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dochealey
dochealey, Senior Consultant
Category: Health
Satisfied Customers: 6131
Experience:  Physician and Surgeon
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I have never had a problem with my right knee or leg before.

Customer Question

I have never had a problem with my right knee or leg before. Three weeks ago it started to feel strange, like it was a little swelled, but not too bad. I walk 30 minutes to work and 30 minutes from work five days a week, no running, nothing else. I took it easy for a couple of days and then woke p one morning and could not bend the knee past 90 degrees. It feels like it's very swelled and tight in the muscle just above the knee but no actual swelling and there is a lot of pain if I stand on it much at all. I cannot kneel or squat. I did not injure it at all. I have rested and tried resuming just regular activity but it is not improving. I went to emergency a week ago and had X-rays and ultrasound done. They checked for blood clot, none, checked for cyst, none, no water on the knee, no sign of arthritis. I was told to rest for a few more days and take ibuprofen. I have done that, it is not improving. It was just so sudden with no injury. I am trying to go for short walks and can, but I have to be careful. It is very painful. I am doing stretching exercises, trying to strengthen the thigh and calf muscles and have no problem doing that, as long as I don't bend the knee. If I try to go past 90 it just hits a wall and will not go any further. Today I had to stand in a line for half an hour and then walked a block and waited fifteen minutes for a bus and could barely stand on it. This is getting ridiculous. I don't understand what's going on here.
Submitted: 11 months ago.
Category: Health
Expert:  Dr. Nitika replied 11 months ago.
Hi,
Associated lower back pain?
Numbness,tingling sensation in leg?
Are you overweight?
Have you seen an Orthopedist?
Is pain continuous or intermittent at certain positions?
Are you currently taking any medicines?
Any other medical illness?


Thanks dear.
Customer: replied 11 months ago.
I have no lower back pain, not on any medication, no other medical illness. I am overweight, but fairly active, used to walking a lot and standing on my feet a lot. I do not have a family doctor, there is a long wait list. ER doctor did X-rays and ultrasound and saw nothing wrong so did not see a reason to refer to anyone else.there is no numbness at all. The pain is constant but varying levels depending if I am standing or just sitting. It's not too bad sitting but I am still aware that there is something wrong. The tightness starts as soon as I try to bend the knee at all. Pain is constant inside near the kneecap, but if I stand long there is also pain in the front of the thigh right above the kneecap and also behind the knee a little.
Expert:  Dr. Nitika replied 11 months ago.
Hi,
Thanks for providing additional information.
I understand your concern and it's my pleasure to help you in every aspect.
The pain around the knee cap can be due to chondromalacia of the patella.
Here the X ray can be normal though there is pain.
Physical therapy is often helpful.
The other possible differential diagnosis may include Nerve impingement, ACL injury, bursitis or tendinitis.
As your symptoms do not improve with self care measures then a review by an orthopedic doctor (if not taken already)can be considered.
MRI scan can be needed ideally, x ray not showing much.
Use an ace bandage and take proper rest.



Hope this helps.
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Thanks.
Expert:  dochealey replied 11 months ago.
HI

I am an orthopedic surgeon and would like to help you with the problem you are having.

I need some additional information from your side.

Is it tender to touch just above or just below the knee cap.
Tell me if the knee is slightly swollen compared to other knee( keep both the knees together and observe and let me know).
Any fever?

Thanks
Customer: replied 11 months ago.

No fever, and it doesn't appear to be swollen in comparison to the other knee. There is slight tenderness on the inside side of the knee cap and barely noticeable small puffiness on the outside side of the kneecap, but just barely. The pain is mostly in the muscle right above the kneecap.

Expert:  dochealey replied 11 months ago.
Thanks for your reply.

From the information you have provided I would like to discuss the possible pathologies which may be responsible for the symptoms you have.
  • This may be a quadriceps tendinitis.Meaning that the tendon attaching the quadriceps muscle to the knee cap has become inflamed causing the pain and difficulty in bending the knee more than 90 degrees as bending the knee causes a lot of stress at this tendon at its insertion into knee cap.
  • You may have developed synovitis and mild effusion of the knee joint ( small amount of fluid in the joint which may be visible only on MRI).This can be due to varied underlying including arthritis which I have mentioned later in my reply.
  • Chondromalacia patellae is also a possibility as suggested by earlier expert but it usually occurs in adolescent age group and is almost non existent at your age.Moreover most people with chondromalacia patellae are able to bend knee much beyond 90 degrees.
  • Tenderness on the inside of the joint may be suggestive of medial joint line tenderness.This is a common feature of arthritis of the knee joint. But at your age this is an uncommon diagnosis ( though possible) and is to be considered only after ruling out other possible causes.

As it has been 3 weeks since the pain started I would recommend that you get yourself examined by an orthopedist who shall be able to pinpoint the origin of your symptoms and order any relevant investigations.

 

I would be happy to answer any further queries you may have.

Customer: replied 11 months ago.
If it is quadriceps tendinitis, how do I fix that? And what is the prognosis?
Expert:  dochealey replied 11 months ago.
Modalities for treating quadriceps tendinitis include
  • Rest and icing.These help any acute inflammation to settle down thereby decreasing pain.A brace which prevents flexion can be particularly helpful in this.
  • Anti inflammatory medicine serves the same purpose.In addition to tablets you must apply local topical anti inflammatory medicine
  • Ultrasonic massage helps in healing the tendinitis process
  • Taping and stretching( only in later stages) may also help decrease the symptoms.A physiotherapist should help in this aspect of treatment.Physiotherapist may also help in improving flexibility at the knee
  • If other measures do not help extra corporeal shock wave therapy and platelet rich plasma injections can be used to heal it.

Most cases of quadriceps tendinitis resolve but may take few months for resolution of symptoms.

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