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What causes pain and swelling in knee?

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Orthopaedic Surgeon
Practicing since : 1994
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Question
I am 44. I have a history of breast cancer, grade 1, Stage 1a, no lymph node involvement. My Once Dx Score was 8…meaning 6% change of reoccurrence. I had a total hysterectomy at 41. I take Arimidex and did not have chemo. My diagnosis was 3 years ago. In April I had been working out with a trainer, doing sprints, running and jumping. I developed pain in my left knee area and saw and orthopedic doctor who specialized in Sports Medicine and received a negative x-ray result then a MRI that showed a stress fracture see attached report. The doctor recommended not impact activities until pain resolved. The area was very painful for 3 weeks then slowly improved. After about 12 weeks the swelling improved and I did not notice the pain for about 1 month. Then about a week after dancing, the pain and swelling returned. It has persisted for 2 weeks. My concern is could this be a re-injury to this area? More importantly does my MRI report suggest any possibility of bone mets from the breast cancer? I can’t interpret what the medical description says, and also read on line that stress fractures can mimic bone mets. I had a bone density scan recently and I am showing bone loss from the Arimidex and lack of estrogen. Please advise.Mri Report from April 2014

Assessment:
Indication: Medial left knee pain
Findings: Magnetic resonance imaging was performed on the left knee in the sagittal, axial and coronal projection using T1, T2, and inversion recovery imaging. The scans were performed on a 1.2 T high field open MRI. The study was compared with plain films.
There was a 3X3 cm area of bone edema of the medial tibia plateau and the medial aspect of the proximal metaphysis of the tibia. There is a horizontal line of low signal at the level of the medial cortex. The changes are felt compatible with a stress fracture. No cortical fracture or dislocations are seen.
The quadriceps mechanism is intact. The menisci are intact. There is no evidence of tear. The cruciate and collateral ligaments are normal.
Impression: Stress fracture of the medial left tibia.
Tue, 2 Sep 2014 in Bones, Muscles and Joints
 
 
Answered by Dr. Praveen Tayal 24 minutes later
Brief Answer:
No evidence of bone metastasis.

Detailed Answer:
Hello,
Thanks for posting your query.
The return of pain and swelling in the knee can be due to an inflammation in the area due to osteoarthritis or a repeat injury. Adequate rest and anti inflammatory medicines with a regular hot fomentation will help in early recovery. Avoid any strenuous knee exercises for at least 3-4 weeks. You can also use knee supports or elastic knee brace to avoid the pain.
Your MRI report is not suggestive of any bone metastasis. You have a mild fracture involving the medial cortex only. There is evidence of bone edema due to inflammation but no bone thinning is see. The bone density scan showing bone loss also goes in favor of a predisposition to bony injuries.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by
 
Follow-up: What causes pain and swelling in knee? 8 minutes later
Thank you for quick reply Doctor. To be clear I should apply heat vs. cold? Does the medical cortex mean only the outside...not bone destruction? In other words if this was a cancerous process would the bone appear more compromised? Is it okay to walk around as normal? Will this area of the stress fracture always be more sensitive to injury? Thank you again.
 
 
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
Details below.

Detailed Answer:
Hello.
Thanks for writing again.
Heat application will be better to reduce the inflammation. Cold fomentation helps in reducing the active bleeding.
Only the medial cortex means only the outer layer of the bone- there is no through and through bone destruction. In case of metastasis cortical thickening with patchy osteoporosis is noted.
If walking does not aggravate pain or swelling then you can continue walking normally.
The area of stress fracture is comparatively a weaker area and is prone to injuries in future also. Be careful.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by
 
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