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  1. #1
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    Brief Medical History Overview

    Age: 30, Male, Presenting Problem Since: 18 months +, Symptom Behaviour: Depends on the day, Symptoms Worse (24hr Behaviour): Erratic but mostly ok unless heavy running/jumping, Aggravating Factors:: running/jumping, Easing Factors:: pain killers, rest, patellar straps, Investigations: x ray and mri, No Diabetes, No Medications, No Osteoporosis, No Hx of Cancer, No Unexplained Weight Loss, No Bowel/Bladder issues, Other Info: Alll in my post

    Major problem / Symptomatic Areas

    Knee - Anterior - Left

    Mystery Knee Pain

    Physical Agents In Rehabilitation
    Hi All,

    I apologize in advance because this is probably going to be a pretty long post.I知 here because i feel like I知 running out of options and this is kind of my last resort and I知 hoping maybe some of the brightest minds in Physio from around the world can help me out.

    First of all, my background/medical history is as follows: I am a 30 year old male who is very athletic and have been my whole life. I playAmerican football and train(ed)/workout/play on average about 5-6 days a week.My job is not necessarily a desk job that I have to sit at a desk for 8 hours a day but I do ultimately sit a lot when I'm not working out. I致e never had any major injuries of any kind. My worst would probably be a pretty bad ankle sprain about 4-5 years ago which I ultimately played through (braced) and hasn稚 given me any direct issues since. Other than that my only other issues in chronological order of their occurrence are right distal biceps demoted tendinitis/oasis, and then grade 2 hamstring strain in my left leg, and then a grade 2 hamstring strain in my right leg. I missed little to no time through most of these 妬njuries. Maybe 2 weeks off from the second hammy because I learned from my first. I utilized the lateral movement and proprioceptive protocol to come back from that.

    Now to my current issue... About a year and a half ago I was camping and was in what I would describe as a deep squat position (ass to grass) position building a fire for what I guess for my body was an unusually long period of time. When I went to stand up I felt whatI can only describe as a twinge in the anteriomedial aspect of my left knee. The best way to describe the location would would be the砺oid/都oft spot immediately adjacent to the medial aspect of the patellar tendon. There was no audible sound of any kind. And the twinge while quite uncomfortable wasn稚 excruciatingly painful or anything but definitely enough to take notice of. Since I was camping I was unable to ice right away not thatI think that would have made that big of a difference but it did feel sore for the balance of the weekend. Ultimately when I returned back from camping I resumed my activities as if nothing happened, only I made sure to ice after every run, football practice, or game as the left knee was always 菟uffier than my right knee since the camping trip. This went on for 9 months to a year all the whileI was trying to figure it out on my own. Then I finally decided to go see my family doc who did all the basic stability tests which as far as I know didn稚 yield any positive signs for injury to any of the major ligaments etc. He prescribed me some pensaid (topical nsaid) and sent me on my way. I fulfilled the prescription went along with the program and it felt ok while I was on it but came back right after I stopped which leads me to believe that he was treating my symptoms not the cause. Feeling frustrated because my on field performance began to degrade I went back which resulted in my getting x rays(allegedly unremarkable), and an mri which was also allegedly unremarkable(although I actually have the written report for this and. I would be happy to share if it will help). So there I was having taken advantage of Canada痴 wonderful healthcare system but still with no answers. I kinda get the impression that none of the doctors really care that much because I知 obvious not dying from my knee pain but football means the world to me and I知 not ready yet to just succumb to this knee pain. So the I set out to research on my own feeling helpless as ever and figured that perhaps it痴 PFPS or Patellar Tendinosis/itis. I managed to do enough research to assemble what I think was a pretty good program using heavy slow resistance closed chain exercises with an extra focus on my posterior chain (ie glute Medius etc). I should also mention that very early in my rehab i experienced a very similar (although to a lesser degree) sensation in my right knee but I just dropped the weights as soon as I felt it because I knew 鍍hat feeling. So there was a brief period where I was dealing with this issue in both knees. My right knee now is close to 100% and I rarely have any pain in it since I致e been doing my strengthening program.However just a couple of days ago while doing some cardio (i worked up slowly)I felt the pain in that 都oft spot of my left knee again. It痴 not anywhere near as bad as it was at first 18 months ago but it痴 annoying and frustrating to feel anything like that after feeling like I was progressing so well. I need to get as close to 100% as possible before the end of May when the season starts again. And I just want to make sure that I知 on the right track and not treating the wrong thing.

    When I look at the anatomy of the knee I can honestly say that the pain is in the exact area of the MPTL or MPML. When it痴 aggravated I can almost feel a small cord-like body in that exact area running in the almost exact same pathway as it appears the MPTL and MPML do. I致e never suggested these two ligaments to my doc because I never want to be that guy who thinks he knows more than the doctor and I figured if there was something to it they would pick up on it since they physically inspected my knee. They did not however.

    In any case here I am. Running out of options. I would be eternally grateful to all of you if you think you can help and will provide whatever additional information necessary in order to figure this out.

    Thank you all so much in advance for your time. I look forward to your responses.

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  2. #2
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    Re: Mystery Knee Pain

    Aircast Airselect Short Boot
    Are you sure it is not a medial Knee plica? - they tend to be sore all along the inner kneecap and snap at times.
    https://www.physio-pedia.com/images/e/e6/Plica.jpg
    If you press on the sore spot and flex and extend knee, it should hurt and snap.
    Hughston Plica Test
    You can inject it with steroid or have it excised:

    Gerrard, Adam Daniel, and Charalambos P. Charalambous. "Arthroscopic Excision of Medial Knee Plica: A Meta-Analysis of Outcomes." Knee surgery & related research 30.4 (2018): 356.
    Arthroscopic Excision of Medial Knee Plica: A Meta-Analysis of Outcomes

    There is a dumbed down version of it described here:
    Nottage, Wesley M., et al. "The medial patellar plica syndrome." The American journal of sports medicine 11.4 (1983): 211-214.
    SAGE Journals: Your gateway to world-class journal research
    which is the infrapatellar plica:
    "infrapatellar plica, or ligamentum mucosum, which runs parallel to the anterior cruciate ligament, and is only of significance in that it can act as an obstruction to the passage of the arthroscope from the medial to the lateral compartments of the knee"

    It could give medial joint line tenderness.

    Possible differential diagnosis would be a medial fat pad syndrome

    Dragoo, Jason L., Christina Johnson, and Jenny McConnell. "Evaluation and treatment of disorders of the infrapatellar fat pad." Sports medicine 42.1 (2012): 51-67.
    https://www.researchgate.net/profile...c6f5000000.pdf

    Hoffa test - Press on sore joint line spot with knee flexed and when straight - should be more sore when straight (pic in article)-

    Article (free online) goes over various approaches in detail.
    Hope you are enjoying our cold snap
    From Canada...




 
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