Lateral Knee Pain

Subsequently

 

A while later after the injury, problems developed.

 

Catching toes

 

I started tripping over the slightest thing: a slightly-raised paving stone; my very thin kitchen mat or absolutely anything, or indeed, nothing. I could catch my toes on anything or nothing, and trip! I did in fact take a fall on one occasion and still have the scar on my right knee to this day!

 

This may involve the biceps femoris as discussed by:

http://www.sportsinjuryclinic.net/anatomy/human-muscles/hip-pelvis/biceps-femoris

 

Insertion

Lateral condyle of the tibia.  

Head of the fibula.  

Actions

Hip extension.  

Knee flexion.

Lateral rotation of the hip when the knee is flexed.

Daily uses

Bending the knee to step over something.  

 

And may also be a peripheral nerve problem resulting in a Foot drop, or Drop foot condition:

http://www.nhs.uk/conditions/foot-drop/Pages/Introduction.aspx

(On website)

Peripheral nerve problems or neuropathy

Foot drop is often caused by compression of the nerve that controls the muscles that lift the foot.

 

 

Can't lift up my bad, right leg

 

I had trouble lifting up my leg, both:

• forwards, knee to chin and

• backwards, heel to bum.

 

I struggled to get over the side to use the bath / shower. Eventually it seemed far too dangerous to even try so I gave up trying, and washed with a flannel in the handbasin. 

 

I have repeatedly been given various physiotherapy exercises to do with the idea of strengthening a variety of muscles, but nothing seems to help. They say that my 'quadriceps muscles and gluteus medius are weaker on the right hand side', but physiotherapy exercises don't seem to make any difference. 

 

Exercises do however result in servere right groin pains, and sometimes in the left side too, because I do the same exercises on both left and right legs.

 

This dilemma reverts me back to an original quandry:

How is it possible for muscles to go weak instantaneiously...???

 

This instantaneious weakness refers to my foot suddenly slapping down when I was jogging; clearly other muscle weakness may have developed with lack of correct use over time. It seems to me that this instantaneious weakness must be related in some way further up the kinetic chain.

 

 

Sore Achilles Tendon

 

I noticed by accident that the area around my Achilles tendon on my bad, right foot was sore to the touch. It felt sore like the pain of a grazed knee after falling over during childhood. This was not confirmed by clinical diagnosis at my local hospital. Also I could, and still can, feel a structure within the back of my heel that wobbles on rubbing, and might suggest an enlarged bursa, but again no clinical diagnosis.

 

 

Patient reports an unstable knee

 

Although nobody could feel it for themselves, to me my knee felt very unstable in two ways:

• Hyperextension... I would describe my knee as '... wanting to bend backwards like an elbow...', which I later determined to possibly mean 'hyperextension',

• Forwards / backwards... As I walked I could, and still do, feel my knee wobble in a forwards / backwards manner, in quick, little movements, which I determined to be 'instability'... 

forwards/back;

forwards/back;

forwards/back.

 

I would frequently describe myself as '... walking around like a drunkard...' I would be all over the pavement when walking home after going to the town or after any activity. And I would describe my leg as being like '... a tree trunk, with a cat flap in it...' because it felt as if it wasn't really part of me, that I was just balancing on top of it, and the tree trunk would wobble around the knee as if the cat flap was swinging too and fro.

 

However, neither consultants nor physiotherapists, either locally or in London, could feel either of these motions that were, and still are, quite evident to me. But more than that, when they write their letters, they state that the '... joint is stable...' They make no mention that this is contrary to that reported by the patient. And as time goes by, stability becomes more and more difficult to understand because inhibited muscles will be facilitated by others, therefore unstable muscles may actually appear to be stable.

 

The popliteus muscle is thought to maintain the stability of the knee; nevertheless this role may be taken over by other structures when the popliteus is non-functional.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724686/pdf/v037p00358.pdf suggests:

(2002)

It is the only muscle that has sufficient mechanical advantage to produce internal rotation of the tibia on the femur during gait.11 It is said to be an important static stabiliser of the posterolateral corner, acts as a secondary restraint to posterior displacement of the tibia in posterior cruciate ligament deficient knees,12 and produces an active pivot shift if electrically stimulated.9 In our case, however, when the joint was stressed, the other posterolateral structures compensated for the lack of the popliteus and maintained the stability of the joint.

 

So stability should not be the deciding factor with regard to the popliteus muscle, especially when the patient describes otherwise.

 

However static, as opposed to dynamic stability is discussed elsewhere in relation to the popliteofibular ligament. Is it possible to differentiate between these for a clinical diagnosis...?

 

 

Knee frequently clicks

 

My bad, right knee would randomly 'click' during various activities, but mainly with those when my knee was at an angle, probably of about 90 degrees. This might be when I was in the process of sitting down, either on a chair or on the edge of my bed.

 

It would also 'click' randomly when I was going downstairs, and could occur more than once on a set of domestic stairs.

 

And it would always 'click' on demand when it was internally rotated, if I stood with my feet flat and firmly on the floor, my knees slightly bent, and I twisted my body repeatedly from right to left, and back. I was told by the consultant fellow not to make it click in this way.

 

 

Walking with slightly bent knee

 

I was told that I was walking around with my knee slightly bent. This was not deliberate, and I can only assume that it was a subconscious strategy to avoid pain or some other discomfort.

 

A description of popliteus injury, and difficulty straightening knee, is suggested by:

http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/popliteus-injury

(On website)

Symptoms of a popliteus injury include pain at the back of the knee joint. There will be tenderness when pressing in at the back of the knee. Pain will be reproduced when the knee is bent against resistance whilst the lower leg or tibia bone is rotated outwards. Athletes with this injury commonly have tight hamstrings. If the injury is severe then straightening the knee fully will be difficult.

 

A preference to keep the knee bent is suggested by:

http://www.sportsinjurybulletin.com/archive/posterolateral-corner-knee-damage#

(On website)

A PLC injury can cause considerable disability. The opposing convex articulating surfaces of the lateral femur and tibia can cause the lateral side of the joint to open when the heel strikes the ground, which produces a distinctive ‘varus thrust gait’. Patients often prefer to keep their knee bent to prevent this.

 

 

Painful when knocked backwards

 

I found out, by accident on a couple of occasions, that the back of my right, bad knee is extremely painful when my leg is knocked backwards. 

I discovered this when I was looking out of an upstairs window in my bedroom. I then moved away from the window, but as I did so I seemed to swing my bad, right leg out backwards. As my leg moved backwards it hit a large box on the floor next to the window. This was so very, very painful. It has happened a couple of other times, but to a lesser degree.

 

 

Lateral knee pain

 

I had pain in the lateral side of my bad, right knee when my knee was at an angle and rotated slightly inwards. It was tender across an area, as shown on the photograph between A and B, with a point in between that continually had severe pain when touched. This point appears to be the fibular head. Although these have been assessed as symptoms of a lateral meniscus tear, they are also indicative of damage to structures in the posterolateral corner (PLC) of the knee and to the proximal tibiofibular joint.

 

There was also sensitivity when brushing my hand over the lateral side of my knee which was present pre-arthroscopy. Note that there is as yet no pain behind the knee.

 

 

Climbing stairs

 

I find it very difficult climbing up and down stairs:

• climbing up, I have to swing my leg out, laterally, in order to get it onto the next step, 

• climbing down, I have to hold on tightly to the stair rail with my left hand so that I don't fall; my leg clicks randomly as I go down the steps; and occasionally my leg has given way such that I need to grab the rail rapidly with both hands before I fall down.

 

Latterly I have had to stop swinging my leg out in order to climb the stairs because it was just too painful. Now I go up one step at a time putting both feet on the same step...

 

 

Can't wriggle toes

 

I wish someone would look at the toes on my bad, right foot. They do not curl up and wriggle properly like those on the good, left leg when I am sitting, with my foot leaning on my heel.

 

They are OK when my foot is flat on the floor, just not when I have my foot leaning on the heel. This must indicate a problem... perhaps with the extensor digitorum longus muscle which is used to bend the four small toes upwards.

 

 

Can't stand on tip toes, on heel, nor on one leg

 

I cannot stand on tiptoes nor on my heel with my bad, right foot. I cannot support the weight of my body in these positions. Likewise so when standing on one leg.

 

 

Things move inside bad, right knee

 

When I do hamstring exercises lying prone (on my tummy) on my bed and bending my knee so that my heel moves towards my bum, I can feel things moving in my knee. Well, I don't know for sure that this is 'within' my knee per se, but definately within the area of the knee, whether in compartment / capsule / whatever, or not.

 

 

Medial knee pain with ultrasound

 

An ultrasound examination of my bad, right knee was performed at my local hospital and found there be no posterolateral corner issues. It did however uncover a new, major pain around the medial side of my knee as the input device, under pressure, was rolled over that area. Although I did ask what had caused that pain, I wasn't given any explanation, either at the time or with the results. I guess it was arthritis!

 

 

Neck

 

During my many visits to my local hospital, I saw a neurologist. The only problem he found, apart from a bit of brain atrophy, was with C2 and C3 vertebra in my neck. He didn't say what the problem was. He did say, however, that he didn't see how these issues could have affected my leg.

 

I wondered whether it might have been my leg that affected my neck. Problems with getting into bed, and then getting comfy in bed, were worrying for me because of the immense effort needed to lift the weight of my leg and the strain this was putting on my back and neck.

 

I have had some pain in my lower back during physical activities involving bending over for a little while like filling the dishwasher, and on the right hand side around my ribs, initially when getting comfy in bed, and then noticeable on applying pressure.