Knee Clicking and Calf Pain After Injury: Causes and Solutions

Knee clicking and pain in the muscles at the back of the calf when bending the leg?

Hello Dr.
Shi: I hope you are well.
I am the patient with the thigh fracture (114292) from last time.
Thank you for your previous response and consultation.
This time, I would like to ask about an issue with my right knee.
During the car accident, my right knee was also impacted, but there were no fractures observed in the X-ray.
Since my left thigh fracture has not yet healed, I have been relying on my right leg to support my entire body weight.
1.
Recently, when I perform bending and straightening movements with my right knee, I have started to hear popping sounds.
There is no accompanying pain, but this was not present before the accident.
Could this be due to reduced joint mobility in the knee, leading to decreased synovial fluid and quadriceps strength?
2.
Additionally, since the accident, when I bend my right calf towards my thigh, I experience pain in the upper back area of the calf near the joint.
Initially, the doctor told me it was due to muscle or soft tissue damage, but it has been four months, and this issue still persists.
Could there be other underlying causes?
3.
After the accident, I noticed that my right foot seems to be slightly externally rotated, and the knee area appears the same.
I previously had an ultrasound and X-ray, and the doctor said there were no issues, possibly due to tight muscles, but there is some degenerative arthritis.
I would like to know if consistently using my right leg for support could lead to tight muscles and external rotation.
Is degenerative arthritis a result of not using the joint normally for an extended period? (As an athlete before the accident, is it too early at 26 years old to have degenerative arthritis?)
Thank you, doctor, for taking the time to assist with my consultation and care!

Mr. Li, 20~29 year old female. Ask Date: 2016/11/05

Dr. Shi Guozheng reply Orthopedics

1.
Yes.

2.
If the calf muscles are not used for a long time, they can atrophy, but with rehabilitation, they may gradually recover.

3.
Valgus deformity may be related to prolonged disuse, but it can also be caused by post-fracture degenerative changes.
Osteoarthritis does not develop due to underuse; rather, it is often caused by overuse, leading to cartilage wear and resulting in arthritis.

Reply Date: 2016/11/05

More Info

After a car accident, it's not uncommon to experience lingering symptoms such as knee clicking and calf pain, even if initial X-rays show no fractures. Your situation raises several important points regarding potential underlying issues and the body's response to injury.

1. Knee Clicking: The clicking sound you hear when bending or straightening your knee could be attributed to several factors. One possibility is that the joint's cartilage may have been affected during the accident, leading to changes in how the knee moves. This can result in the patella (kneecap) not tracking properly, causing it to "catch" on the underlying structures. Additionally, decreased joint lubrication due to reduced movement can lead to friction, which may also contribute to the clicking sound. The quadriceps muscle strength is crucial for stabilizing the knee, and if it has weakened due to disuse or injury, this could exacerbate the problem. Engaging in physical therapy to strengthen the quadriceps and improve joint mobility may help alleviate this symptom.

2. Calf Pain: The pain you experience in the back of your calf when bending your knee could indeed be related to soft tissue injuries sustained during the accident. Muscle strains or tears can take time to heal, and if the pain persists after four months, it might be worth considering other potential causes. Conditions such as tendonitis or even referred pain from the knee joint could be contributing factors. A thorough evaluation by a healthcare professional, possibly including imaging studies like an MRI, may be necessary to rule out any significant soft tissue injuries or other underlying conditions.

3. Knee Alignment and Arthritis: The observation that your right foot appears to be externally rotated (or "turned out") could be a result of compensatory mechanisms due to your left thigh injury. When one side of the body is injured, the other side often compensates, leading to altered biomechanics. This can result in muscle tightness and imbalances, which may contribute to the external rotation of your knee. Regarding osteoarthritis at a young age, while it is less common in athletes, it can occur due to previous injuries, joint instability, or repetitive stress on the joints. The lack of normal joint use following your accident may also contribute to the early onset of degenerative changes.

In summary, your symptoms of knee clicking and calf pain after the car accident could be multifactorial, involving soft tissue injuries, muscle imbalances, and altered joint mechanics. It is crucial to consult with a healthcare provider, such as an orthopedic specialist or a physical therapist, who can perform a comprehensive assessment. They may recommend a tailored rehabilitation program focusing on strengthening the muscles around the knee, improving flexibility, and restoring normal movement patterns. Additionally, they can provide guidance on managing any potential early signs of arthritis and help you return to your previous activity levels safely.
Remember, recovery from injuries can take time, and addressing these issues early can help prevent further complications down the line.

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