Knee Pain: Symptoms, Diagnosis, and Treatment Options

Regarding knee pain issues?

Hello Doctor, around July 28, while exercising outdoors, I jumped down from a height and felt something unusual in my right knee.
That night, when I went to bed and slept on my left side, I suddenly experienced severe pain at the lateral joint line of my right knee, feeling as if it was twisted.
Later, when I lay flat and got up the next day, I noticed some pain around my patella.
I didn't pay much attention at the time and went for a light jog, but I couldn't run more than a hundred meters before experiencing intense pain in the middle of my right knee.
After resting for two to three days, I felt significant pain around the patella when sitting or getting up from bed.

I then consulted a doctor who performed an ultrasound on my knee and mentioned slight inflammation, diagnosing it as a patellar ligament strain.
After taking the prescribed medication, I felt no improvement.
Two weeks ago, I visited another doctor who took X-rays and diagnosed me with prepatellar bursitis.
During the recovery period, I frequently sat with my legs elevated.

As of now, my symptoms fluctuate, and I have been observing the condition of my right knee, which includes the following issues:
1.
In the morning, after waking up or resting my knee while lying flat, it becomes very stiff.
Bending the knee causes significant pain around the patella, and my quadriceps feel tight, although the discomfort lessens with movement.

2.
Recently, when lying on my right side, I experience sudden severe pain at the lateral joint line of my knee, but not when lying flat.

3.
Bending my right knee causes pain at the medial and lateral joint lines, as well as the posterior aspect, and the patella also hurts.

4.
I am unable to perform a full squat; attempting to do so results in tightness throughout the knee, especially around the quadriceps and severe pain around the patella.

These symptoms fluctuate, and I am unsure whether the issue lies with my patella or the meniscus.
This situation is causing me significant anxiety.
Do you think I need to go to a larger hospital for an MRI? I would appreciate your advice.
Thank you.

Ss, 20~29 year old female. Ask Date: 2017/08/23

Dr. Shi Guozheng reply Orthopedics

First, adopt conservative treatment by taking medication or undergoing rehabilitation.
If there is no improvement after six weeks, then consult a physician for examination and further management.

Reply Date: 2017/08/23

More Info

Knee pain can be a complex issue, often stemming from various causes, including injuries, inflammation, or degenerative conditions. Based on your description, it appears that you may be experiencing symptoms related to patellar tendinopathy, patellofemoral pain syndrome, or possibly issues with the meniscus or ligaments in the knee. Let's break down your symptoms and explore potential diagnostic and treatment options.

Symptoms Analysis
1. Pain Location and Nature: You mentioned pain on the side of the knee joint and around the patella (kneecap). This could indicate issues with the patellar tendon or the surrounding structures. The fact that the pain worsens with certain movements, such as bending or squatting, suggests that the knee joint is under stress, which could be due to inflammation or mechanical issues.

2. Stiffness and Tightness: The stiffness you experience in the morning or after resting is common in knee injuries, particularly those involving inflammation. This can be due to synovial fluid accumulation or muscle tightness, particularly in the quadriceps, which may be compensating for the pain.

3. Pain with Specific Movements: The sharp pain when lying on your side or attempting to squat indicates that certain positions or movements exacerbate the underlying issue. This could be related to the alignment of the patella or the integrity of the meniscus.

Diagnostic Recommendations
Given your symptoms and the previous diagnoses of patellar tendon strain and bursitis, it would be prudent to consider further imaging studies, such as an MRI. An MRI can provide detailed images of the soft tissues in the knee, including the cartilage, ligaments, and meniscus, allowing for a more accurate diagnosis. This is particularly important if conservative treatments have not yielded improvement.

Treatment Options
1. Rest and Activity Modification: Continuing to rest your knee and avoiding activities that exacerbate the pain is crucial. This includes high-impact activities like running or jumping, which can further irritate the knee.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can design a rehabilitation program focusing on strengthening the muscles around the knee, improving flexibility, and correcting any biomechanical issues that may contribute to your pain.

3. Ice and Compression: Applying ice to the knee can help reduce inflammation and pain. Compression wraps can also provide support and reduce swelling.

4. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. However, since you mentioned that previous medications did not provide relief, discussing alternative pain management strategies with your healthcare provider may be necessary.

5. Injections: In some cases, corticosteroid injections may be considered to reduce inflammation in the knee joint. This should be discussed with your physician based on the severity of your symptoms.

6. Surgical Options: If conservative treatments fail and imaging reveals significant structural damage, surgical options may be explored. This could include arthroscopy to repair or remove damaged tissue.

Conclusion
Your symptoms warrant further investigation, particularly with an MRI, to rule out any significant injuries to the meniscus or ligaments. In the meantime, focus on rest, ice, and gentle range-of-motion exercises as tolerated. Consult with a sports medicine specialist or orthopedic surgeon for a comprehensive evaluation and tailored treatment plan. Remember, early intervention can often lead to better outcomes, so seeking further medical advice is a wise decision.

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