 30, 2018, 06:21:23 PM »
It is possibly a birth defect. No injury. I stood up from the table and that started it, probably simmering for a while.

Well If the pain comes back as bad as it was something needs to be done. But since its not on a pressurepoint it might take longer. Well there are some other options, won't be needed anytime soon. For now I focus on my current rehab.

I know I shouldnt google too much. Altho being objective in it is not bad.

"It'll bung you up too so long of water and fibre :)" I have no clue what it means. Since my native language is not English. But nsaid was not strong enough and tramadol give too big of a side effect. I know oxynorm from my own hospital and it is a good strong painkiller with limited side effects and if most often not that severe. I am going to use it only for the first week.

I think my eating habits are pretty good. I love veggies and fruit and also like cooking. Recently bought ginger and curcuma to sometimes at to my dishes. But I am a sweettooth! I recently started with fish oil and had a vitamin D deficiency so am using dcura in winter eversince. My sis told me about lysine, I will google it tomorrow (yes more googling). And maybe find something else nice.

Im glad to hear that you can almost do everything, gives me hope. I looked into your first post. How much damage one fall can bring and how much you had to endour. Are you in pain now? Do you use painkillers?


Offline Vickster

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Re: 4 months of pain without known cause (short version)
« Reply #14 on: March 30, 2018, 06:28:27 PM »
Sorry, bung you up = make you constipated like all opiates!

I didnít take painkillers for a long time, unfortunately I have some more inflammatory issues so am taking NSAIDs (Celebrex) and more recently oral steroids but my rheumatologist is switching me to something else. I have quite generalised pain, stiffness aching. With the knee, very specific things seem to cause pain (twisting, running, kneeling, prodding around the damaged area and fat pad, walking for 20 minutes or more too, Cycling on steep hills)
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