Burning knee pain and swelling above the kneecap for past 2 months. MRI and PT. patella subluxation.

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Hi,

I didn't have any injury. I started a walking routine in the month if August in the steep hilly roads. I did it for a month. the knee pain started in September. It started like burning pain above the kneecap. after a month, i see some swelling above the right kneecap. then i went to an ortho doctor in october. they did an xray and ordered an mri. the first MRI didn't cover the area properly. the area above the kneecap. But the ortho didn't want me to redo the MRI as there was no much issue other than PFPS. She told me to start PT and prescribed voltaren gel for topical application for the swelling. She said it can be done inflammation.

I started PT and it's been 6 weeks. There is no improvement in the symptoms. Its the same. I still have the burning pain above the knee. the swelling is the same too. So, i did contact there doctor and she told me to take MRI for the area which is not covered in the first time.

I did MRI second time to cover that area. doctor told me ti continue the PT. Its been 6 weeks of PT, i really don't see any improvement.

How long does it take for patella subluxation to heal? what to do for the recovery?

My MRI:

first mri:

Findings/conclusion:

  1. Anterior compartment: Mild lateral patellar subluxation is present with no patellar tilt. There is developmental prominence of the lateral trochlear ridge. The trochlear groove tibial tubercle distance is within normal measuring 1.4 centimeter. The quadriceps and patellar tendons and retinacula are intact. The patellar tendon is congenitally elongated with high patellar position (patella Alta). There is no evidence of fatty impingement.

  2. Fluid collections: No sizable knee joint effusion or popliteal cyst.

  3. Ligaments/tendons: The cruciate and collateral ligaments are intact. The popliteus tendon and iliotibial band are intact.

  4. Medial meniscus: No tear is identified.

  5. Lateral meniscus: No tear is identified.

  6. Osseous/articular: No arthropathy, osteochondral defect, stress fracture, or suspicious bone lesion. An incidental small subcortical benign bone lesion is present in the medial tibial metaphysis which may represent an old nonossifying fibroma or bone island.

  7. Other: Superficial varices are present in the posterior medial subcutaneous soft tissues.

second MRI:

Markers have been placed over the distal quadriceps tendon and superior patella to indicate

the site of clinical concern. No soft tissue mass, hematoma, or localized inflammatory process is seen

in this region. Specifically, there is no evidence of inflammation involving the pre femoral or quadriceps

fat pads which lie above the patella. The quadriceps tendon appears normal with no evidence of

tendinopathy. There is mild lateral patellar subluxation, a congenitally prominent lateral trochlear ridge,

mild chondromalacia patella, and a developmentally high patellar tendon (patella Alta) which likely serve

as the etiology for the suprapatellar pain, per provided history.

please let me know if you have any inputs. how long does it take to heal and recover from this? what to do for this?

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18 Replies

  • Posted

    No idea what all that means, but...

    If the x-rays and MRIs show no structural damage, then that's a good thing. Also know that MRIs are frequently inconclusive when it comes to soft tissue injuries in and around the knee. Voltaren Gel is the best RX topical anti-inflammatory but it seems to have no effect on you. You may consider CBD ointments or the full plant tincture creams.

    Questions: Are you icing and elevating the knee as much as you can? Have you stopped putting strain on the knee so it can heal? Have you tried an NSAID for 10 days max? Any relief?

    A lot of us on here have had total knee replacements so we know pain intimately. After a TKR, the pain is really intense (even on opioids) for about three months. Swelling only subsides after many more. Everyone is cautioned not to push the knee beyond what it is capable of at any time or you get "balloon knee". Don't do that.

    In my experience, I had four (4) painful knee situations when I was still playing hockey in my 50's. In every case, the MRI showed nothing so, again, each time, my orthopedic surgeon scoped the knee and found torn meniscus cartilages twice and ripped off femoral condyle cartilages twice. In every case, the repairs were made and I was fine in a week...back on my skates.

    Some possibilities:

    • If it's above the knee itself, you could have strained or torn the quadriceps tendon where it attaches to the knee. Painful plus it takes a while to heal if it's just a strain. A tear might have to be surgically repaired...but...
    • It seems that docs are less likely to do an exploratory scope these days. Worked great four times for me. Can you find a doc who will do that procedure?
    • Your ortho should have offered you a cortisone shot as it's the first thing they do to reduce pain and inflammation. I'm surprised your doc did not mention this.
    • Another option is COOLIEF (Cooled Radiofrequency Ablation) which deadens the nerves in and around a joint to stop the pain signals from going to the brain. FDA-approved, 15-minute procedure under sedation. Might take a few weeks to fully kick in but it can last a year or more. Check the website for more information and to find a certified doc near you.

    I'd recommend a second opinion with a SPORTS orthopedic surgeon. Find a group near you who takes care of the local high school, college and/or pro teams. See if a different doc can pinpoint the problem and provide a plan to fix it. You do NOT want this to get worse. No one should live in constant pain when there are alternatives. Meanwhile...acupuncture??? Worked a few times for me. Good luck.

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    • Posted

      thank you so much for your reply. appreciate it.

      i went to a sports orthopedic doctor only. She didnt give me cortisone shot. and also, i don't have any inflammation. I don't know what is the source of my problem. I am just doing on PT for few more weeks and see if it improves.

      I did icing and that helps a bit. But swelling didnt reduce at all. also the burning pain.

      I dont know why it gives me the burning pain.

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    • Posted

      My wife has pain right above both knees. The ortho did the xrays and the exam. Nothing wrong with her knee...he said that the quad tendon was the issue...which is why I mentioned that. Gotta find a doc who can give you a definitive diagnosis!!!

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    • Posted

      thank you again!!

      i went to a sports medicine doctor. No proper diagnosis yet. i am looking for some second opinion. i have to find a good ortho doctor. my symptoms are the burning pain and the swelling above the knee. don't know the cause of these symptoms.

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    • Posted

      what is a cortisone shot? i didn't heard that before. is it given on knees?

      and you mentioned that it takes a while to repair if its a strain above the knee. how to know or diagnose if its strain?

      i am exactly having the burning pain above the knee. i have a little swelling too. Its been the same last 2 months. no changes in the pain and the swelling.

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    • Posted

      Arthroscopy. No incision; just three little holes for light, camera and instrument. Doc went in, saw a torn meniscus and repaired it. Three little bandaids. I'd have surgery on a Friday, iced and elevated the knee for the weekend and was back at work on Monday with an AirCast (cryocuff) bucket and knee sleeve. Did that for a few days plus took ibuprofen for the inflammation. All done in a week...and I did this four times. Never, ever a problem.

      image

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    • Posted

      "Cortisone" is a corticosteroid injection done intop the knee (or shoulder or hip, or...wherever) to stop pain and reduce inflammation. It might take a few days for the med to kick in so be patient. For many people, relief can last up to a year. Docs can do no more that three (3) injections in a 12 month period.

      If the diagnosis is a sprain, strain, etc., the hope is that relieving the pain while reducing the inflammation will allow the area in question to heal. This is a pretty standard first approach to knee pain. If it works, you're done. If not, the docs have to look further. Since your injury sound like a result of trauma, I doubt they'll be talking to you about arthritis which doesn't seem likely from your description.

      Again... If the x-ray shows no structural damage, that's a good thing. Soft tissue injuries are a lot more common and can be caused by a problem with so many areas of the knee compartment or even above or below it. Your symptoms plus an exam should pinpoint the affected area.

      My wife had brain surgery and has fallen a lot over the years. Her knees hurt. However, the ortho exam showed that she did not have a problem with the knee proper but with the quad tendon above the knee. When the doc pressed on hit, she hit the ceiling. Cortisone shot plus extensive exercise to build up that area again to avoid more pain in the future.

      For her, it worked. For you??? I think you need a definitive diagnosis of exactly what's wrong and attack it from there. Unfortunately, MRIs are frequently inconclusive for soft tissue injuries of the knee. That's why my ortho did the arthroscopy procedure those four times to find and fix the problems.

      Hope this helps.

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    • Posted

      thanks for your reply.

      i don't have arthritis. nothing showed up in the xray except patella misalignment to the lateral.

      you may be right. my issue might because of the strain. i don't know how long does a strain pain and swelling takes to heal?

      and corticosteroid injection is for pain due to strain too? i have to followup with my doctor as the symptoms still the same. she was also not sure why i am getting these symptoms.

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    • Posted

      The cortisone is useful for any painful, inflammatory problem. It is the first tool the orthos use. If it is a strain/sprain, the steroid will ease the pain and reduce the inflammation...that's what a steroid does. Your condition came on suddenly which indicates some trauma and not arthritis which would be gradual and affect the knee compartment itself.

      If it is an actual patella problem, it might require a brace of some kind to realign it or even a surgical fix. I have no experience with this type of problem. Unless it is clearly a surgical issue, docs will start with the steroid first, especially to reduce the inflammation before any surgery is done. This is all up to the doc and how she wants to proceed based on her definitive diagnosis.

      Note: Diabetics will need to monitor their blood sugar level for 48 hours post-injection and will absolutely need more insulin as the steroid will definitely spike one's sugar levels.

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    • Posted

      thank you so much for the reply.

      I had a follow up with my doctor to review the second MRI images which i have taken recently and to update the current status.

      she reviewed the images and said, she cant find anything and she is not sure why i am getting the burning pain still. and also the swelling.

      she us guessing it might be a muscle strain or quadriceps tendinitis. she is not sure though.

      she wants me to continue PT for few more weeks and come back to her after 3 months if pain still there.

      I went to a orthopedist who specializes in sports medicine.

      i don't know if i should go for a second opinion. Which doctor should i consult? orthopedic surgeon or sports medicine doctor? I got a recommendation from my PT now for a sports medicine doctor.

      is orthopedic surgeon or sports medicine doctor is good in diagnosing these?

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    • Posted

      As I mentioned, MRIs of soft tissue injuries are frequently inconclusive but they do rule out major knee damage. Try this... Sit in a chair with your feet flat on the floor. Now with your thumb, press down hard between your patella and lower front thigh. This is what the ortho did to my wife and she hit the ceiling. Diagnosis: lower quad tendon inflammation. Yes, a cortisone shot took all the pain away and allowed her to rehab the tendon. Also, Voltaren Gel (generic diclofenac) is the best topical anti-inflammatory out there (RX in the US, OTC elsewhere). You may also give that a try. Your ortho should offer you the shot but any sports med doc can do it.

      Diagnosing? The ortho concentrates on structural knee damage; the sports med docs have more experience with sprains, strains, etc. Still, cortisone and/or Voltaren should ease the pain and inflammation. Remember... Medicine is equal parts science and art. It is, more than anything else, a trial-and-error profession. Docs will give you what works for most people. If you get no relief, they try the second thing that works for the remainder of people.

      If it was me (and I saw this with my wife), I'd get the shot and use the Voltaren. I'll bet you have some relief within a week and then a lot more down the road. If it is a severe quad strain, you want to reduce the inflammation so you can exercise and restore your strength. If this does not go away with that protocol, you may want to discuss what you can do if it's actually a tear...some heal by themselves over time while others need a surgical fix.

      However... Don't go there in your head. Shot + Voltaren...see if that works first.

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    • Posted

      thanks again.

      I got the prescription for voltaren gel from my ortho in october. i tried that. it doesnt help me at all. i applied that 4 times a day for a week. it really didn't help me.

      my ortho is guessing it can be quadriceps tendinitis or some strains. But the burning pain is not reducing at all.

      my PT recommended a doctor who is sports medicine physician who is not an ortho. I am looking for some doctors for second opinion. either ortho who specializes in sports medicine or the sports medicine physician. or i can go to ortho who specializes in knee joints.

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    • Posted

      I use the #1 ortho group in Fort Worth, TX (recommended by doctors and nurses we know). They have specialists focusing on one joint each. My knee guy did the TKR almost 4 years ago.

      Sorry the Voltaren didn't help. Maybe icing it 24 x 7 for a while could do some good. Get a cheap AirCast with the knee sleeve and then see a sports med doc...

      image

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    • Posted

      Look at the picture. Load the bucket with ice and a little bit of water. Put the reflective pad over the ice, close it and hold it above your head. The ice water fills the cuff...lasts for a few hours. Then reverse the flow (put the bucket on the ground) so all the water runs back into the bucket, shake the bucket and hold it above your head again. The water should stay cold for 6-8 hours. Then just empty the bucket and refill with ice and a bit of water. Repeat. Always use new, cold ice for the time you go to bed. Elevate the leg and keep it cold. Recirculate the water when you go to the bathroom at 3AM.

      Yeah, it's $100 on Amazon but once you have the system, you can get casts for elbow, shoulder, ankle, etc. plus wraps to use whenever you need to ice a joint or leg or arm or brain... Insurance may cover it if RX'd by a doc. Gotta check.

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    • Posted

      thank you. will check it out.

      i am also planning to seek a second opinion with sports physician who is not an ortho though. hope they are good as much as ortho doctors.

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    • Posted

      and my bad...i dont know where i got hurt..my left knee got some sprain and it hurts from today morning. with a little swelling around the left side of the knee. able to walk. just keeping up with ice.

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