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Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done?

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Orthopaedic Surgeon, Joint Replacement
Practicing since : 1991
Answered : 20 Questions
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Four months ago, I was sitting on a friend's couch with my leg under me. I turned to look at something and my knee went "pop" really loud with horrible pain for about 20 minutes. I couldn't walk on it real well that day. After that it only hurt going up and down stairs. I'm military so I went to this school for 2 months and it got worse - pain all the time, popping and snapping after my knee would lock up, stiffness if I sat too long and pain up and down stairs. Got back and went to the doctor. The PA told me after examining my knee he felt it was patellar tendonitis. Gave me naproxen and set up a physical therapy referral. Had me get a Xray and said that if it did get worse, come back and we'd get a MRI. Well it got worse. I had a MRI done and waiting the results and physical therapy tomorrow but it hurts all the time, I started to have hip pain at the end of July and now my thigh is really tight, probably overcompensating. I can't straighten my leg out and if I do it hurts like hell. I can't really support even my own weight on it. Talked to a couple people today and they said it looks a little swollen now.

Question is - if the MRI comes back negative, should they do an arthroscopy? I know something is wrong and it's not just tendonitis. It didn't start hurting because of overuse. It started after the loud pop followed by pain. I'm just worried that if it comes back negative, they won't try anything else.
Posted Fri, 5 Oct 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Deepak Goyal 12 hours later
Dear,

Thanks for your query.

Based on your description, I feel you have got a Meniscus tear.

Don't worry. MRI scans will confirm that.

If MRI confirms meniscal tear then you shall require Arthroscopy. It is a small surgery (keyhole), usually a day-care and you are relieved of your pain.

There may be some rehabilitation required depending upon type of tear.
Locate a good Arthroscopist in your area and consult him is my suggestion to you.

Hope this answers your query. Let me know if you have other enquiries.

Best wishes
Dr Deepak Goyal
Cartilage, Arthroscopy & Knee Surgery
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 8 hours later
If it is negative, should I be referred to ortho or get a second opinion? I've talked to other people who had a similar issue and had negative MRI and it took them a couple years to figure it out. I'm in the military so sometimes we don't usually have the best doctors or its a PA looking at us.
 
 
Answered by Dr. Deepak Goyal 2 hours later
Hi,
Thanks for writing back.
Let us wait for MRI report. You can upload it once we have it. We'll discuss it in this forum
Regards
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 33 minutes later
I went to physical therapy and they did not give me a copy of my MRI results. The physical therapist said that the results came back showing no tears but she said that sometimes MRIs can miss things. She showed me some exercises to do because she said my knee and my thigh muscles are really weak. But she said there's something that's causing the pain. I have an appointment with the PA on Thursday and wonder if I should ask for a referral to orthopedics when I talk to him.

I just wonder if there isn't something. I know my body and this is not something to ignore. I would think even inflammation would show up and she didn't say anything about that. Also with my knee locking sometimes, does that mean something is getting stuck in the knee cap? I just wonder if I don't need an orthopedic surgeon to go in and look around because it just doesn't feel right to me. I know that yes my muscles are weak after not doing any exercise for a month but when this originally started, it was due to a "pop" and I felt something tear.
 
 
Answered by Dr. Deepak Goyal 28 minutes later
Hi,
I dont think the physiotherapist or the physician assistant is the right person to be making a diagnosis here. You should be asking for a copy of your MRI results or request a referral to an orthopedician. Without a scan result or an examination, it becomes extremely difficult to comment on the exact condition.

Regards
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 2 hours later
At my appointment with the PA Thursday, I was going to ask for a referral to an orthopedician and for my MRI results because the physical therapist saying it came back showing "no tears" didn't seem right. I will reply again Thursday after my appointment at the clinic.
 
 
Answered by Dr. Deepak Goyal 13 hours later
Hi,
Ok. Kindly upload the entire report and not just comments. Will discuss further after the report.
Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 34 hours later
It's going to be next week before I can get the images from the MRI. When I went back to the PA today, he said he examined the MRI and there were no tears. So he gave me a stronger anti-inflammatory drug and said I need to continue the physical therapy exercises but gave me a profile for no running, jumping, marching unless mission required and that I can continue physical therapy while deployed, which looks to be mid-October. The only thing they gave me at the hospital today was the comments from the radiologist that there were no tears found. Next week I'll reply with the images. The PA said it seems like Patellar Femoral Syndrome but I don't know.
 
 
Answered by Dr. Deepak Goyal 53 minutes later
Hello,

Thanks for reverting.

Can you reconfirm me with more details like your country and state? Also if possible name of Dr?

May be I can help you to locate a doctor.

Without detailed clinical examination and MRI pictures, it is difficult to suggest further.

Best wishes
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 21 hours later
I'm in Kansas, in the U.S. I am in the military. I'm not sure about how we can see a civilian doctor off base and have Tri-Care (our insurance) cover it. I'm not sure if my provider- the PA - would have to put in a referral or not. It's going to take until next week to get the MRI because of the Labor Day 4 day.
 
 
Answered by Dr. Deepak Goyal 1 hour later
Hi,
Thanks for writing back.
In that case, without reports and clinical details; it is better to do a basic treatment.
Ice packs 3 times a day.
Avoid stressful activities.
VMOS Exercises
Hams stretching Exercises
Take your Physiotherapist in confidence, reconfirm and hope for the best.

Best wishes.
Dr Deepak Goyal
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 15 days later
I have the MRI and Xray images from a couple weeks ago. I uploaded the four MRI images that were on the CD. They physical therapy exercises have helped slightly but it still hurts up stairs and long distance walking and still pops and cracks.
 
 
Answered by Dr. Deepak Goyal 6 hours later
Dear,

You have uploaded insufficient images. MRI typically has 150 or more images. Kindly send your reports at one go so that it saves your time and multiple follow up queries are avoided.

Alternatively, you may mail me the full report at YYYY@YYYY with subject as 'Attention to Dr. Deepak Goyal'.

Regards
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 11 hours later
All that's on the CD is four images and when I tried to upload the viewer, it said it had to be a JPEG on here. I'm not exactly sure what I need to send then. When I open the CD it lists the following folders:

DICOM, Libraries, Preferences, Stack, Worklist and then has "AUTORUN" and a program called "MediaViewLauncher" that opens up two Xray photos and four MRI photos.

When I open the DICOM folder it has 146 files in it that are DCM files. If I knew which ones needed to be sent that would be helpful. But everything I listed is on the CD.
 
 
Answered by Dr. Deepak Goyal 12 hours later
Dear,

Thanks for writing back. I am sorry, but I need to see all 146 pics.

Take the help of some software expert to get this done.

Awaiting your response.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Popping knee, painful, stiffness after sitting too long, hip pain. Should arthroscopy be done? 28 hours later
Dear Doctor, Please check your email-box for the pics.

 
 
Answered by Dr. Deepak Goyal 6 hours later
Dear,

I had a look at all the pictures I appreciate the efforts taken.

Good news is that all the pictures that you have sent is normal. However, I am unhappy to see number of cuts that has been taken. I mean normally we take cuts at interval of 2 mm or 3 mm; but in your case they are quite apart.

May be, this is the protocol of the hospital where you get this done.

Only two final options from my side:
1. Continue with physiotherapy.
2. Go to a specialist and consult.

Unfortunately, this is limitation of e-consulting.

All the best

Deepak
Above answer was peer-reviewed by
 
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