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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29576
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My sturdy, but Alzheimer stricken, 81 - year - old husband

Resolved Question:

My sturdy, but Alzheimer stricken, 81 - year - old husband has been having knee pain in just one knee for several months, and it has become progressively worse . Until this, he has never experienced knee pain. In the foot of the same leg, he stepped on a nail in our yard when our house was being re-roofed a year ago. That foot has bothered him for a full year. About three months ago, in the middle of the night, something happened with my husband's knee in the bathroom. He said aloud, and woefully, "Oh, no," and came out of the bathroom with knee pain. He has alzheimer's, so he was unable to tell me what happened -- I assumed he twisted his knee somehow (although he is not at all uncoordinated and I didn't hear him fall -- which he has never done). I poked around on his leg and tried to figure out what had happened, but found nothing unusual. He was able to walk just fine except that it hurt, he said. We went to the doctor and the doctor he patted the knee and said it was neuropathy. We went again to the doctor this last week and the doctor ordered an xray. It will be a week before we see the doctor and we live in a rural town, but I have picked up the x-ray report. Following is what the x-ray report says (it is gobbledygook to me. Can you decipher it? Does it mean my husband could have a nail or something in his knee? ("foreign body"???)

"On the lateral view, there is a 15mm oval bony foreign body projecting in the suprapatellar bursa. On the frontal view, there is an 8.1 mm osseous body projecting in the intertrochanteric notch. No joint effusion is seen. No fracture or dislocation is seen. Mild narrowing is seen at the medial femorotibial compartment. Tiny osteophytes are present.
IMPRESSION: 1. Findings are consistent with free osseous bodies within the joint. Consider CT scan or MRI for better characterization. 2. Mild degenerative change
Submitted: 10 months ago.
Category: Health
Expert:  Dr. Nitika replied 10 months ago.
Hi,
Associated swelling,redness on knee?
Associated popping sound while bending the knee?
Is he taking any medicines?
Can he walk without pain?

Thanks dear.
Customer: replied 10 months ago.


I measured his knees, believe it or not, and they are the same size. He does take neurontin (gabapentin) for an unrelated condition, and he has been taking it for about two years . He has pain only in one knee, and it hurts him a lot to walk because of his knee. There is no popping.

Expert:  Dr. Anil Kumar replied 10 months ago.
Hello,
Thanks for providing more information.

Most likely there are chances that there is a broken osteophyte seperated from the bone in the knee joint.( free osseous bodies within the joint.)
Usually in such cases the treatment is conservative.
And includes
NSAIDS
Physical therapy.
Rest

It is a rare possibility that it may be a foreign body.
If you can send us the scan copy of the x-ray we can able to help you further to narrow down the possibility.



I hope this helps.
If you have any further query then feel free to ask.
Positive feedback and bonus are highly appreciated.
Thank you.

Customer: replied 10 months ago.

Can you decipher it? That is my question. Can you please rewrite the following in English. That is what I am asking. Please tell me what the words mean. I don't know what an "osseous body" is or what a "suprapatellar bursa" is or what an "intertrochanteric notch " is. I don't know what an "effusion" is. Please enlighten me. Thank you for saying I can send a copy of the xray. Wow! I didn't know that was possible and didn't get a copy of it. I think I will be fine if you can just interpret the language used to describe the xray. Can you do that?

"On the lateral view, there is a 15mm oval bony foreign body projecting in the suprapatellar bursa. On the frontal view, there is an 8.1 mm osseous body projecting in the intertrochanteric notch. No joint effusion is seen. No fracture or dislocation is seen. Mild narrowing is seen at the medial femorotibial compartment. Tiny osteophytes are present.
IMPRESSION: 1. Findings are consistent with free osseous bodies within the joint. Consider CT scan or MRI for better characterization. 2. Mild degenerative change

Expert:  Dr. Arun Phophalia replied 10 months ago.

Hello,
I am Dr. Arun and will be helping you today.

Following are word meaning of the terms;

Osseous body; bony pieces. These may form due to degenerative arthritis.


Suprapatellar bursa; Suprapatellar is above the knee cap area. The bursa is fluid filled cushion like normal structure around the joint for the smooth movement of the tendons.


Effusion is swelling or fluid usually due to inflammation in the joint.

Your report would be thus deciphered as;

On the lateral view, there is a 15mm oval bony foreign body projecting in the suprapatellar bursa. = the side view of the x-ray show, a 15 mm bony piece going in to the bursa (fluid filled cushion for the smooth movement of the tendon) above the knee cap.

On the frontal view, there is an 8.1 mm osseous body projecting in the intertrochanteric notch. = In the front view of the x-ray there are bony pieces (osseous-which are usually formed due to age related arthritis) projecting in between the depression (notch) of two prominent (inter trochanteric) portion of leg bone.

No joint effusion is seen. = No fluid in the joint is seen.

No fracture or dislocation is seen. = No fracture or joint dislocation.

Mild narrowing is seen at the medial femorotibial compartment. = On the inner side (medial) of knee joint the space is narrowed between the thigh and leg bone which forms the knee joint (femorotibial compartment). This again denotes the age related or degenerative arthritis.

Tiny osteophyte are present. = Small pieces of new bone (osteophyte) are present in the joint. Again this is due to age related arthritis (termed osteoarthritis).

 

Following measures would be helpful in the knee osteoarthritis;

1) Knee care in the activities of daily living. Few simple self-care measures can be remarkably effective in ending pain cycle.

a) Avoid prolonged standing or walking or sitting with joint in a single position.

b) whenever you sit, keep the knee stretched and fold them intermittently.

c) Squatting, sitting cross legged should not be done.

d) Avoid climbing stairs.

e) Avoid sitting legs unsupported or hanging.
f) Reduce weight if over weight/obese.

2) Rest: Taking a break from normal activities reduces repetitive strain on knee, gives the time to heal and helps prevent further damage.

3) Anti-inflammatory medications

4) Physical therapy; the goal of physical therapy is to strengthen the muscles around knee and help regain knee stability. Ideal is supervised physical therapy. Stretching exercises are also part of the physical therapy regime.

5) Orthotics and bracing. Knee brace

6) Glucosamine and chondroitin orally for about 1-2 years and a trial of diacerin for three months.

7) Hyaluronic acid injections in knee.

8) Local analgesic sprays and ointments to skin may help relieve the pain and stiffness of osteoarthritis.

9) Deep Electrotherapy by physical therapist.

These are the exercise resource for the knee.

http://bigkneepain.com/knee-exercises.html

Please feel free for your follow up questions. Also please do not opt out the expert when you press the reply button. Just click the reply. If you press opt out button, I am barred to reply you by the site administration.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

 

I hope that this information is helpful. If you need further information, please just send me a reply asking for clarification. Once you are satisfied, I hope you will enter a positive rating so that I will be credited for assisting you. Thanks again for using this service. Your business is appreciated.

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29576
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 5 other Health Specialists are ready to help you
Customer: replied 10 months ago.

Thank you! You are a big help! I was very worried about my husband's knee. He can't talk to me to explain to me what is going on, and the x-ray language just baffled me further.


 


We will follow your advice.


 

Expert:  Dr. Arun Phophalia replied 10 months ago.

You are very welcome,

 

Good luck.

 

It is privilege assisting you.

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