Tendonitis like pain in multiple joint

[Anagha_r]

Hi,

I have had multiple tendonitis-like symptoms in both elbows and both knees.

A bit of background - I'm a 26 year old female who was morbidly obese for most part of my life. At 22, weighed around 95kilos and thats when I started on a weightloss journey through a calorie deficit diet along with brisk walking for 7kms daily. Managed to reduce 30 kgs of bodyweight over a period of 1.5 years, aiming for 0.5 kg reduction every week. I felt very healthy, fit and over the moon, never looked better in my life. But by the end of this journey, i started having pain below the knee cap bilaterally, it was diagnosed as knee fat pad impingement. I did some PT and symptoms got better and I started brisk walking again after 4 months, but it would occasionally hang around, especially after standing for long.

3 years later, I gained 4 kgs and tried to lose it using the same technique that I used the first time around. Only this time I tried to do a few basic dumbbell exercises (3kg) for 3-4 weeks along with a lot more brisk walking. This time I also included more protein in my diet. I lost those 4 kgs in 3 month. All of this with mild pain along the patellar tendon, but not enough to stop me from exercising.

A month later, my knee pain got so severe that I was unable to do anything pain free, sit, lie down, walk even for a few mins.But There has been no loss of functionality in my limbs so far. I now have the following pains, all playing musical chairs with me on a daily basis

1. Pain on either side of patella on both knees and along the patellar tendon.

2. Pain right above the patella, and quadracep muscle pain. MRI says no sign of tendinitis, but mild fat pad inflammation. Went to a dozen orthopedics with all of them telling me, its a normal MRI. Tried stretching hamstrings, quads and calves for 2 months and PT, but no significant improvement.

( I also have a little bit of patella alta and mild knock knees. The only thing doctors diagnosed was that this misalignment of my knee along with overuse is causing pain. But it just doesn't seem to go away even after rest and PT. )

3. Tricep tendonitis like symptoms - constant nagging near the back of the elbows and tricep pain.Here again no loss of function or strength, but i occasionally feel a little bit of weakness especially while typing on my computer with no elbow support. Again MRI was negative and only said mild joint effusion.

4. Neck pain which refuses to go away despite trying multiple sleeping positions and pillows. Never had neck pain before. MRI says mild disc bulge at C5-C6 and C6-C7. Doctors say such minor bulges are there in 8/10 ppl and there's nothing to worry about and that my tricep pain is unrelated to neck pain. ( Not cervical radiculopathy)

5. Mild pain on the outer hip muscles which increases on sitting for long periods.

6. Occasional dull aches in both wrists and ankles near the achilles tendon, but not constant like the knee or tricep pain.

7. Loud Cracking sounds coming from ankles, elbows, shoulders and knees very frequently even though I'm active through the day.

8. 8 years ago, when I was a teen I was diagnosed with a disc bulge in the spine at L4-L5, severely pinching the sciatic nerve. I suffered through this pain for 3 years while in school sitting for long periods of time, got so used to the the pain, I had almost accepted it as part of my body. Finally got a discectomy surgery done back then and the sciatic pain has been gone since 8 years. But there is still some mild disc degenration at L4-L5 and L3-L4, which causes occasional flare ups which are very painfull. I dont have any radiating pain in the legs now.

I have known what pain feels like and certainly not someone who overplays my pain. My real frustration comes from the fact I have had doctors telling me that I don't have any issues, and that I'm just over reacting or my brain is presuming pain, but I really am in constant pain in multiple areas hampering my daily routine every single day in the last 4 months. When the pain is extreme , I get severely nauseous too. Also when one the pains for example knee pain is extremly severe, I can almost always not feel pain/negligible pain in elbows, neck or hips. Maybe its just the body's way of dealing with pain.

I also consulted a few rhematologists to rule out autoimmune diseases, got all the necessary parameters tested. Most tests ( RA factor, Anti CCP, HLA B27) came out negative except slightly elevated ESR and CRP levels, but after examination of my joints, all doctors cleared me of any autoimmune disorders. I have no other symptoms of RA like fever, or visible swelling of joints. No redness also. And no genetic history of autoimune disorders in the family. Doctors also ruled me out of fibromyalgia since I dont have pain in all the sensitive points clinical of fibro, no digestive issues or headaches.

I got my blood tests done for deficiencies and found out I was low on VItamin C and D. Took supplements for these along with collagen supplement for 2 months along with following a balanced diet and yet no sign of improvement.

I have tried doing a lot of research to get to the bottom of these problems, did everything in my control - met many doctors, did PT, fix my nutrition, stay positive, did so many tests and imaging. I thought there must be some muscle imbalance in my limbs since I lost a lot of weight causing tendon issues and tried to do some strength testing exercises like the single leg glute bridge. I seemed to be doing okay and I'm very flexible in most things. After all this I still find myself not in any better situation.

When I lost those 30 kgs, I felt I started a new life and it changed me for better on so many ways. But now, I feel like an old person with so many pains and not being able to do things by myself pain free. I feel down mentally not just because of the pain but also because of being unable to find the root cause and fix it. I just want to live a normal healthy life and get back on track.

I'm not sure why so many tendons seem to be painful bilaterally. I believe tendon injuries are caused by overuse and can be age related, but I'm not sure if I have overused so many of my tendons, especially triceps/hips/neck.I never went to the gym and did heavy weight training. Can this be a systemic tendon issue?At this point I'm not even sure if they are tendon related or anything else.

Also why is nothing showing on imaging?

Sorry for the really long post, but it would really help if anyone has ever experienced similar things and shared it here. Thanks in advance.

[Fruitandnutcase]

‘ My real frustration comes from the fact I have had doctors telling me that I don't have any issues, and that I'm just over reacting or my brain is presuming pain,’

I really sympathise with you and what you are up against, it is frustrating and depressing when your doctors don’t seem to take you seriously.

You have done extremely well losing so much weight, that ought to be helping your body feel better and you must be feeling very proud of yourself which makes still being in pan even worse.

Could it be yur thyroid? Have you had your thyroid tested if so what were your results? If not it might be worth having a complete thyroid panel done as well as checking out vitamins D3, B12, ferritin, folates. Have a look at ThyroidUK on Healthunlocked too.

I would say that from experience doctors tend to say ‘Your results are fine’ when they mean they come within the lab range. However lab ranges seem to be quite wide and you may not be at a point that is optimal for you.

Hopefully someone can come along and give you more advice related to rheumatic disease and pain.

[Anagha_r in reply to Fruitandnutcase]

Hi Thank you for your words. I did get my thyroid levels tested and they came out normal. I have had no other hormonal issues related to my menses too. But I will get my D3, B12, ferritin, folates tested to check for deficiencies. Hope something comes of it.

[Fruitandnutcase in reply to Anagha_r]

‘Normal’ to doctors can mean anywhere within the range - which is enormous- it could be normal for the doctor or his receptionist or the cleaner but might not be optimal for you.

[stbernhard]

Good morning. When I don't listen to my body and exercise too much, I get tendon pain and it takes time to heal. My RA started in the knees, so the large tendons in the legs are particularly sensitive. Maybe you have over exercised and your body is telling you to tone it down a bit? I'm just starting to do upper body strength training again after an inforced period of abstinence. I made it very clear to my personal trainer that my body is different and it will be a very slow process and I won't be pushed beyond what I think I'd reasonable. I know how frustrating and debilitating your pain is, but maybe you need to take a step back. My very best wishes to you.

Ps this advice is solely based on my experience, so I may well be completely wrong. I hope you will find a solution.

[Anagha_r in reply to stbernhard]

Hi, thank you. Yes, I did exercise a lot despite my body telling me to tone it down. But I have stopped exercising since the last 3 months ( still active though) and given it adequate rest. At this point I'm not even sure if it really could be auto immune or something else. Hope I find the right track of treatment soon.

[CallMeSunny]

Perhaps an appointment with a neurologist might be helpful? Good luck to you; I’m sorry this is happening to you particularly as you appear to be on “the right path” now.

[Anagha_r in reply to CallMeSunny]

Yes, I did consult a couple of neurologists, they gave me a few nerve relaxants for a month, but that didn't really do any difference. Thanks for the suggestion though!

[MissMinto]

Hello Anagha_r,

You sound wonderfully proactive so I can completely understand your frustration at not being able to make sense of things and move forward.

Firstly, two months is not long in terms of the vitamin and collagen supplementation, I would try longer. What type of collagen did you use as there are many types and all are not equal.

My first instinct was to suggest seeing a nutritionist/Functional Medicine practitioner to rule out any aggravating intolerances and look closely at your diet to see if you have any other deficiencies and to see what kind of fats you consume - ghee/butter much better for you than vegetable/seed oils etc.

I’d also try including bone broth daily into your diet (ideally from grass fed animals) as this, along with collagen is a terrific aid for soft tissue/joint/cartilage health.

A nutritionist would also be able to consider the state of your gut microbiome to eliminate leaky gut syndrome because I know from personal experience it can cause havoc.

Finally, has anyone considered/ruled out the possibility that you might have EDS (Ehlers-Danlos Syndrome)? EDS is a group of rare inherited conditions that affect connective tissue including tendons and ligaments. My friend’s daughter has this which is why it came to mind. It’s a complex condition, there are 13 different types) and for many years little was known about it in the UK. I notice you’re in India so I’m not sure what the situation is there but this site might be a starting point: nhs.uk/conditions/ehlers-da...

Good luck in your quest, I hope you get some answers and relief from your symptoms 💐