Question
the left knee
dear Dr.Gerald Anzalone
i had interestings about chiropractic since first i heard about it,i practicing taekwan doo and martial arts since i was 16 yrs, by the way i am medical intern,, and has left knee problem, my history is started by medial compartment pain, since i started standing for long time,, in emergency room about 2 years ago, i started to wrap it with crip bandage and the pain disappear completely,i kept using i for about 3 months after that i recognize small swelling medial to patella,, then it got bigger and extend to the lateral side of patella,I've been told is hoffa's syndrom( fat pulging ) but nothing run with it, and it isn't bursitis,because rather than swelling and pain i had no tenderness or redness etc..by examination:- i have small degree ( more than 10 degree)Geno-valgus,, and i guess there s small widening between the femur and tibia on medial side,, when i am doing side split i feel stress on the left joint, its like iam stressing the ligaments, its not something about meniscal tear or something,because i have no sign of it.
i need at least proper diagnosis, nothing convince me to this point,, i hope u have the answer to my problem and i will attach some pic of my left knee.
*BUT why there was kind of popping ( sound of like friction or stretching two rubbery band ) in the knee while i was doing the squatting before the swelling appear ?,and i did x-ray and ultrasound and revealed no significants.
best wishes
AnswerAhmad,
A 1999 study (Uncommon causes of anterior knee pain : A case report of infrapatellar contracture syndrome) published in the American Journal of Physical Medicine and Rehabilitation stated:
"The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations."
Schwartz's Principles of Surgery, 8th edition, states:
"The most commonly injured muscles in the lower extremity are the hamstrings, quadriceps, and gastrocnemius. Injuries to these muscles either originate from a direct blow or, more typically, from a sudden eccentric contraction (acute lengthening of muscle as it is trying to shorten). This, in turn, ruptures muscle fibers. In severe cases, a defect in the muscle can be palpated; however, in most cases there is no gross defect. A well-defined sequence of events then occurs: bleeding, damage to muscle cells, and an inflammatory response that leads to a repair. Scar tissue then forms, ultimately leaving the muscle stiffer (less elastic) and more prone to reinjury. Treatment, therefore, involves controlling the pain and inflammation acutely and stretching as the muscle heals to try to keep it at its normal resting length. In severe cases where there is a disruption in the muscle tissue, both remodeled muscle tissue and postinjury muscle strength are improved by suturing the torn muscle tissue together.The knee is a commonly injured joint. These injuries occur predominantly in young, healthy athletes and are the major focus of most "sports..."
An MRI of the knee might be needed to provide optimum visualization of soft tissue abnormalities of the knee joint. I would also recommend seeing a physical therapist or a chiropractor with a post-graduate certification in sports medicine for additional evaluation and treatment.
