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Undiagnosed knee pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by airamasor, May 10, 2011.

  1. airamasor

    airamasor Active Member


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    Hi, I am a bit lost with one of my patients and I was hoping for some help.

    This 30yo male suffers with excruciating Right knee pain since august last year at the back of lateral aspect of knee. Pt can pin point pain clearly. Also reports very mild tingling sensation that it's a warning before the pain strikes. No injury in that knee. Rupture of ACL and meniscus left knee years ago, otherwise fit and well.


    Worse at night, no swelling, bruising or heat. Stabbing pain for 5-10 seconds in the same spot. The pain does not irradiate / move. When pain strikes, no movement settles the pain. No restriction of movement either. No locking or giving way of the knee noted on examination. No idea of what triggers pain. it does not affect walking.


    on examination: No TOP. No ligament or meniscus problems. Normal ROM. Patella mob and joint line fine. SLR and PKB fine, hips fine, slightly tight H/S bilaterally. No TOP lumbar spine.
    Short hamstrings, bilateral, since childhood. Has done plenty exercises

    Resting will worsen pain, but exercise during pain won't improve symptoms. Pt reports multiple episodes a day and then can be pain free for few days to 6 weeks. Loud clicking of R ankle, by fibula attachment, noted on walking and when pt moves ankle around.

    Gait showed late resupination, early heel lift & subtalar joint medially deviated.
    Hallux limitus R>L . Forefoot inversion and RCSP everted rearfoot.

    Any ideas???

    The physiotherapist and I are truly lost with this patient.

    Thanks in advance.
    Rosa
     
  2. Hi Rosa

    I would like to see if I can help but will need some more info -

    Pt can pin point pain clearly Great but back of lateral aspect of knee does not really help much.

    can you be more specific maybe a picture with an arrow where is hurts ?
     
  3. airamasor

    airamasor Active Member

    HI Mike, sorry for the lack of specific information.

    I would say it is the apex of the head of the fibula.
    Sorry I couldn't load a picture. I'll try tonight.

    Rosa
     
  4. Ok Rosa got some reading for you. From the info we have this is the first place I would start

    - We have Also reports very mild tingling sensation that it's a warning before the pain strikes - nerve

    - We have location - Head of the Fibula

    - We have - No injury in that knee. Rupture of ACL and meniscus left knee years ago, otherwise fit and well - change in gait perhaps ? ie more stress on the right side to compensate ?

    - We have - Loud clicking of R ankle, by fibula attachment, noted on walking and when pt moves ankle around. So maybe the fibula is moving due to ligament laxity distially causing compression of the common peronael nerve the proximal end - some may call this a subluxation of the Fibula.



    SYNOVIAL CYSTS ABOUT THE KNEE CAUSING PERONEAL NERVE PALSY

    Proximal Entrapments of the Lower Extremity

    Taken from said article -
    Peroneal Nerve Entrapment – A Case Study

    Hope that help Rosa but still a stab ( get it ) in the dark internet , not seeing the patient etc etc.
     
  5. airamasor

    airamasor Active Member

    Mike that was very helpful, thank you.

    I think what got me (and the physio) doubting was our inhability, or the patient's, to reproduce any symptoms. This however doesn't mean we tested the right thing!.

    I should investigate further when he comes back for his orthoses review. We did think that his biomechanics could have something to do with it.

    Thank you for the information, I really was lost, although when I read your posting, it made sense!!

    I'll keep you posted.
     
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