Your armchair diagnosis: knee issue

In My Humble Opinion
1

I’m not actually seeking medical advice. I’ve seen my doctor, and I have an MRI scheduled for next week. But since we have a little time before I get any MRI results, I wanted to see what other people think, particularly based on any experiences they’ve had.

A little more than a month ago, while playing tennis, I turned my body to hit a ball while my foot stayed planted, basically pivoting on my left knee. I felt a pretty sharp twinge toward the inside of that knee. I limped around for a couple of minutes, trying to walk it off, and ultimately resumed playing. Over the course of the following week, I played three more times, each time feeling that same tweak in that same spot of my knee more often. The area started to feel “weak” and a bit unstable in the sense that any kind of push off I wanted to do that would impact that part of my knee became harder to do, and by that third night of playing, I had to quit halfway through because I felt like I couldn’t push off at all.

I took about two and a half weeks off from playing. In the interim, I re-tweaked that same spot on my knee pretty badly while climbing down from a ladder. Same issue where I was trying to pivot my leg out to the left, but my shoe had a pretty good grip on the ladder step, so my foot didn’t turn with the rest of my leg. I spent the next two or three days hobbling any time I tried to walk stairs, particularly when going down the stairs. But that seemed to go away after a while.

When I resumed playing tennis a week and a half ago on a Sunday, it was mostly OK. I did feel a couple of twinges in that spot while playing, but was able to keep going. However, the next couple of days afterward were rough going. I played again on Thursday, and basically had the same experience. Finally I played again this last Saturday. I was able to play for just over three hours without experiencing significant pain. And the day after, I was largely pain-free. But on Monday, the pain in that same part of my knee flared up again, and with a vengeance. I don’t recall anything specific triggering it.

For this entire week, I’ve found myself experiencing varying level of pain even when just walking, though against most notable when using stairs. It feels sharpest as I’m straightening my leg when I’m walking, sometimes feeling like the knee is about to “lock” on me. And there’s also an occasional popping coming from the same area. Again, it comes and goes, so that sometimes I can walk almost normally, sometimes it’s moderate, and sometimes I’m limping pretty noticeably. And the level of pain can change dramatically, either direction, from one step to the next.

I finally gave in and called the doctor this morning, and was lucky to get an appointment this afternoon. Her reaction to the description above was that it sounded like a torn meniscus. However, when she did some movements with my leg and knee, I didn’t have any pain or difficulties. She mentioned it was also possible that I might have just sprained the MCL, or that maybe there was something else going on.

So, quarterbacks—what say you? What’s your best guess as to what’s actually going on? Mild meniscus tear? MCL sprain/tear? Other? Feel free to also:

[ul]
[li]place bets on physical therapy vs. surgery[/li][li]share your own experiences of figuring out and/or healing from knee trauma[/li][/ul]

Happy Friday!

2

I don’t know enough about knees to guess (or even really know what questions to ask to guess across the internet with the info given), but googling ‘twisted knee injuries’, gives a lot of possibilities.

What did your doc say? I assume you saw someone, right? Someone had to order the MRI, did they give you any thoughts?

My WAG, is that you’ll get a shot of cortisone and a few sessions of rehab and then the “option” of surgery if you aren’t doing better.

I put option in scare quotes, only because if you’re seeing an ortho* at this point, you have to remember that cutters want to cut and often times that’s their end goal. Don’t get me wrong, usually that fixes things, but don’t hesitate to slow them down or tell them you want to see how thing progress for a few months. Take your age and activity level into account and decide if the surgery and recovery is worth it to you vs what may or may not happen if you skip it.

Now, if this were a shoulder, I might be of more help.

*sometimes a GP is better since they don’t always have the ‘we have to go in and fix this’ mentality.

3

Hard to say. The initial twinge part sounds like the problems in my right knee. Probably not exactly the same though, in my case I developed tissue flaps in my right knee after years of carrying all my not insignificant weight on my right leg due to a torn ICL in my left leg. It could be something similar because of swelling that started just from a strain. More than once just a little too much stress on either knee results in a worsening condition due to swelling, swelling that is not always externally apparent. It can take a couple of weeks of ice and rest before it goes away. I keep the problem knee elevated all that time. Even when I’m working I’ll prop that leg up on a trashcan or something and keep ice on it as much as possible. The problem comes from the rest of your leg trying to compensate which just increases the swelling. Good luck with this. Rest and ice are what you need no matter what happens.

4

Torn meniscus. Arthroscopic surgery. Back on the court in about 6-8 weeks in a brace (more for peace of mind).

IANAD.

5

I’m no doctor, but that sounds like a torn meniscus. The meniscus sits in the joint in between the two bones to prevent them from grinding against each other. It serves a similar purpose to oil in an engine, although it takes a very different form, as the meniscus is cartilage (same kind of tissue as your ears and nose).

If the meniscus tears you can get a little flap of it hanging out. If the flap gets pinched between the bones you can get the pain you describe. If it gets wedged in the wrong place your knee can lock up.

And having read the OP fully, the doctor is leaning the same way.

6

My doctor is the one who ordered the MRI, and she was leaning toward torn meniscus, while noting other possibilities. She said it might be possible to rehab the knee if there is a minor tear, but otherwise might have to refer me to an orthopedic surgeon.

7

My guess would be a ruptured or ‘strained’ deep MCL. If so, you should be able to feel a pain or instability from a certain torsion of the knee in the kinematically closed (grounded) position, whereas a meniscus tear should indicate pain in multiple positions. (I’ve noticed that some orthopedists only test joints in the open position, e.g. sitting on an exam table manually manipulating the joint which does not load the joint in the fashion that is causing you pain.) Cortisone, which reduces inflammation, may help with the initial healing process but be circumspect about it; just because it doesn’t hurt doesn’t mean there isn’t damage that needs to help. An MRI may or may not show indications of damage in soft tissue depending on the resolution of the scan and type of damage, but unless there is clear sign of rupture or damage to the meniscus my general recommendations would be to avoid aggravating the injury and give it a few weeks to heal, and then pursue physical therapy before considering surgical intervention unless the injury becomes intolerable.

There have been a handful of metastudies on the efficacy of surgical intervention on joint injuries and while there is a clear trend of short term reduction in pain there is a disturbing indication that it may have little effect in the long term (although the options for minimally invasive surgeries available today are at least less likely to result in ancillary damage). Even if the damage is permanent (significant ruptures will result in some amount of scarring) good physical therapy and strengthening of the supporting muscles of the joint can help protect from further injury, as will flexibility exercises (once the original injury has sufficiently healed) to help lengthen and strengthen the ligaments, which are unnaturally weak because of all the time we spend not moving or loading the joints.

You don’t mention if your doctor is a speciallist or a general practicioner, but you should consult both an orthopedist (preferably one specializing in sports injuries) and a sports physiologist who has practical experience in treating and rehabbing knee injuries. If the recommendation is for surgery, I’d strongly recommend getting a second and even third concurring position for the reasons mentioned above.

Stranger

8

The thing with a torn meniscus, IIRC from my shoulder tear, is that it’s very unlikely the tear will heal (not saying it can’t, but it probably won’t).

So, right now your body is coping to deal with the pain, you’re probably walking funny, struggling to do anything involving that knee, etc (even if you don’t always notice it).

The goal of therapy is to build up the muscles around the injury and, more or less, reteach you how to use your knee properly again so you don’t walk with a limp and screw up other parts of your body (ie your back, ankle, your other knee) in the process.

If you want to avoid surgery, take it to heart, do the “homework” they ask you to do, like they ask you to do it and see what happens. OTOH, as others said, if it’s a torn meniscus and no other complications, it’s possible you’ll go from someone saying “I’m your anesthesiologist” to someone saying “40 Love, next point and I have the game and set”…at least that’s how it was for the few people I’ve seen go through it.

9

Thanks for the response. The doctor I saw today is just my GP. She provided the referral to the MRI, which I’ll have mid-next week. So right now, I have zero official opinions on what’s going on.

Yeah, after five straight days in this stage, I’ve started automatically limping even when I’m not feeling pain. Which is really awkward when I catch myself doing it.

This afternoon hasn’t felt bad for the most part, so now I’m in that fun mental space where I think I’ve somehow exaggerated the problem, or that it has fixed itself. Neither is likely, but the seed of doubt is planted.

10

Walking around funny for a few days probably isn’t going to do any long term damage, but you will probably notice things crop up as other joints move in ways they usually don’t to compensate.

As for exaggerating the problem, I actually did that before my surgery. When I didn’t know for sure what was going on, I’d often move my arm around in circles (think: windmill) to push it through some of the more painful spots in an attempt to keep it stretched so it wouldn’t freeze. As it turned out (without getting into the details) that was actually making it worse. Luckily, my pre-surgery PT, took care of that.

As long as your trust your GP, it’s probably safe to assume it’s not too serious or they would have sent you for the MRI and/or ortho consult sooner rather than making you wait until next week. If it makes you feel better, you probably won’t do any harm throwing some ice on it for a half an hour here and there (maybe alternating with heat for a few minutes) and taking some advil or tylenol.

11

My GP called this evening to let me know they’d gotten the report back from the MRI imaging technician. They don’t see a tear in the meniscus. They talked about missing cartilage and inflammation in the knee capsule, both of which they attribute to older injuries. However, the GP said that the description of my pain still fits with a torn meniscus. So they’re apparently sending me to an orthopedic surgeon, along with the MRI images, so that they can render a more accurate opinion.

I’ll try to make an appointment tomorrow, and I will report back when I know more.

12

No possibility of an ACL tear? That sort of twisting motion during tennis is a common way to tear your ACL.

13

Good luck! Hope you’re back to full strength soon.

14

I’m glad you got the referral to the Orthopedic surgeon. Hopefully someone with specialist knowledge will be able to help you get to the bottom of the issue.

15

The anterior cruciate ligamnet (ACL) is on the outside of the knee. The o.p descibes the initial pain as being to the inside of the knee.

Stranger

16

No it is not.

It’s the front of the cross of ligaments inside the knee.

You may be thinking of one of the collateral ligaments.

17

Not that anyone has mentioned to me thus far. I assume that would have been obvious to someone looking at any MRI, but I know very little about MRIs.

I appreciate all of the good wishes very much, by the way. I just want to get back out on the tennis court, dammit! It’s the only exercise I ever get. :slight_smile:

18

Well, wielding that ban-hammer is pretty strenuous.

19

Sounds exactly like my first torn meniscus.

Initially tore it turning around while running wind sprints for basketball practice, it would go away for a while, months even, then come back, pain, clicking, knee locks up. I had a very early arthrogram (this was 1983?), and they said they couldn’t really do anything. I dealt with it for 5 years, then had a further tear and arthroscopic surgery.

And as I recall from 15 years ago they said it is sometimes hard to see cartilage in an MRI.

20

I’ve got an appointment tomorrow morning with an orthopedic specialist, so we’ll see if he spots anything on the MRI that the others didn’t.

Of course, I’m having an unusually pain-free day today. On the one hand, it would be great to think that it’s tendinitis or something that is getting better. On the other hand, I’d hate to walk in to the orthopedist tomorrow and have him say, “Well, you’re feeling better and we don’t see anything on the MRI, so RICE it and you’ll be good to go in a few weeks” if there’s actually something more than that going on.