AndrewS & internet doctors

Hey all,

Searching for a diagnosis. In Feb I was ski touring a bunch. I've only got a little bit more endurance than Iron, and it's sea level endurance so I struggled some days. One day after about 6hrs hiking, I got to the top of a ridge pretty fatigued. I was just walking in ski boots around getting ready for the descent, and I kind of stepped funny on my heel and locked my knee back fairly sharply (like a hyperextension movement but nowhere near that extreme, and with no significant load on the leg). Instant shooting pains in my knee. I struggled down and took it easy for the next couple of days. Kept skiing for a week or so and dealt with minor pain. Then, on another day I took a small drop and landed backseat and off-balance. You can see me struggle with my balance on my brother's vid at about the 5s mark. I had all my weight on the dodgy knee and it was kind of torqued too. After that run I wanted to do another lap, but the pain was pretty intense. I took the rest of the day off.

Anyway, long story short - what could I've done? Cartilage damage? So far, my rehabilitation program has involved deadlifting and squatting :rolleyes:. Two legs and there's minor pain at the bottom ROM of both those lifts. If I try a pistol, however, and get more than about a 90° bend, shooting pain. As usual, I'm a dick and refuse to rest. I also haven't seen a doc or got MRI/X-rays or anything. I thought the initial injury wouldn't have been enough to damage things this much so as usual I ignored it and dealt with the pain. It's going on about 6 weeks and I still get the pain at lower ROM.

Any armchair doctors or real ones want to comment?

Thanks in advance guys, and hope you're all well.

On a related note, right at the end of that skiing vid you can see my where my brother did his MCL in his right knee :p.

I am recovering from the same injury, from the sounds of your symptoms. Mine was a sprained MCL. It's been healing about 6 weeks. The last week I have finally regained full ROM with no pain, but if I flex it too much (triangles, etc...) it throbs at night.

The surgeon told me that unless it's locking up on you, it's probably not cartiladge.

MRI is the only way to tell for sure.

Huh. I didn't think any of the CLs because if I rub the bottom of my kneecap, there's a definite tender area. You know how you can relax your leg when it's straight and move the kneecap around? Well, when I do and rub the bottom, pain, irrespective of its position when I rub it. So I figured some sort of cartilage damage, or the kneecap (meniscus?) itself. But the nature of the injury wasn't enough to do that sort of damage, or so I thought at the time.

I should see a doc and get scans, but I suck.

Forgot to add: I can manipulate the hell out of it with no load on and feel no pain. E.g. I can bring my knee to my chest and torque my ankle left and right and nothing. I can bring my foot up near the opposite chest/shoulder (like I was trying to put my foot behind my head) and no pain. It's only when I bend it under load (e.g. a pistol is impossible right now). The pain is definitely at the bottom of the kneecap, right where it hurts when I press on it directly.

Sorry, I don't know what's wrong with your knee, but that was a pretty cool vid. :)

Nice vid. It really sounds like some ice and rest is what you need. But it also sounds like you won't do that. Good luck.

Heh. Yep, he's got a cool helmet cam that he used a fair bit this season. It was good to spend a few weeks in the mountains with him and his mates.

Too bad Chris hasn't chimed in yet. But for my two cents, it sounds like thits quote from my very old medical encyclopedia (printed same year I was born :eek: ):

Quote:

---

The knee, more than other joints, is liable to effusions of fluid by the synovial membrane of the [joint] capsule. This may follow any strain, twist, fall, or blow sever enough to damage a significant part of the joint... The whole joint will swell, obscuring the out-line of the kneecap which is raised by the swelling and "floats." An effusion will generally subside of itself, but rest is essential... Application of hot wet packs or dry heat several times a day is beneficial.

---

Thanks Becca, but I doubt it. There was no noticeable swelling at the time, and none after. It definitely didn't cause the kneecap to float like in the quote you posted.

Prob'ly muscle got pulled, then. Or maybe a tendon, but every time I goof up that tendon, I also get a horrible cramp-like pain in my calf. You didn't indicate that, so I doubt it.:)

On a side note, I think the mucsle head for the quad is right above the kneecap. That part of the muscle is more like a tendon in that it has little blood flow and no nerve. If it is swollen, you might be feeling it in the kneecap because it is pressing in on it.

Hey Toby,

apply all disclaimers about internet based advice and diagnosis, etc, ad nauseum.

It sounds to me like you may well have managed a partial tear or sprain of the posterior cruciate ligament based on your symptoms and mechanism of injury. I have seen a ruptured Baker's cyst present this way; medial meniscus or MCL injury seems less likely, ACL is still a possibility.

You need to see a sports MD, and, unless there is compelling reason not to, get an MRI to define this problem. If you have a partial tear surgical repair may be warrented, and you should be much more cautious if the decision is made to manage it conservatively (without surgery), while a simple sprain is far less worrisome and less likely to progress if you resume normal activities earlier.

Hope this helps,

Andrew

Thanks AndrewS. I'm in Oz so you don't have to worry about the whole litigation crap.

The compelling reasons not to see a doctor or get an MRI is because:

(a) I suck
(b) I'm lazy
(c) I suck

I'm also addicted to my exercise and don't want surgery to recover. That's why my ignoring technique works so well. I commute on a bike as well, so I don't want weeks/months off from that while recovering.

But yeah, sounds like I should see a doc. There's an excellent sports medicine doctor literally 4 houses away from me that I saw for my shoulder osteolysis. How's that for lazy :D.

Probably a patellar tendonitis. Inflamation of the tendon that goes from the kneecap to attach to the tibial tuberosity of the the tiba. There is a bursae there too so it could be bursitis. Both should respond to rest and antiinflamitories ( aleve or motrin. Diagnosis really needs to be hands on to be sure. Just as we never make a DX over the phone. Go to a Family Practice MD first and he/she can direct you from there. A ligament or Cartilage is more internal and will cause symptoms more of locking or instability. I of course cannot rule this out either. Iam a Doc, but I dont play one on TV.

I agree with Andrew S. I bet it's the ligament or ligaments. Several years back my husband tore his skiing and ignored it. After more trauma to the knee, it was much worse. All ligaments were torn and his knee was held on by a literal thread and he could also manipulate it like you are explaining, mainly the ACL caused this for him. Does it also feel like it has to pop? Try to get an MRI. Reconstructive knee surgery was how his story found itself. Good Luck.

Belated follow-up. It is/was tendonosis/tendonosity(?). Like tennis elbow of the knee - the tendon goes all soft and weak in my case right near the knee joint. Ultrasounds confirmed the doc's thoughts. Ultrasounds clearly showed clusters of new red blood cells in the tendon that shouldn't be there. I could've had injections of something that shrinks/shrivels/kills the new blood cells (experimental) but it would've required rest and I suck at rest. Instead I'm using nitroglycerin patches for 3 months to reduce blood pressure in the area (also experimental).

Recovery period should be long term and it's gotten better and worse again since I started the thread. Luckily, PT involves ... heavy lifting! Doc said after a few months I can start bike riding ... uh, yeah, I commute 15-20min twice a day already. OK, so I can start rowing after a while ... I do HIIT twice a week on a rowing ergometer. Alright, how about skipping? Yep, 5min warmup and cooldown before/after lifting 5xweek. Finally he said I can do plyometrics after about 5months, but didn't say what plyos to do. He kind of knows I will just do what I want anyway. I might do some box jumping.

Running hurts. Going down steep inclines hurts. Bending too deeply with weight hurts. I try not to favour the strong leg, but I know I do sometimes. Hopefully it will recover sufficiently before next winter - we're planning to go to Europe for a month.