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Diagnosed with joint effusion, signs of tendinosis present. Zero effect with Panadol and Codapane. Best treatment?

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Orthopaedic Surgeon
Practicing since : 2000
Answered : 170 Questions
Hello from Australia.

I have just been diagnosed with

mild to moderate joint effusion. Signs of tendinosis are present in the quadriceps tendon. The tendon is heterogenous distally. No tear of the tendon is demonstrated. There is a moderate increase in blood flow within the tendon. The patient was tender when scanning was performed directly over the area. The patellar tendon is normal in appearance. No abnormality is present elsewhere.

Conclusion. There are signs of tendinosis within the quadriceps tendon.


About three weeks ago, I did some spinning in a chair for balance (vestibular function). I noticed that my right leg became sore after a few days of this activity. I have a stationary bike at home and ride on it every few days. I continued on the bike but noticed the pain in the knee getting worse.

For about a week, there was marginal swelling. I found it difficult sleeping on either side as my knee would be sore and would be very stiff in the morning.

My current symptom is that when I bend the right knee, at a particular point the pain is severe. I am not in pain when the leg is straight or slightly bent. The pain is not on the knee cap but just above it. (Initially there was pain below the knee cap, but that pain has dissappered now). If I keep my leg straight and put only a little pressure above the knee with my hand (pointed fingers) there is a lot of pain.

Before I saw the surgeon the family doctor had an xray done, which showed that my knees (bones) were in good condition; no detoriation.

I am 64 years of age; not on any medication, and although slightly overweight, I am quite fit.

The surgeon today wants me to see a physiotherapist for treatment. (I did initially see a physiotherapist before the diagnosis, who taped my knee, gave me some knee lifting exercises and put me on some mild anti inflamattory medication. This treatment had zero effect in helping. However I was only on this treatment for 4 days).

The pain killers that I have tried, following the doctors orders, have been Panadol Osteo 6 tablets daily, which had zero effect in reducing the pain, then Codapane Forte (Paracetamol/codeine) two 500 mg/30mg tables 4 times a day, with zero improvement in reducing the pain. I have been told to start Moxicam (Meloxicam) tablets 15mg, once daily and take the Codapane if needed.

What is the best treatment for this problem? Are vitamin supplements recommended? Would you recommend any other xrays/tests?

I am very keen to get back to optimum health for my age.

Thank you for your help.

Paul Copeland
Posted Mon, 16 Apr 2012 in Bones, Muscles and Joints
Answered by Dr. Atul Wankhede 2 hours later

Thanks for posting your query.

It is very important to reach a proper diagnosis before we talk about treatment. The symptoms suggest that you most likely have some pathology of the quadriceps just before it merges in your patella. If you have pain just above the knee cap that means it is either a tear (thus the heterogenicity on scan) or misalignement of the quadriceps mechanism of knee extention causing the patella to hit on the lateral condyle causing pain.

For confirming this, you must ask your Orthopaedician to rule out all things of XXXXXXX derangement of knee like ligament, meniscus, cartilage or synovial pathology. From what it seems if you think that the scan has not been conclusive, I suggest you take a second opinion and repeat the MRI. If you are in a lot of pain, I recommend you visit an arthroscopy surgeon near you and get a diagnostic plus therapeutic arthroscopy done in same sitting.

Mean while you might want to change the anti inflammatory medicines to a little stronger ones under your physicians guidance. Avoid climbing stairs as far as possible. Try not to bend the knee, there are few braces available in market that helps one do that. Wait for the pain to subside completely before you do any physiotherapy, it might aggravate your symptoms. Give your knee little compression with crepe bandage for keeping the swelling from increasing. Hot fomentation once in a while is helpful.

I dont think vitamin supplements is a necessity but not contraindicated, so you might want to take them. In my opinion if all the tests fail and you still have pain, Arthroscopy is the gold standard investigation for your knees.

Hope I answered all your queries. Please accept my answer in case you have no further queries.

Above answer was peer-reviewed by
Follow-up: Diagnosed with joint effusion, signs of tendinosis present. Zero effect with Panadol and Codapane. Best treatment? 21 hours later
Hello Dr. Wankhede.

Thank you for your very informative response.

I see the physiotherapst tomorrow for a new evaluation.

Today I have not taken any pain killers.

Today I needed to drive the car to the local shopping centre and back. Bending my leg to get into and out of the car caused extreme pain for the bent leg. The moment the leg straightened out, the paid dissapeared.

I am not in any pain at other times, only when I bend the leg to a certain angle.

I will let you know what the physiopherapist says.

Bye for now.

Answered by Dr. Atul Wankhede 8 hours later
I'm glad to be of service.

Sorry to hear that the pain reappeared on sitting in the car. It sounds that the knee somehow gets locked in bending position. This is suggestive of meniscal problem. With proper evaluation this should be diagnosed.

Indeed let me know what your physiotherapist tells you. I'll guide you through it.

Good luck.
Above answer was peer-reviewed by
Follow-up: Diagnosed with joint effusion, signs of tendinosis present. Zero effect with Panadol and Codapane. Best treatment? 12 hours later
Hello Dr. Wankhede

Thank you for your response.

I perhaps didn't explain myself fully.

My leg is not in any pain when it is reasonably straight. But the moment I bend the knee there is a spot where the pain is severe just above the kneecap (not over the kneecap). This is most obvious when I try to get into a car or out of a car.

I saw the physiopherapist today.

This is our plan.

I am to take anti-inflamatory tablets for 4 days.

The knee is taped up so that I can't bend it much.

I am to do an exercise many times a day being :-

Lift the leg up straight (horizontal to the floor) while sitting, and tense the quadracep muscle knee for 10 seconds. Then support the leg with the other leg as I rest the leg down.

If on Monday there has not been any improvement, the plan will be to most probably have an MRI done (the previous test was the ultrasound).

We are looking into the MRI costs. If a physiotherapist orders an MRI the cost is $295 without any rebate. If a specialist orders an MRI the cost is reduced, but not all MRI clnics can give the discount and apparently there is a wait for to get an MRI done with a MRI machine that provides a discount.

One reason I need to be healthy is :)

My wife and I care for a profoundly disabled young man (Grant) in a wheelchair who suffers from intractable seizures (Lennox gastault syndrome). He is now 23 years old. We have been caring for him full time since he was 18 months old. I took XXXXXXX to the day centre today. Just getting in and out of the vehicle caused a lot of pain for a few seconds when the knee was bent.

You can see a video fo XXXXXXX here WWW.WWWW.WW Make sure you turn the volume up :)

I understand that this is my last consulation with you, so thank you very much for your expert advice. I am sure that in time my leg will improve.

Best wishes to you and your family. I am sure that many patients who contact you via XXXXXXX are blessed and and helped a lot as I have been.

Best wishes.

Answered by Dr. Atul Wankhede 6 hours later
Thank you for your kind words, these inspire me and my team to work with more enthusiasm.

Thanks for sharing with us the beautiful journey of XXXXXXX You and your family has done an outstanding contribution in bringing him up and nurturing him. I wish him all the best for his future.

I beg to differ from your statement sir, you explained yourself fully, and I read it correct. I have reason to believe that if the knee pains only after bending in particular position while getting in or out of your vehicle, then it might have a meniscal problem. Meniscus as you know are soft natural cushions that prevent friction between Femur and Tibia. If they wear out naturally after a certain age, then the aforesaid bones rub against each other causing pain in bending and relief in straightening. As I previously said, MRI is the investigation of choice, it has to be done. I understand the financial constraint, but we can wait and let things take more definitive course.

The plan made by your physiotherapist sounds appropriate. If the exercise is not painful or does not give you the apprehension of pain, you may continue doing it for as long they want you to it. Rather than taping which might be a little inconvenient, you may use a brace. Its good to keep it as straight as possible till it heals completely.

I wish you a speedy recovery and appreciate the positive approach you have towards your health.
Good luck.
Above answer was peer-reviewed by
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