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Dr Chip (M.D.)
Dr Chip (M.D.), Doctor
Category: Neurology
Satisfied Customers: 32716
Experience:  20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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I was diagnosed 20years ago with ankylosising spondylitis. I

Customer Question

Hi I was diagnosed 20years ago with ankylosising spondylitis. I am often afflicted by overpriduction of synovial fluid and swelling in my left knee. This has been controlled over the years with Enbrel. Approx 6weeks ago I was experiencing swelling and tightness in the back of BOTH knees. When I was walking to my office I felt like I overextended and felt (not heard) a pop. My lower right calf swelled and went literally numb. It looked like a huge sausage. I went for massage the next day and the Therapist suggested a bakers cyst popped. I was uncomfortable and swollen for two weeks until I could get in to my rheumatologist. I asked him to aspirate before injecting the steroid unto both knees. He said my knees were not swollen (They were huge) and only injected then sent me in for X-rays. He too wrote it off as a bakers cyst. The steroid lasted about two days and the swelling resumed I have now been in bed for 1.5 weeks elevating my knee. I can not put any pressure on it without an immeasurable amount of pain on tightness on the back inner right knee. The rheumy hasn't called me back for 5 days after I put a new call in to him. I also have small little red painful bumps all on the back of my knee and as well as a bruise outside of the steroid injection site. I feel 10x worse than before I went to see the rheumy. Could the steroid injection have caused an infection? I am familiar with ankylosing spondylitis pain. This is not it. Any suggestions please
Submitted: 11 months ago.
Category: Neurology
Customer: replied 11 months ago.
I think this should be referred to an orthopedic surgeon or rheumatologist. Some how I got a wrong specialist request
Expert:  Dr Chip (M.D.) replied 11 months ago.

Hello and welcome. 'm Dr Chip

First off, I don't think this was from a ruptured Baker's cyst--way to much edema fluid involved there.

This definitely sounds like a septic infected joint--perhaps from the injection.

You need an aspiration of the fluid and have that sent for cultures and sensitivities as well as an MRI of the knee to check for a torn meniscus or cruciate ligament--that would account for the pop you felt. Also--the Enbrel makes you more susceptible to infections.

I formerly was a trauma surgeon and critical care specialist so I do know about joint problems.

Please let me know if you need more information.

I don't think any of this is related to your AK.

Customer: replied 11 months ago.
Hey Dr Chip. Thank you. Due to my AK, I have a pre-existing so that leaves me with wonderful obamacare. This is only the 3rd time I have visited this rheumy. If he only requested X-rays, how do I go about authorizing an mri? That is what I thought I needed in the first place Beacause of the damage to my synovium, it doesn't communicate I have several 'pockets'. In the past, I have had previous ER techs and even rheumys afraid to aspirate because of their fear of nerve damage (I'm serious) It would make sense that all docs should be able to aspirate, but I once waited in the ER for an orthopedic for 3 hours and he never showed. Do I go,the ER route (scary) or should I try a PPO orthopedic surgeon. Waiting time is approx 1 month. I am in LA if you know anybody capable. Thank you
Expert:  Dr Chip (M.D.) replied 11 months ago.

Hi again. Your primary care doc or the rheumatologist can order the MRI and there's more than enough of a case for it here that I don't think approval will be a problem. Since we may be dealing with a septic joint I'd consider that an emergency and so I'd suggest the ER for the aspiration, and there really wouldn't be much of a risk for nerve damage if it were done properly.

Keep in touch and let me know how things go.

Customer: replied 11 months ago.
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Customer: replied 11 months ago.
Although inflamed, the knee and surrounding tissue is not red or scaly as I just saw in photos on Google
Expert:  Dr Chip (M.D.) replied 11 months ago.

Hi again. This may not be a septic joint but considering the entire scenario, I can't rule that out so it would be best to get to the ER