Swollen Knee

[Little-runner]

Hello,

I'm hoping for some advice on a swollen knee and I've had various different knee problems over the years.

The dates are hazy but first off my left knee swelled up a number of years ago and I had it drained when the swelling didn't go down after months and months. The draining definitely fixed the problem for a good while. The same knee I also had a tear in the meniscus which was tidied up with knee arthroscopy. (I think the tear was from a really old injury from about 15 years prior). Since then until recently it's been all good.

Then my right knee swelled up for no reason, no injury, no pain. Then eventually the pain came on after a few months, mostly on downhills when hiking presenting itself directly under the kneecap. Swelling wouldn't go down for months and years (during Covid) and I had all the scans etc. Consultant said my pain didn't match what was showing on the MRI (a radial tear) and all they did was give me a steroid injection and drained the fluid. The injection helped the pain for a few months and swelling went. Most of the time it's okay, it just bothers me mostly on the downhills on a big hike. The consultant suggested I could just keep having injections to manage the pain which I've been waiting for an appointment to go back and have heard nothing 2 years later. I know I should chase it but have just been coping with taping and pain killers which sometimes if fine, and sometime isn't enough.

Then, just before Christmas my left knee swelled up again out of nowhere. No injury, no overuse other than the usual actives. No excessive kneeling. Because I know the swelling really doesn't go down despite RICEing it, I went to see the Dr. They gave me a prescription for Voltarol gel and sent me on to see the physio.

The physio basically told me it's arthritis, which I'm not saying it isn't, it could be and I'm due to have a blood test next week. I am 52 so I appreciate it's pretty likely to some extent. But he sent me away saying he can give me injections when the pain gets too much. No advice about any specific exercises to do. He told me not to wear knee sleeves. Nothing about what's going to happen long term, no leaflets or information about arthritis. No Xray or MRI.

The reason I'm posting here is because what if it's something else that he's not considered, especially as it's not especially painful at the moment? No amount of googling is giving me anything I think it could be! The pain is more discomfort from the fact that it's swollen. The lack of range of movement in my knee currently is not because I don't have the range of movement, it's because it's swollen and I can't fully bend the knee which makes things like crouching painful. I read somewhere that swelling for long periods of time can lead to damage and now I'm wondering if that's what happened to the right knee! It certainly feels like history is repeating.

When I suggested having it drained, both the physio and the Dr reacted as though this is a really unusual thing to do. Is this true?

From my point of view based on experience, the swelling in my knees only goes by having them drained. I can't take ibuprofen because of meds I'm on. So what do I do? Just cope with this big fat swollen knee??

I'm a pretty active person, I don't run anymore so ignore the username (I should probably change it!). I do lots of hiking and biking and strength training. I have a sedentary job but try to walk every lunchtime. I also have Scoliosis which could be linked...who knows!

Any advice or similar experiences would be most welcome.

Thanks for reading!

Zoe

[Runrig01]

It sounds like you have Osteoarthritis with an effusion. Most effusions do eventually resolve on their own. Draining the knee, is a last resort, as it increases the risk of introducing infection, same with steroid injections. I injured my knee last summer, which resulted in bursitis, tentonitis, my knee cap is subluxed, making the tenfon cramp when I’m lying down. The fall also triggered a flare of inflammatory OA. All in all it has been excruciating for months, and I was keen to get a steroid injection, but rheumatologist refused as he was referring me to orthopaedics for potential surgery, and the injection could interfere with that. Orthopaedics don’t want to operate, as due to another medical condition, I’m a high risk, and at 58 deemed too young. He was very anti steroid injections, and said to just do physio. Despite this happening last June, I’ve only this week started physio sessions.

They will be reluctant to do an MRI, if there is no injury or anything alarming on examination, such as instability, to warrant scanning. It’s generally only done if the results would alter treatment. Unfortunately, physio and painkillers are the main treatments for pain, until it’s at the point of needing to be replaced.

Hope it improves soon for you. I have an inflammatory arthritis which affects my spine and most joints. I’m currently off my immunosuppressants as I’m having foot surgery in just over a week. This has resulted in all my joints playing up, from omitting meds. It’s just never ending 🤗

[Little-runner in reply to Runrig01]

Hello Runrig, thank you for taking the time to reply and sorry to hear all that you've gone through.

Everything you say makes perfect sense, and I do understand the reluctance to keep sticking needles in the knees! I guess I'm not thinking of it in a medical POV and thinks aren't as simple as I'd like them to be!

I will persevere with doing what I can to look after the knee and hopefully the swelling will eventually go down.

Good luck with the physio and I hope it helps with your issues, and also good luck for your foot surgery!

[Runrig01 in reply to Little-runner]

I completely understand the frustrations, and the wish for a quick fix with a needle to either aspirate or inject steroids. I’ve been there myself. 🤗

[Wolf68]

Hi, sorry to hear about your knee issues, it does sound very familiar.

I got to say I share your frustration with the information available and how some of the advice from professionals seems to contradict previous advice.

Some of my problems sounded similar to yours and it did suddenly deteriorate over a relatively short period of time to the point of barely being able to walk for weeks on end, so I would suggest to keep up the low impact exercises but not to overdo it, try not to get to the point where you feel any twinges at all, slowing down is better than stopping, perhaps introduce swimming into your routine.

I too have had fluid taken off the knee when the swelling was too bad and it is like instant relief but the fluid is supposed to protect the knee after injury so it shouldn’t be done regularly. Do you know if the fluid was tested for gout? Have you noticed that certain foods could make the pain and swelling worse? A simple food diary may help.

Have you noticed a deterioration in the muscle around that knee? If so that can make things worse, I would recommend specific exercises to target that but again don’t overdo it. I was told to lie on my back and lift the bad leg with toes pointing out try to write your name, eventually move onto doing the alphabet. To avoid tightness in the quad, while standing bend the knee slightly and loop a towel around your ankle pulling the foot backwards slightly just to stretch.

I have been told to avoid ibuprofen now because I have bowl problems but it was helpful in bringing the swelling down a bit, can you still use ibuprofen gels? They may help although I don’t think they are as good as the tablets.

Other than that I think you are doing the right things, just keep pushing for answers from the doctors who will probably continue to put you off saying you are too young for surgery etc but if things do get worse it can be miserable so don’t let them fob you off.

Good luck with it.

[Little-runner in reply to Wolf68]

Hi Wolf,

Thanks for taking the time to reply and sorry to hear about your knee issues too! You're absolutely right about slowing down and not stopping. Although I do find this hard, I'm trying to keep disciplined and be gentle with my knee and instead trying to improve otherwise neglected areas of my regime such as upperbody and core strength.

Thanks for the tip with the knee strengthening exercises too, will certainly give those a try. I'm going to look into the gels as well to see if I can take those with the meds I'm. Otherwise I shall continue to ice it and elevate it whenever I can.

Certainly if things do get worse I shall be straight back to the Drs but for now I'll give it a month or two and see how it goes.

Thanks again!

[katieoxo60]

Hi Little-runner, I understand your frustration but your story is very familiar . I have been that way on more than one occassion. My leg on one side is permently damaged fortunately I am much older than you but have had problems since in my thirties. I do take opiods and paracetamol but I have bursar problems too so the pain never goes away. But find low level activity helps keep the pain at bay. I would suggest you try one of the arthritis sites for varied ideas on how to manage the pain, discomfort ect I can't do stairs very easy and exercise is very limited due to age , multi joint arthritis, and other illness that impairs ability to walk. This week it as been suggested that muscle bulk reduces as we get older so no matter what we still need to do some exercise or physio to try and prevent muscle use loss . So keep up the exercise if possible even if only chair or bed exercise. I have a knee replacement by the way which was done in my 70s. Have a good day

[Little-runner in reply to katieoxo60]

Hi Katie, thanks for you reply and sorry to hear about your ongoing problems. Yes I agree about the importance of maintaining strength as we age, especially for our bone health and keeping mobile. I hope you knee replacement helped with your issues and also hope you are having a good day! 😊

[jointpain]

After seeing a consultant for my painful knees (mostly left) I had arthroscopies on both, trimming the loose cartilage just over twenty years ago. They didn't really get much better! Around five years ago, he wanted to operate and put in wedges in my upper tibias so the wear was transferred to the less worn-out surface. As I was getting a lot of benefit from vitamin B12 injections and didn't want to be bandy or knock kneed. I refused. Two years ago I explained I was drawing synovial fluid out from he Bursa behind my left knee which I did when it became stiff. This was every week or more. As I was in effect flushing the synovial through at a rate of five to ten ccs a week it was doing good. January I saw him again, and he was looking at five year old x-rays, and said he'd recommend having half knee replacement. Though agreed the B12 was a good idea, the bursa is still visible but I don't need to draw anything out of it as the stiffness and pain is much better than it was . I refused the knee surgery again, and will see him again when I'm 69 or 70 years old.

[Little-runner in reply to jointpain]

Hey JP, thanks for your message. How frustrating that those arthroscopies didn't help you! I've not heard of B12 injections, I shall look that up with intrigue. Surgery is a big decision and I'm currently an outpatient with a spinal clinic as a disk in my spine has deteriorated causing me sciatic pain, but I keep putting off surgery until the pain gets really really bad. Good luck with your knee journey!

[Batty1]

Draining is only good if you have water on the knee but it’s just temporary it doesn’t address the underlying issues …. You have arthritis of the knee or another meniscus tear and the swelling is inflammation … steroid injections help again temporarily and in my opinion isn’t something you should do often because they can cause tendon damage over time …. I say wear a sleeve when your out hiking or walking distance and if you run I would probably give that up … The reason doctors don’t want you using sleeves is because it can cause muscle weakness around knee area if used it 24/7 but its not going to harm you to use it while hiking or walking distance …. Reduce your pack load if you possible .

[Little-runner in reply to Batty1]

Hey Batty1, thanks for your message and information about draining. It all makes sense really and it's not as black and white as I'd like it to be! (ie if it's swollen - drain it to fix it).

I think I will wear knee sleeves when doing activities as they instantly provide support and makes my knee feel so much better.

Good tip about reducing the pack load! I'll just offload everything to the husband, I'm sure he won't mind! 😆

[Batty1 in reply to Little-runner]

Also if you don’t already use hiking sticks you should these will help you with balance and help keep some of the pressure off your knees.

I do refer to my hubby as my pack mule

[Kneesandtoes]

I cut out added sugar and white flour about a year ago and my joints have improved. Apparently insulin prevents the cartilage from taking up nutrients. I did not have anything like the problems you have though.