Patella Femoral pain VS MRI scan results VS ice

My knee utterly broke in July 2013, it had been wrong for 12 months before that and the medical profession’s stock answer had been that it is patella femoral joint issues (aka runner’s knee) and that I should rest it, dice it and elevate it.

After this many months I am beginning to lose my good humour and I am getting rather ‘eager’ to have someone with half a brain suggest an actual fix.

ice - arctic - guardian

(Photo from the guardian – ice)

The private physiotherapist took under 10 minutes to say that it was a tracking problems of the patella femoral joint and it seemed a believable conclusion as the knee cap was so stiff that it couldn’t easily move – even when manually pushed!

The treatment was £1 a minute and it got results initially – my knee certainly seemed to like the diathermy machine, the ultrasound seemed to reduce the swelling and the stretching exercises seemed to be a good idea. However after a few months there wasn’t any change in the treatment and asking for strengthening exercises (as oppose to just stretching ones) didn’t get a positive response. It started to feel like they wanted to keep me coming back by taking away the symptoms but not treating the cause.

Several months later the NHS physiotherapist didn’t disagree with the tracking diagnosis, although they did express concerns about the pain areas were what they would expect to cartilage damage. However on the letter back to my doctor they specifically said to get a MRI scan for a menisci ligament. They gave me a handful of basic strengthening exercises but didn’t seem overly interested in treating the pain side of it – the nearest they came to ultrasound or diathermy was they stuck a heat lamp on it at one point.

ice - telegraph

(Photo from Telegraph – ice ice)

For the sake of completion; the chiropractor seemed a bit of a quack said it couldn’t be a tracking problem – whilst yanking my knee joint backwards. So we will ignore him entirely.

It was concluded by the second physio clinic that I have weakness in the Vastus Medialis Obliquos (VMO), which is one of a rather useful set of muscles that help stablise the patella – including its tracking. So I knew that I need to continue to build these up regardless of the MRI result.

However I was expecting the MRI result to be helpful and something that my doctor could comprehend – this was not the case. I was already under-impressed that the results were going to my doctor and that I would have to bug them for the results, but I did and found that they a) hadn’t bothered looking at them, b) didn’t understand them in the slightest and c) couldn’t work out who to refer me to.

baby - telegraph

(Photo from Telegraph– ice ice baby)

The report was written using the biggest words imaginable and was supremely unhelpful even after I used Google to translate it – for example the report concluding that “…suggest underlying patellofemoraldyfsunction”. Strictly speaking they should have said “patellofemoral dysfunction “and given that directly translates as “bad knee” I don’t think that is a particularly helpful statement!

However it wasn’t all a waste of time as the MRI did reveal was that I have patella alta, aka the high riding patella. In English this means that my knee cap is rather higher up my leg than would be nice. However there doesn’t seem to be a way to correct this so good to be aware of but is of limited real use.

Someone I work with has a ladyfriend who is an NHS physio – although most of the stories seem to involve her getting covered in some icky bodily fluid by confused old people. She kindly looked over the wibble provided by a Dr Hussain and has translated it in a way that I can understand – and that matches my Google-powered buzz-word bingo results.

fat pad pinching

(fat pad photo from hughston.com– really interesting read on the page too)

There are a few things of note, most of which the dude in radiology has decided aren’t part of THE problem so has barely mentioned, although I feel that the back of my knee cap having “change” present in the cartilage is something to be concerned about! This change also backs up a tracking issue as having been present – although I can guess that the cause of this might have been horribly inflamed internal knee tissue pushing the knee cap into the wrong place.

The conclusion is that some soft tissue might be getting caught between the joint, however the chap who formally wrote up the scan results didn’t explain what tissue nor does he suggest a course of action!

My current guess is it might be the infrapatellar fat pad (aka hoffa’s fat pad) which is a fatty pad filled with nerves that sits below my knee cap and behind my patella tendon. It basically acts as a shock absorber and doesn’t like being trapped between the femur and the patella. This injury likes rest, ice, elevation and some pressure. There is also some rather drastic sounding surgery – although all knee surgery seems pretty major!

However I am currently waiting for my doctor to find a specialist to refer me to, so I fear that I will acquire a short-term addiction to ice and bugging my doctor!

Copyright © WhereEvilThoughts 2014 – excluding pictures! Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Links may be used, provided that full and clear credit is given to WhereEvilThoughts with appropriate and specific direction to the original content.

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