Undiagnosed knee pain.

KneePain313,

You have had a pretty thorough workup. One good thing is that the MRI and orthopedic evaluation shows that you do not have any obvious structural abnormalities. In other words, your cartilages and ligaments are intact, you don't have any masses inside the knee, and your articular surfaces are okay.

However, you do have something going on, because swelling is not normal. To have enough fluid for the rheumatologist to aspirate is more than normal. Everyone has to have a little joint fluid, to keep the joint lubricated, but it should not be enough to pull any out with a syringe.

It is not uncommon for the knee to be uncomfortable in the posterior (back) aspect when there is an effusion (swelling inside the knee joint itself).


Unfortunately, there are a multitude of inflammatory arthropathies. Some of them have tests, from which they can be detected. But, the vast majority do not.

Some have known causes, such as infectious diseases (Lyme disease, Chlamydia, gonorrhea, salmonella, viruses, fungus), but in the vast majority, the cause is still not known.


If you have an active inflammatory process going on, your inflammatory markers should be elevated. These are the ESR (erythrocyte sedimentation rate) and the CRP (C reactive protein).



Sorry about your knee problems. It is going to be very difficult to figure out what is actually going on. But, if you continue to seek an answer, one will usually finally be found. It may be that you have just presented before the classic symptoms have shown up. With time, your symptoms may change and finally fit a particular disease process. Keep looking.

Hang in there. Good luck.

Thanks for the reply! According to the rhumetologist there was very little fluid in the knee. According to him the test for inflammation was negative, it did not show inflammation. My knee hurts worse when I try to push something to the side. Again I appreciate your reply, I have no choice but to keep looking!

KneePain313,

When you state that the pain is worse when you push something to the side, is that when you actually push to knee to one side, you when your push an object with your side to it (with your shoulder against it)? Probably doesn't matter too much, because the forces are basically the same.


It could be that you are stressing one of the ligament (either the collateral or cruciate). Which would not show up on an MRI, because it is a static snap shot of the anatomy. It doesn't really tell you what is going on physiologically.

Again, you could be stressing some structure within the knee. The ligaments are the first to come to mind, but it could be the capsule, the menisci, you might have a synovial plica, problems with the articular cartilage (chondromalacia), etc.


Since you do not have inflammation at the present time, it may be that the place to look is with the orthopedist. Even thought the MRI was "okay", that does not mean that you do not have a dynamic problem. One that only really shows up when you are stressing the joint. Unfortunately, these are some of the hardest problems to figure out.

You may have to see a couple of orthopedic surgeons till one finally figures out what is going on. Try to see a specialist in the knee or sportsmedicine if you can.

Good luck. Hope you can figure out what is going on.

I would see another Dr. I have had chronic knee pain since I was 21. I am know 33. I was bounced back and for between the ortho and rheumatologist for years. I never did get any where with either, so I just stopped going. Until finally the pain was so unbearable I just could take it anymore. Now 12 years later I am facing a total knee replacement, as I have 0 cartilage left in my knee.

I know it may be a hassel, but maybe if you keep on them you will not end up like I am now.