Chronic Knee Pain and Irritation

[fisherc2]

Hello-

I have been experiencing ongoing knee problems for the past 2 years. The pain initially began while I was hiking. I experienced intermittent sharp pains in my left knee that did not occur as a result of trauma. Then it became stiff and swollen. Unfortunately, I had to 3 miles back to the car, which really exacerbated the knee. After several weeks the pain subsided to the point that I could walk within a range of a quarter mile before I experienced more pain. After some more time passed I could walk about .5 to 1 miles. Unfortunately, it never improved beyond this point and was re-aggravated multiple times. In May of 2012, an orthopedic surgeon prescribed a high dose NSAID. When that did not work, I had an MRI, which only showed some inflammation of the patellar tendon. He told me to do leg presses and extensions to build up my quads. Unfortunately, this only aggravated my knee more and did not return for over a year due to financial difficulty. A month ago, I returned and he gave me a cortisone shot. It did not get rid of the irritation completely but it seemed to shorten the duration of symptoms. In the meantime, I have been going to physical therapy. Leg presses and lifts still aggravate my knee so I have been doing exercises to build up the side of my legs and my gluts in hopes of off-loading weight from my knee. These exercises  have caused mild irritation but are now aggravating my knee, presumably because the cortisone is wearing off. Neither the doctor not the physical therapist can pin point a diagnosis. Its really frustrating and I am reluctant to do surgery when the MRI showed nothing. Does anyone have any ideas? Thank you.

[fisherc2]

Thank you very much for your response.

[Dr. Kokil Mathur]

Hi!
The inflammation of the patellar tendon is probably causing patella femoral syndrome. This can happen due to overuse of joint, excess weight on joint, muscular dysfunction, foot deformities causing wrong weight transmission to knee and some biochemical changes. Also, there may be mild tears in the patellar tendons. Hence first physical therapy is started. Other treatments include knee caps and braces, taping the patella to reduce friction, anti inflammatory drugs, custom designed foot wear to correct arch problems if any and rest to the knee joint. Please discuss these treatment options with your specialist. You probably need an initial period of rest for the knee (maybe strapping it in braces) followed by physical therapy. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.