Knee pain 13yo - at a loss as to where to go.

[Kelster1_holly]

My Daughter 13y/o, weight 45kg, has right knee pain isolated to the lower outside area of the knee. This pain is preventing the use of the knee and is sever when the knee is bent. She has limited movement with out pain.
Currently we are into the 9th week of pain.
Other symptoms are numbness of the knee area, Limited swelling (not much) and currently in the last week she has started to get sharp stadding pain, ocassionally the knee gives way..
The injury happened during a jazz dancing fall. In a turn, she fell and landed on her knee and jarred the area. She dances 4-6 hours a week i Jazz, Point Ballet, and tap.

We have visited a physio, who initally taped the knee cap to raise it away from the onderlying area. After two week pain had not improved so we then went to a gereral practictioner and had X rays of the knee. Nothing was out of place. Refered on to an Orthopedics surgeon.

Had MRI of the knee were to look for a Meniscal Tear or Patellofemoral chondromalacia.
Findings: Non Contrasting Inage Performed.
Medially, the mniscus, articular caritage, bown marrow and collateral ligament, popliteus and biceps femoris attachment are intact. Normal Cruciate ligament. the Patellofemoral comaprtments unremarkable. Normal articular cartitlage and bone marrow. No evidence of patella alta. Normal extensor mechanism. Minor prepatellar subcutaneous soft tissue oedema is noted. The supra and infrapatellar fat pads are unremarkable.

Conclusion Unremarkable study. Specifically, there is no evidence of meniscal tear or patellofemoral chondromalacia.
From this the ortopedics surgeon has advised he is unable too assist and to go back to a physo.

Have seen the physo for treatment twice. No improvement. Suggested it might be bone bruising.
Due to increase in pain in the last week went to general emergency and had further x-rays of the hips and knee taken -  Normal.

Blood tests also taken – Normal.
Emergency has advise to put leg in a splint and use crutches. Prevents usage pain but no improvement in the week it has been on. During this time the stabbing pains have started.
Currently we are at a loss as to where to go.
Can anyone offer any suggestions where we should try next?

  

[Kelster1_holly]

Just to round out this story for those that may come accross it.

Daughter has been diagnosed with Reflex Sympathetic Dystrophy Syndrome Association (OLD name) OR CRPS Comple regional pain syndrome.

If the pain is out of porportion to the injury or continues past healing time. As a doctor about this. - Not very well known.

Wish us luck.

[JMcCormack]

The foot and lower limb turning blue doesn't sound normal.  Even though she doesn't fit the normal criteria for P.V.D. the symptoms.

http://en.wikipedia.org/wiki/Peripheral_vascular_disease

Or perhaps she has damaged the Popliteal Artery bilaterally as a result of knee hyper extension.  

Either way the root cause to the 'feet and lower legs turning blue' needs to be addressed by a physician sooner rather than later.

Cheers  

[Kelster1_holly]

Thanks for the help, Takeing her to a sports medicine specialist who works on footballers knees. He is also at a loss as the pain is not easily idintified.
We are going back for a second MRI Friday.

Currently the foot and lower leg is turning blue on occassion last 15 to 20 minutes. Has happened twice in 24 hours. Normal usage during this time and then blood flow looks like it returns for no apparent reason.

Leg can be fully flexed but with pain. Movement of knee apears to be normal, with no clicking.

Oh this is so much Fun!

I will discuss ITBS with current doctor.  But not all causes are associated in the correct pain area.

[JMcCormack]

Perhaps ITBS (iliotibial band syndrome)

http://orthopedics.about.com/cs/sportsmedicine/a/itbs.htm

or a possible impingement of the distal lateral cutaneous nerve...

Just a couple things to check out...