Dear lazyweb, diagnose my knee problem: bursitis? Tendinitis? Ligament? What?

OK, I have queried Google and the places it points me to extensively, and now it’s over to you physiotherapists, chiropractors and other readers on the lazyweb. I mean, if I can’t crowdsource a diagnosis for my knee, then what the hell use is the intertubes?

(Everyone else may find this utterly boring, and self-indulgent. Which it is. You’re completely let off reading. It’s an experiment, OK?)

OK, so here is the history. Because I broke my finger (don’t ask) I wasn’t able to play squash – my favoured form of exercise – so I went on a running machine. First time for an hour (no trouble) and then three days later for half an hour (no trouble) and then a week after the first one for another half an hour, on quite a tough program. I don’t recall any knee pain after any of them.

Possible data point: the day after the last run, I played a game with the youngest of the children – who weighs 10kg+ – in which I crossed my legs and he’d bounce on the foot. So that would be putting a lot of strain over the knee attached to the foot. And as it happens that’s the knee that hurts. But that was two weeks ago.

Symptoms: If I crouch down, bending both knees, the affected knee (right) starts to feel as though something is being squashed – like trying to compress a cushion. And it becomes really painful; I can’t crouch all the way. I can’t pull the lower part of the leg back to touch the upper part (which I can on the left): there’s too much tightness across the top of the leg, on the quadriceps as it comes over the knee.

It doesn’t hurt to straighten my leg; doesn’t hurt to twist my lower leg. If I hold my leg up and bend it, I feel tension on the outside of the knee. If I stand and then gradually crouch, I feel a tension from the top of the inside of the knee diagonally down to the bottom of the outside of the knee. And the muscles on the outside of the knee are enlarged; in fact the whole of the front of the knee seems a bit enlarged. The swelling isn’t obvious except in comparison to the OK knee; then it is.

It doesn’t stop me moving around; I’m just aware of it, particularly when I’m going up stairs; don’t notice it going down. But it’s there, almost all the time.

And that’s about it. My guesses are, in order
-ligament strain: because my knee was bent and turned when child3 was bouncing on it, I’ve strained the ligaments on the outside there. It just seems like a long time to heal.
-bursitis. Might explain the apparent swelling, but the precise location of the feeling of stress doesn’t seem to fit the cause.
-tendinitis: inflamed from running? Possible, but I’ve never had it before.

OK, do your worst. What’s wrong? I’ve tried taking ibuprofen, which has little effect.

Oh, and I plan to play squash competitively tomorrow (having tried it out on my own this afternoon; no pain, just a little tightness, which actually eased when I played. Aches afterwards but not much of it.) The clock is ticking!

(Perhaps a new category needed: self-indulgent wibble.)

12 Comments

  1. I think what you describe as enlarged muscles is in fact liquid but my primary concern would be the fact that you feel pain. Playing serious squash doesn’t sound like the smartest move you could make as your trial-run surely doesn’t replicate the stresses you’d encounter in a proper game.

  2. Charles

    Sunday 16 November 2008 at 11:38 pm

    @John – re the enlargement, I can definitely feel the tendons attaching the quadriceps much more clearly on the affected knee when I begin to squat down. It’s *all* bigger. So yes, one thinks “liquid”. But – from a ligament strain? Or bursitis? As I said, it’s been two weeks, which in my experience is usually enough for symptoms of ligaments to subside. I’ve never done bursitis, so dunno.

  3. Check out http://www.physioroom.com/injuries/knee/index.php if you haven’t already.

    I managed to strain my knee ligaments just getting in the car, it doesn’t really hurt either but I know it’s their when I twist it. According to Physioroom it can take MONTHS to heal.

    I suppose you could always see a doctor?

  4. I happened onto your blog. Very well done.

    I have extensive experience in treating athletes with a variety of musculo-skeletal problems. Karate,judo, running, and boxing in particular, develop predictable problems with the elbows, wrists, shoulders and knees.

    I currently use a non-prescription topical anti-inflammatory cream that I developed, originally for my daughter’s horse.(her hobby) I introduced commercially, for human use 6 months ago.

    The cream works in about 30 seconds, pain relief lasting 2-4 hours. There is no odor, no noticable sensation of burning or cooling. The pain, simply goes away. Most of the problems are inflammatory, and the cream is a transdermal anti-inflammatory of a rather potent nature.

    The blog site is: [removed by blog owner]
    The product is called “kink-ease.” It is a high concentration MSM lotion, and it is particularly useful for pain problems in the feet, hands, wrists, ankles and shoulders. It is somewhat useful in the hip and lower back, but only in slender people.

    It is pharmaceutical grade and is priced very reasonably.

    David S. Klein, MD, FACA, FACPM
    Pain Center of Orlando, Inc.
    dsklein@earthlink.net

    [Edited by CA to remove blatant and rather useless advertising]

  5. Charles

    Monday 17 November 2008 at 12:03 pm

    @davidsklein – nice attempt to advertise your product. I’ve left the name in (and your email, which you added, so you can get spammed), but your signal failure to attempt a diagnosis or prognosis suggests to me that you’re a bit estranged from the Hippocratean principle of “first, do no harm” since you haven’t attempted to figure out what’s actually wrong – only to profit from my injury, even if in doing so you don’t benefit me.

    This case here is non-predictable: it’s an injury that I can’t find described in its symptoms in any of multiple sites. My own thinking suggests it must be a ligament strain due to overloading of the knee, and that climbing stairs is contra-indicated as that repeats the original injury situation.

    And I’ve booked a chiropractic appointment. As it happens, they’re at the top of a flight of stairs…

  6. Commiserations, Charles. May be worth remembering the concept of deferred pain. That is, the site of the pain as experienced by you is not always the actual site of the injury. (I take your point that the knee looks inflamed. But you may not have entirely identical knees anyway.)

    You can get pain in the front of thigh and knee from hip conditions. According to this jolly article http://www.arc.org.uk/arthinfo/medpubs/6524/6524.asp

    It also gives a handy diagram of the bursae of the knee. And tells you who tends to get housemaid’s knee. (Carpet fitters and builders.)

    The question of whether to rest painful joints and tendons is tricky. Movement is generally regarded as good & healing. Little and often better than intense workouts. So climbing a few stairs might be better than a game of squash. Who knows?

  7. Perhaps a new category needed: self-indulgent wibble

    New? If someone did an accurate and honest tag-cloud for the blogosphere that would be the only category visible!

    I have nothing useful to say about your knee though except ‘get well soon’, sorry.

  8. Perhaps it’s from all those hard-done-by PR people sticking pins in their effigies. Admit you are no longer 25 and get well soon.

  9. Charles, I think you have a bad knee.

  10. I found this site looking up what I think are the exact same symptoms. I have been with a trainer for the past 6 months who has been intense on muscle building exercises, low-impact moves with heavy weights. Everything’s been going fine until I noticed a tightness in one knee when I go to bend it or put weight on it (such as use it as my leading knee when climbing onto my bed). I just today noticed there is an actual difference between my two knees … there is some painless swelling on the outside of the affected knee that is not in the other knee. It doesn’t hurt, it’s just that uncomfortable “squashing” sensation, like something’s going to pop. If you have figured anything out, I’d love to know.

  11. It sounds like an effusion – excess fluid in the joint, inside the joint capsule – which prevents the joint going into the close-packed (minimum volume) position.

    Why is another matter, the knee tends to do that in response to a lot of things. It doesn’t sound specially like meniscal problem, or a ligament problem though.

    Squash probably isn’t ideal – cycling, or skiing or swimming where you can put a lot of effort across it without shocks may be a better move.

    See a physiotherapist or one of my GP colleagues, is the best advice I can offer. If you come to Exeter you can see me (if that isn’t too much advertising).

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