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After having a cortisone injection and a gel infiltration of…

After having a cortisone...

After having a cortisone injection and a gel infiltration of my knee, it became bruised, swollen, and has lumps. It was painful to have this injection and doctor said that my knee had lots of debris. He gave me antibiotics, anti inflammatory, and cortisone and 3 weeks later it is still the same. Orthopaedic specialist said he doesn’t know and is trying to send me to another specialist because I have an infection as my blood work shows and he wants to get a second opinion. I have been icing it but pain and swelling do not go away.. I would love to get a MRI done as doctor did agree but he changed his mind now. What do you recommend? Tks

Doctor's Assistant: How long have you had the lump? Is it hard or soft?

Several lumps on my knee they are very painful more on the hard side

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I removed both cartilages when I was 20.( used to be a basketball player at university). I am followed up by an orthopaedic surgeon every year because he says that I need a knee replacement. I have an appointment booked for December. It was my third time doing this injection with this new doctor and only this time this happened. I am very worried .

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Answered in 1 minute by:
10/30/2017
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,772
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Customer reply replied 8 months ago
Thank you

I agree, that you need an MRI for the evaluation.

Second opinion by the another orthopedic may be not contributory to the management unless an MRI is done.

Ice, anti inflammatory analgesics, knee brace, deep electrotherapy and physical therapy are the mainstay of the treatment meanwhile.

You may have bursitis and tendonitis presently, concomitant to your primary knee issue.

Please feel free for your follow up questions.

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

Thanks for using Just Answer.

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Customer reply replied 8 months ago
Is there a way that I can attach a photo of my knee? Also what caused those lumps? Allergic all to the infiltrations? Did doctor hit a nerve?

Lumps can be due to allergy or inflammatory nodules in the soft tissue.

You can send the photo;

You may do it as following;
1. Click the paperclip icon
2. Click the Browse icon
3. Click the Browse button
4. Select your file and click Open
5. Click OK
6. Click Insert
7. Click Save Changes on this page

http://ww2.justanswer.com/help/topics/142

http://screencast.com/t/eHsvtij7WT

I may be able to send the follow up answer in around 45 minutes as I just have to a minor emergency procedure.

I will answer as soon as I see the picture.

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Customer reply replied 8 months ago
Where can Ido an MRI urgently?
I am trying to send you a picture and it is not working. I will keep trying. I will wait for your follow up answer Good luck with your emergency procedure. Thank you
Customer reply replied 8 months ago
I will try to send the picture now..
Customer reply replied 8 months ago
Here is another picture. I am icing my knee everyday several times a day. I can’t even tolerate a sheet on my knee at night that’s how sensitive and painful it is. I am very upset because I don’t sleep at night...

I saw the pictures. There is lot of bruising also, it seem.

There is iontophoresis and phonophoresis done at physical therapy centers. That should be beneficial.

These are likely to be inflammatory nodules.

Acupuncture, very mild massage may also help you.

Keep it elevated as much as possible.

Avoid prolonged standing or walking for a while.

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Customer reply replied 8 months ago
lots of bruising indeed. I am taking Vimovo
Customer reply replied 8 months ago
Blood work shows infection too not on white cells.

Your doctor may take an aspirate from the nodules or knee and send it for the culture test. An antibiotic according the culture report should be able to resolve it.

Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,772
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
Verified
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Customer reply replied 8 months ago
Is this clinical situation dangerous? I mean this persistent and on going bruising, swelling and nodules,Thank you Dr Arun.

You are very welcome.

It is not dangerous.

This would resolve.

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Customer reply replied 8 months ago
Thank you again. You made my day.

You are most welcome.

Wishing you all the very best in life.

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Customer reply replied 8 months ago
Hi Dr Arun, I had an apponyment today with a GP still regarding my knee because I am in excrutiating pain. Still waiting for an appt with specialist. The GP believes that I have fatty necrosis and will help speeding up the process of seeing the specialist asap. What has to be done if the GP's diagnosis is correct? Tks
Customer reply replied 8 months ago
Thank you

Even for fatty necrosis; deep electrotherapy (iontophoresis, phonophoresis, short wave diathermy) and physical therapy will help.

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Customer reply replied 8 months ago
I am in excruciating pain. The nodules are so painful..

A very mild massage, deep electrotherapy, acupuncture can help you.

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Customer reply replied 8 months ago
I am in excruciating pain. Will this go away .? I have suffering for the last two months.Not even antibiotics or cortisone helped. When does an aspiration or cleaning this area is advisable? The knee looks exactly the same , colour wise, but the nodules are bigger.

I am sorry for your pain. Following comprehensive measures may help you in resolving the pain;

1) Physical therapy; this is the mainstay of the management. Stretching exercises, strengthening exercises, mild weight bearing exercises, swimming on the week-ends etc would be helpful.

2) Deep electrotherapy; this entails going to physical therapy center and take care of specific painful points around knee.

3) Glucosamine and chondroitin supplements

4) Diacerin too can be tried which suppose to regenerate the cartilage.

5) Local analgesic sprays

6) Mild massage

7) Warm shower in morning.

9) Capsaicin (Zostrix, ArthriCare) is an irritant derived from chili peppers that provide relief by depleting a chemical that transmits pain from nerve endings. Various strengths are available without prescription. (It causes a burning sensation thus one has to be careful while applying and should wear a disposable plastic glove).

10) Acupuncture; most popular forms of alternative or complementary medicine, particularly for pain relief.

11) Analgesic patches too are available for the pain relief.

These are the exercise resources for the knee. You can pick the exercises which suits you;

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

http://www.pamf.org/sports/king/kneerehab.html

If overweight is an issue; long term is achieved by weight reduction. High impact exercises should be avoided; like kneeling and bending.

See if you can tolerate the knee brace. There are hinged braces which you can wear all day.

To summarize:

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 your normal activities reduces repetitive strain on your 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 your knee and help you regain knee stability. Ideal is supervised physical therapy. Stretching exercises are also part of the physical therapy regime.

5) Orthotics and bracing.

Hope this helps.

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Customer reply replied 8 months ago
If it is bruising in two months the colour should be yellow, eg fading away, no? In my case the red is colour is still the same from day one....
Customer reply replied 8 months ago
I am not overweight but I am on a stric diet to lose more weight preparing myself for the knee replacement. I lost three kilos already. I am a size 10.
Your explanation is amazing by the way. Sorry for all these questions. I am so frustrated. No doubt that this was caused by the knee injection( durolane), don’t you agree?.

This is likely to be caused by the injection. There may have been;

1) Infiltration in the soft tissue instead of knee which caused tissue necrosis and significant inflammation.

2) Or there was a reaction to it.

I can understand. This is frustrating. A lingering issue can cause so much of discomfort.

Thanks for your kind words.

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Customer reply replied 8 months ago
Is fatty necrosis dangerous? Will this brownish colour will go away?

Fatty necrosis is not dangerous. The brownish discoloration would go away but it takes significant time.

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Customer reply replied 8 months ago
Thank you so much for your explanation. I will be back for sure as time and my knee situation progress.

You are most welcome.

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Customer reply replied 8 months ago
Where are you located? Canada? USA?

Site rule prohibits divulging personal details on this thread, I am afraid.

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Customer reply replied 8 months ago
No problem. Thank you again.

You are always welcome.

Wishing you a speedy resolution.

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