Post-partum bursitis

I had severe sciatica during my pregnancy which caused me to walk very strangely creating hip, knee, and foot discomfort.  5 months post-partum, I developed periodic pain-free swelling in one of my knees.  This swelling would occur as a result of walking many stairs or any kind of torque on the knee (such as sitting with a leg folded under me.)  The swelling would subside after 3 or so days.  7 months post-partum the other knee started behaving in the same manner.  I had foot pain at that time and visited a podiatrist for orthotics (fallen arches.)  I'm now 10 months post partum and the swelling occurs at the same times in both knees with a frequency of about every two weeks.  This swelling is brought on by lots of walking (like a theme park.)  I visited a physical therapist and after examination was told that my knees are very healthy and strong.  The PT believed that I have arthritis of some type.  My mother has RA, but she had rheumatic fever as a child.  My symptoms are different than her RA in that I don't have stiffness in the morning, muscle weekness, joint pain, or warmth to the joints with the swelling.  The discomfort to the knee during the swelling phase seems to be more of the ligaments surrounding the knee.  I'm wondering if it's related to the many months of strange walking during pregnancy combined with the fallen arches post-pregnancy.

So, my question really is how should I proceed from here?  Should I start a slow exercise program to strengthen the "strong" knees or should I pursue testing for RA?

Thank you.

[Kevin Pho, MD]

Imaging the knee can rule out arthritis - this can include an MRI or plain films.  

If negative, you can consider things like tendonitis or a ligament strain or tear.  Again, a knee MRI can help with the evaluation.

I would consider an orthopedic referral at this point, along with imaging.  An exercise program with a physical therapy would likely be the first step if the knee is structurally sound.  

Blood tests looking at the ANA level as well as rheumatoid factor can be considered to look for more systemic causes.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_