Swelling Persists Post Lateral Collateral Ligament Injury

[sietzeh]

Dear Sietze,

Sorry, I should have made it clear that there indeed was trauma. I was cycling at speed and lost balance, so I tried to use my left foot to restore balance. But I placed my leg too far out in front of me, so my foot just rammed into the ground hurting my knee. I went to a GP straight afterwards, but the GP just told me to take Ibuprofen. Hope this clarifies my situation.

Thanks

Kate

hmmm, trauma can cause a LCL to hurt, but this should result in a swelling of the whole knee, not only to the lateral side of the knee, although the LCL is an extracapsulair structure. If the LCL ruptures, this should also have impact on the other lateral structures, capsula. If an LCL is ruptured you may have instability, but not only when climbing or descending the stairs, but also with normal walking and turning. Especially on an uneven surface. Then still an ibuprofen is not the way to treat it. It only reduces the first events of inflammation, and then mainly on pain.....not on recovery. Strengthening the muscles is then the way to go, together with external support of the knee with a brace or something that gives (mental) support to head and knee ;-)
You did not perform any exercise what so ever? You only took ibuprofen and started jogging? And continue to live and use the knee in an normal way, without giving it an extra rest? Then still I would think that swelling would become less, as PT/exercises only reinforces (if performed on the right level) natural recovery...it is not initiating it. I still have enough questions and options for alternative diagnostics.

To my idea these are the options, in random order and with no order in importance:
1. IT band
2. LCL rupture in stead of sprain
2b LCL rupture with an avulsion fracture of its insertion on the head of the fibula
3. lateral meniscus
4. Myofascial trigger point in the lateral head of the mm. quadriceps


My questions:
Is the swelling of the knee the whole knee or just the lateral aspect?
Which activities except from jogging and using the stairs do aggravate the pain?
Is there a difference in ascending or descending the stairs?
Does your knee lock? (are you sometimes not able to flex or extent it?)
Is the function of the knee impaired? When you compare you left with the right knee, do they perform the same or is for example the extension (straight) less?
Does is hurt more when you it more?
Does it become worse of less when you continue to use it?
Are you able to palpate the pain? If yes, where is the most painful spot?
Are you able to fully squat?
Is there a difference in size between left or right upper leg? Use a centimeter approx. 5 cm above (cranial) of the knee cap?
Is there a marked difference in getting up from a chair using your left or right leg only?

Life is not easy over the internet. I prefer to see the patient in sight....but it is fun to get the brain working

Sietze

[kate_r]

Thanks so much for your detailed explanation.

Here's a drawing of the swelling/worst part:

hmmm, trauma can cause a LCL to hurt, but this should result in a swelling of the whole knee, not only to the lateral side of the knee, although the LCL is an extracapsulair structure. If the LCL ruptures, this should also have impact on the other lateral structures, capsula. If an LCL is ruptured you may have instability, but not only when climbing or descending the stairs, but also with normal walking and turning. Especially on an uneven surface.

In the first 2-3 weeks, the knee gave way a lot even on a flat surface and even after the pain had subsided. It no longer gives way now though.

Then still an ibuprofen is not the way to treat it. It only reduces the first events of inflammation, and then mainly on pain.....not on recovery. Strengthening the muscles is then the way to go, together with external support of the knee with a brace or something that gives (mental) support to head and knee ;-)

Would strengthening also reduce swelling?

You did not perform any exercise what so ever? You only took ibuprofen and started jogging? And continue to live and use the knee in an normal way, without giving it an extra rest? Then still I would think that swelling would become less, as PT/exercises only reinforces (if performed on the right level) natural recovery...it is not initiating it. I still have enough questions and options for alternative diagnostics.

Well, I couldn't move about at all for the first 10 or so days, so I had to cycle (very slowly) to work. I had to use a lot of my right leg to do the walking. As with jogging, even now I can't jog very far (for about 10s) - it feels a bit painful if I keep on going. But mostly, it just just feels funny if I keep on jogging. The pain isn't excruciating enough to stop me going further, so I'm not sure if it's the weakness or something else.[/QUOTE]

my idea these are the options, in random order and with no order in importance:
1. IT band
2. LCL rupture in stead of sprain
2b LCL rupture with an avulsion fracture of its insertion on the head of the fibula
3. lateral meniscus
4. Myofascial trigger point in the lateral head of the mm. quadriceps

I wonder if the above drawing helps?

My questions:
Is the swelling of the knee the whole knee or just the lateral aspect?

It's actually not so much on the side, but the front. About 8 o'clock from the kneecap. It feels like the swelling is mostly in the 'dent' in that position.

Which activities except from jogging and using the stairs do aggravate the pain?

I can't really push my left knee back. So, if I tighten my knee/hamstring and try to push it back, I can feel sensations of pain. It can't go as far back as my right knee can. Also, if I put my left leg on a chair and try to reach my toe, I can't reach as far and I can feel a bit of pain too.

Is there a difference in ascending or descending the stairs?

Not so much. I can only go up and down at a rather slow pace.

Does your knee lock? (are you sometimes not able to flex or extent it?)

Sorry, I don't quite know what locking feels like. Is it when the joint is stuck and feel the bones hitting against each other? If so, no. However, it can get very tight if I stay on my feet for like 10-15mins. I have to do some quad stretches in order to get it to flex again.

Is the function of the knee impaired? When you compare you left with the right knee, do they perform the same or is for example the extension (straight) less?

Very much so. I can't reach

Does is hurt more when you it more?

Missing a keyword there?

Does it become worse of less when you continue to use it?

It does. It's far easier for me to, e.g., walk 200m than to walk 2km. It's not the pain that makes it harder, but it just feels funny and perhaps weak as well. I'd end up leaning on my right.

Are you able to palpate the pain? If yes, where is the most painful spot?

Not anymore. Initially, the 'dent' at 8 o'clock was the worst area. Even the top of the shin bone too.

Are you able to fully squat?

Yes, but I can feel tightness in my left knee. Getting up isn't easy though. Kneeling is particularly hard - perhaps it's because it makes me put pressure on the swollen area.

Is there a difference in size between left or right upper leg? Use a centimeter approx. 5 cm above (cranial) of the knee cap?

Do I measure it from top to bottom? If so, no - but it's swelled up though.

Is there a marked difference in getting up from a chair using your left or right leg only?

Yes, very much so. It feels there's a lot of going on if I use my left leg. Not so much pain, but a tingly feeling. A lot more going on. (Apologies for the lack of a better description!)

Life is not easy over the internet. I prefer to see the patient in sight....but it is fun to get the brain working

Sietze

Thanks so much for your patience. I agree it'd be much easier in real life. I was just hoping that I could cut my local medical system some slack if my knee can be somehow healed at home.

Kate

[sietzeh]

Thanks so much for your detailed explanation.

Here's a drawing of the swelling/worst part:

In the first 2-3 weeks, the knee gave way a lot even on a flat surface and even after the pain had subsided. It no longer gives way now though.


Would strengthening also reduce swelling?


Well, I couldn't move about at all for the first 10 or so days, so I had to cycle (very slowly) to work. I had to use a lot of my right leg to do the walking. As with jogging, even now I can't jog very far (for about 10s) - it feels a bit painful if I keep on going. But mostly, it just just feels funny if I keep on jogging. The pain isn't excruciating enough to stop me going further, so I'm not sure if it's the weakness or something else.

I wonder if the above drawing helps?



It's actually not so much on the side, but the front. About 8 o'clock from the kneecap. It feels like the swelling is mostly in the 'dent' in that position.


I can't really push my left knee back. So, if I tighten my knee/hamstring and try to push it back, I can feel sensations of pain. It can't go as far back as my right knee can. Also, if I put my left leg on a chair and try to reach my toe, I can't reach as far and I can feel a bit of pain too.


Not so much. I can only go up and down at a rather slow pace.



Sorry, I don't quite know what locking feels like. Is it when the joint is stuck and feel the bones hitting against each other? If so, no. However, it can get very tight if I stay on my feet for like 10-15mins. I have to do some quad stretches in order to get it to flex again.



Very much so. I can't reach


Missing a keyword there?

Very much so, but you gave a good answer with the next question


It does. It's far easier for me to, e.g., walk 200m than to walk 2km. It's not the pain that makes it harder, but it just feels funny and perhaps weak as well. I'd end up leaning on my right.


Not anymore. Initially, the 'dent' at 8 o'clock was the worst area. Even the top of the shin bone too.


Yes, but I can feel tightness in my left knee. Getting up isn't easy though. Kneeling is particularly hard - perhaps it's because it makes me put pressure on the swollen area.


Do I measure it from top to bottom? If so, no - but it's swelled up though.


Yes, very much so. It feels there's a lot of going on if I use my left leg. Not so much pain, but a tingly feeling. A lot more going on. (Apologies for the lack of a better description!)



Thanks so much for your patience. I agree it'd be much easier in real life. I was just hoping that I could cut my local medical system some slack if my knee can be somehow healed at home.

Kate[/QUOTE]


Hi Kate,

so when I give a summary of the above, you still have pain at 8 o'clock from the knee cap and that's also the place with the most swelling, escpecially when kneeling. What I mean with difference in size is the circumferense. I suspect and expect it to be much less as you haven't been able to use that leg for 10 weeks in a normal way: more than 2 cm difference.

What worries me is that you are not able to fully stretch your leg, this gives a clue, together with continued swelling, pain while kneeling and funny feeling while walking and sort of locking of the knee after sitting/kneeling/bending that you have a meniscus tear. I think that you at least need to consult a PT specialized in sports, but I recommend that you visit your GP and ask for a orthopeadic surgeon as I suspect the lateral meniscus to be impaired.

As you had giving away sensations at least the LCL has been torn and there is even a change that you injured the ACL... That is the worst case scenario, but then the swelling should have been almost instantly, within 2-3 hours after trauma.

From your answers I do not expect the knee to get much better from doing exercises. You should first need to rule out serious damage to the knee and please do not let you sent away by the GP without a proper examination of the knee. He should check swelling, function loss, and stability for LCL, ACL and PCL. A good self assessment for the meniscus can be done with the thessaly test, https://www.youtube.com/watch?v=84pZh0n_rMg. More info following this https://www.youtube.com/watch?v=BV6jawESuhA and https://www.youtube.com/watch?v=PWAm027JtjQ. You should not try to force the extension nor the flexion of the knee.

In an answer to your question about the swelling and exercises: muscle training itself does not reduce the swelling, but the activation of blood circulation after approx. 5 days makes the re-absorption the hydrops go better, but only when one respects the maximum load capacity of the impaired structures. Ibuprofen takes away the chemical pain in the first few days and counter attacks the sterile inflammation response of the impaired tissue (whether one should use NSAID after trauma is still a big debate, as nature is not doing anything stupid normally. So why suppress a natural event??) Continued usage of NSAID after 5-10 days makes no sense, it is like putting on a band aid when a wound stopped bleeding.


I wish you good luck with the further rehabilitation and recovery. Sorry to cause a not so good beginning of 2015. You could try to consult a PT via this link Find A MDT Clinician | The McKenzie Institute International®. Being a Diplomat MDT myself I can not help to be in favor of this treatment method. This method emphasizes your own role in recovery, see the rest of the website....


Cheers,

Sietze

Ps. I would like to know the result. You could try to answer me via gmail and put seatsah in front of it.

[kate_r]

Thanks so much for the pointers. I'll go find a PT and will update you with the result!

Have a great New Year!