Suggest remedy for severe pain in the knee

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Posted on Tue, 16 Jun 2015 in Bones, Muscles and Joints
Question: Hi, I was pushing a very obese pt in w/c, shortly after started to feel a slight pull lat and posterior to rt knee. By morning became very painful. hurts most driving car especially anterior knee down my shin to ankle. Injury is to right knee. finally had MRI done, states
1.oblique undersurface tear of the medial meniscus at the body posterior horn junction
if injury is medial, why is my pain laterally?
2. deep fissuring of the medial trochlear facet with underlying marrow edema and there is moderate generalized thinning of the medial patellar.
what does this mean?
unfortunately waiting on employee health for follow up with orthopedics
doctor
Answered by Dr. Vivek Chail 2 hours later
Brief Answer:
Small tear in a structure between the right femur and tibia in knee joint

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

Sorry to hear about your pain and discomfort.

1. There are two C shaped structures, one each on outer (lateral) and inner (medial) sides between the opposing surfaces of the femur and tibia in the knee joint which are called menisci. Singular is meniscus and these provide cushioning between bone surfaces at knee joint and facilitate smooth movement.

2. In your case, there is probably a small tear involving the under surface of right knee medial (inner) meniscus at the junction between the body and posterior horn. Most patients can be managed with conservative treatment for 6 weeks if it is a small tear. Rarely it might take more time to heal and surgical treatment might have to be thought of, depending on the grade of tear. I guess your tear is a small one which will heal quickly.

3. Mild degenerative cartilaginous changes are observed between the articulating surfaces of patella and femur in the right knee joint. This is not a serious concern.

4. There is a small cyst called Bakers cyst in the back of the knee joint and this is an incidental finding and not a serious problem.

5. The injury is in the central portion of the knee joint at the junction of the posterior attachment and the body. Rarely, such an injury might mildly affect the soft tissues and attachments and bring the opposing surfaces of the bones slightly closer on the lateral side and therefore the pain. This is not always observable and clear.

Please allow rest to the affected knee, though you might feel comfortable in doing light work. Please use your discretion in using pain relief medications and ointments and stay away from physical work which might affect your injured knee. Hoping for an early consultation with your orthopedician.

Wishing you a quick recovery.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 18 hours later
am I doing more damage driving? or preventing it from healing properly? because that's when it hurts the most. it's been almost 3 weeks and hurts just as bad or worse than when it first happened.
doctor
Answered by Dr. Vivek Chail 3 hours later
Brief Answer:
The driving is causing stress on the meniscus tear and degenerative changes

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Meniscal tears might require at least 6 weeks for recovery. Usually pain and discomfort might be felt when doing activities like climbing down stairs and making twisting movement in the knee joint. It is important for you to consult a physiotherapist and go in to rehabilitation.

2. Driving might be causing more stress on the meniscal tear. At your age, degenerative changes also start to appear in the structures in the knee joint and these together might be causing more discomfort. This is the probable reason that you are finding it more painful sometimes. Not every meniscal tear requires surgery and most of them show good recovery with physiotherapy alone.

3. I suggest you mark yourself based on a popular scoring method called Lysholm score.

Please find the link to such a scoring chart below

http://alaska XXXXXXX org/locations/pvmc/Documents/Lysholm%20Knee%20Scale.pdf

Using the above link you can give yourself points with reference to the activities you are comfortable in participating and the amount of associated discomfort. The scores to be calculated under each heading is mentioned in brackets and the total score is to be considered. The higher the score, the more comfortable is the patient. This scoring is followed by many doctors and I would like to know your score to get an objective idea of your discomfort.

You might also score yourself at present and at the time when the injury surfaced. Comparison between both scores will give us an idea on your pain improvement and recovery.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 20 hours later
score before hand was 95, after injury 55
never without some discomfort, even in bed sleeping. would wake up if position wrong. thank you for your help
doctor
Answered by Dr. Vivek Chail 3 hours later
Brief Answer:
Your pain and discomfort is significant

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Your pain and discomfort is significant and I am sorry that you are having to go through all this.

2. Most people with a score of 55 might feel better following surgery. However, before considering surgery we need to give natural healing a chance. It is possible that your driving is affecting the progress of healing.

3. Please consult your orthopedician at the earliest and seek remedy for your pain and discomfort following clinical evaluation.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

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