Rheumatologist Questions Rheumatologist

Knee pain?

My knee gave way about 4 weeks ago and it is still very painful, very swollen on left by the top of the knee. An X-ray shows no stress fracture. Dr won’t refer me for a scan. It's not getting any better.

Female | 78 years old

4 Answers

Could be your meniscus. Ice and rest until it improves before you start physical therapy.
Try ice and/or heating pad as long as your circulation and sensation are good. No more than 20 minutes at a time. You can try physical therapy for 4-6 weeks. A knee brace may also help. If it doesn’t get better an MRI would be helpful. Seeing a specialist can help with diagnosis and treatment.
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You have muscle weakness and need physical therapy.You certainly need an x-ray at least and better an MRI.
Most likely reasons include a meniscus tear or a loose body (piece of cartilage or bone). Either can get stuck in your knee temporarily and cause the knee to give way. Your knee can swell as part of the response to it. The pain can be from the swelling itself, the piece still being stuck between the two bones or a resulting bone bruise from the impact when your knee gave way. An mri scan would be helpful in ruling these out, and can show other concomitant pathologies such as osteonecrosis, ligament tears and fractures for example. The x-rays should have shown if there is any arthritis which often is associated with meniscus tears and loose bodies. The first step right now is to get the swelling down which will help reduce the pain related to that, and allow the beginning process of regaining motion and strength. Seeing an orthopedic knee specialist for repeat physical examination and further imaging if still necessary should be considered as well, so that treatment can be adjusted properly and get you back to your normal self.

Ron Noy, MD, FAAOS



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