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Undiagnosed knee pain.

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For 6 months I have experienced pain in my right knee. The pain somedays is worse and can be debilitating. Pain is more of an achyness rather than sharp pain and appears to be somewhere on the side or back. There is some swelling associated with the pain. Other days can be less painful and can actually walk without limping. I have been to an orthopedic doctor who xrayed and mri, no indications of problem. Also went to see a rhematologist who did some blood tests and took fluid off knee for testing, no indications of problems. I have had two cortisone shots, temporary relief but not longer than 2 weeks. I have been taking diclofenac which doesn't seem to help much either. I have been to a chiropractor who did some electric shock therapy with no lasting relief. Ice helps temporarily. I have been reluctant to really try PT because I don't know what is wrong and I don't want to risk further injury.
Prior to the onset of pain, I was on vacation in Italy where we did a lot of walking. No known injury or other incident that immediately started the pain. Really didn't notice it until a couple of weeks after I got back home. I think I have noticed that I have some joint pain or discomfort in my right hand finger joints. It seems to also coincide with flare up of knee pain. Maybe related? This is very frustrating not knowing what could be wrong.
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First Helper User Profile Gaelic
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replied March 6th, 2012
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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.
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Users who thank Gaelic for this post: ErikLarsson 

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replied March 7th, 2012
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!
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replied March 8th, 2012
Especially eHealthy
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.
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replied April 6th, 2012
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.
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