Persistent Knee Pain and Numbness Six Weeks After a Fall: What to Do?

Persistent numbness and pain in the knee for six weeks after a fall?

I fell six weeks ago, and although there were no external injuries to either knee, both were significantly bruised and painful.
The pain was particularly pronounced on the outer side of the right knee and in an area about the size of a palm below it, which has been numb.
Although the bruising has subsided, the pain and numbness have not improved, and I am unable to kneel on either side.
Additionally, in the past two days, the numb area has occasionally experienced sudden severe pain.
About two weeks after the fall, I visited an orthopedic department at a medical center, where an X-ray showed only mild knee joint degeneration without any other abnormalities.
The physician prescribed a topical analgesic for home use and suggested that I consult a neurologist if issues persisted, but I have not pursued any further treatment since then.

I have a history of a T12-L1 compression fracture, a comminuted fracture of the right heel, and fractures of the right ribs 5-9 due to a car accident in 1997, for which I underwent T10-L3 spinal fusion surgery.
Later, in 2002, I had another car accident that resulted in a C5 herniated disc, leading to another spinal fusion surgery.
I have long-term chronic lower back pain, sciatica (radiating to the right calf and the third toe on the right foot), and pain on both the inner and outer sides of the thighs in the L3 region.

I would like to ask Dr.
Yeh for advice on how to manage the pain and numbness around my knee.
Thank you.

Jizhu shoushu bingshi, 30~39 year old female. Ask Date: 2010/09/01

Dr. Ye Boshou reply Neurology

If there is pain and numbness near the knee without any abnormalities in the lower limbs, calves, or feet, it is likely due to local inflammation or swelling.
Applying a warm compress, engaging in mild activity, and taking medication can be helpful, but avoid excessive movement.

Reply Date: 2010/09/01

More Info

It sounds like you are experiencing persistent knee pain and numbness following a fall six weeks ago, which can be quite concerning. Given your history of significant spinal injuries and chronic pain, it's important to approach this situation carefully. Here’s a comprehensive response to your concerns, along with some medical insights.

Understanding Your Symptoms
1. Knee Pain and Numbness: The pain and numbness you're experiencing in your knees, particularly the right side, could be due to several factors. The bruising you noted initially suggests soft tissue injury, which can take time to heal. However, the persistent numbness and pain, especially if it radiates or is accompanied by sudden sharp pains, may indicate nerve involvement. Given your history of spinal issues, it's possible that there could be some referred pain or nerve compression affecting your knees.

2. X-ray Findings: The X-ray showing mild degenerative changes in the knee is not uncommon, especially in someone with a history of chronic pain and previous injuries. While these changes can contribute to discomfort, they typically do not explain acute symptoms like numbness unless there is significant joint involvement or mechanical instability.

Recommended Actions
1. Follow-Up with a Specialist: Since your symptoms have not improved and are affecting your quality of life, it would be prudent to follow up with a healthcare provider, preferably a neurologist or an orthopedic specialist who can assess for any nerve damage or further complications. They may recommend imaging studies such as an MRI to evaluate soft tissues, ligaments, and potential nerve compression.

2. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can help you with exercises to strengthen the muscles around your knee, improve flexibility, and potentially alleviate some of the pressure on the nerves. They can also provide modalities such as ultrasound or electrical stimulation to help with pain management.

3. Pain Management: Since you have a history of chronic pain, managing your pain effectively is crucial. If topical analgesics have not provided relief, consider discussing other pain management options with your doctor, including oral medications or injections that might help reduce inflammation and pain.

4. Activity Modification: Avoid activities that exacerbate your symptoms, such as kneeling or high-impact exercises. Instead, focus on low-impact activities like swimming or cycling, which can help maintain fitness without putting undue stress on your knees.

5. Monitoring Symptoms: Keep a close watch on your symptoms. If you notice any new symptoms, such as increased swelling, changes in sensation, or difficulty bearing weight, seek medical attention promptly.

Long-Term Considerations
Given your history of significant spinal injuries and chronic pain, it’s essential to adopt a holistic approach to your health. This includes:
- Regular Check-Ups: Regular follow-ups with your healthcare provider can help monitor any changes in your condition and adjust your treatment plan as necessary.

- Lifestyle Modifications: Maintaining a healthy weight, engaging in regular low-impact exercise, and practicing good posture can help alleviate some of the stress on your knees and back.

- Pain Management Strategies: Explore various pain management strategies, including physical therapy, medications, and possibly alternative therapies like acupuncture or chiropractic care, which may provide additional relief.

Conclusion
Your situation is complex, and it’s crucial to have a thorough evaluation to determine the best course of action. Persistent pain and numbness should not be ignored, especially given your medical history. By working closely with your healthcare team, you can develop a comprehensive plan to address your symptoms and improve your quality of life. Remember, early intervention can often lead to better outcomes, so don’t hesitate to seek further evaluation and treatment.

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