Knee Pain: Essential Tests to Diagnose Your Condition

Q: Knee Pain: Essential Tests to Diagnose Your Condition

Hello： Based on the symptoms you described, it is highly likely that your knee is experiencing a hematoma and inflammation in the prepatellar bursa following an injury. <br>Currently, the presence of scar tissue may be causing pain when kneeling, as well as soreness after prolong

What tests should be conducted to determine the cause?

Hello Doctor: A few years ago, my knee was injured when I fell off my bike, causing a significant swelling in the area.
The doctor said that the skin and underlying tissue had separated, and there was a collection of blood and fluid inside.
About a month later, when I visited Chang Gung Hospital, the doctor used a syringe to aspirate the accumulated fluid.
That night, my knee suddenly swelled up significantly and was so painful that I couldn't walk.
Later, a nearby hospital performed surgery to remove the fluid.
However, since then, I have experienced persistent discomfort and soreness in my knee.
It hurts when I kneel, and walking or standing for extended periods causes aching pain.
Despite multiple visits to orthopedic specialists and X-rays that showed no issues, I am still concerned.
What could be the problem? What tests should I undergo to determine the cause? Thank you, Doctor.

Long A, 20~29 year old female. Ask Date: 2006/06/14

Dr. Chu Baijun reply Orthopedics

Hello: Based on the symptoms you described, it is highly likely that your knee is experiencing a hematoma and inflammation in the prepatellar bursa following an injury.
Currently, the presence of scar tissue may be causing pain when kneeling, as well as soreness after prolonged walking or standing.
Since this issue does not involve bone pathology, X-rays may not be sensitive enough to reveal the underlying problem.
If the condition is severe, surgical treatment may be necessary.
I recommend that you visit an orthopedic clinic for a detailed evaluation and treatment.
Sincerely, Dr.
Chou, Orthopedic Specialist.

Reply Date: 2006/06/14

More Info

Knee pain can be a complex issue, especially when there is a history of trauma, such as the one you described involving a fall that led to significant swelling and the accumulation of blood in the knee joint. Your symptoms of persistent discomfort, particularly when kneeling or after prolonged walking or standing, suggest that there may be underlying issues that are not visible on standard X-rays.

Given your history, it is essential to consider several potential causes for your ongoing knee pain. One possibility is that you may have developed post-traumatic arthritis, which can occur after an injury to the knee joint. This condition can lead to inflammation, pain, and stiffness, particularly after periods of inactivity or after extensive use. Another potential issue could be related to the soft tissues surrounding the knee, such as ligaments, tendons, or the meniscus (the cartilage that cushions the knee joint). Damage to these structures may not always be visible on X-rays, which primarily show bone.

To further investigate your knee pain, your doctor has recommended blood tests and an ultrasound of the knee joint. Here’s what these tests can help determine:
1. Blood Tests: These can help identify markers of inflammation or autoimmune conditions that might be contributing to your knee pain. For example, tests for rheumatoid factor or anti-nuclear antibodies can help diagnose rheumatoid arthritis or other inflammatory conditions. Additionally, tests for uric acid levels can help determine if gout is a factor.

2. Knee Ultrasound: This imaging technique can provide a dynamic view of the knee joint, allowing for the assessment of soft tissue structures, including ligaments, tendons, and the meniscus. It can also help identify any fluid accumulation in the joint, which may indicate inflammation or injury. Ultrasound is particularly useful for guiding injections or aspirations if needed.

3. MRI (Magnetic Resonance Imaging): If the ultrasound suggests soft tissue damage or if your symptoms persist despite normal ultrasound findings, your doctor may recommend an MRI. This imaging modality provides detailed images of both bone and soft tissues, allowing for a comprehensive evaluation of the knee joint. It can reveal tears in the meniscus, ligament injuries, and other soft tissue abnormalities that may not be visible on X-rays.

4. Physical Examination: A thorough physical examination by an orthopedic specialist is crucial. They can assess your range of motion, stability, and any specific areas of tenderness. They may perform special tests to evaluate the integrity of the ligaments and meniscus.

5. Joint Aspiration: If there is swelling in the knee, your doctor may consider aspirating the joint to analyze the synovial fluid. This can help identify infections, crystals (as in gout), or other inflammatory processes.

In summary, your ongoing knee discomfort after a significant injury could be due to a variety of factors, including post-traumatic arthritis, soft tissue injuries, or other inflammatory conditions. The combination of blood tests and knee ultrasound will provide valuable information to help pinpoint the cause of your pain. If necessary, further imaging such as an MRI may be warranted to ensure a comprehensive evaluation of your knee. It’s essential to communicate openly with your healthcare provider about your symptoms and concerns, as this will guide the diagnostic process and subsequent treatment options.

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