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Patella subluxation for past few months. Burning pain and swelling above knee.

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  • Patella subluxation for past few months. Burning pain and swelling above knee.

    Hi,
    I didn't have any injury. I started a walking routine in the month if August in the steep hilly roads. I did it for a month. the knee pain started in September. It started like burning pain above the kneecap. after a month, i see some swelling above the right kneecap. then i went to an ortho doctor in october. they did an xray and ordered an mri. the first MRI didn't cover the area properly. the area above the kneecap. But the ortho didn't want me to redo the MRI as there was no much issue other than PFPS. She told me to start PT and prescribed voltaren gel for topical application for the swelling. She said it can be done inflammation.
    I started PT and it's been 6 weeks. There is no improvement in the symptoms. Its the same. I still have the burning pain above the knee. the swelling is the same too. So, i did contact there doctor and she told me to take MRI for the area which is not covered in the first time.
    I did MRI second time to cover that area. doctor told me ti continue the PT. Its been 6 weeks of PT, i really don't see any improvement.
    How long does it take for patella subluxation to heal? what to do for the recovery?
    My MRI:
    first mri:

    Findings/conclusion:

    1. Anterior compartment: Mild lateral patellar subluxation is present with no patellar tilt. There is developmental prominence of the lateral trochlear ridge. The trochlear groove tibial tubercle distance is within normal measuring 1.4 centimeter. The quadriceps and patellar tendons and retinacula are intact. The patellar tendon is congenitally elongated with high patellar position (patella Alta). There is no evidence of fatty impingement.

    2. Fluid collections: No sizable knee joint effusion or popliteal cyst.

    3. Ligaments/tendons: The cruciate and collateral ligaments are intact. The popliteus tendon and iliotibial band are intact.

    4. Medial meniscus: No tear is identified.

    5. Lateral meniscus: No tear is identified.

    6. Osseous/articular: No arthropathy, osteochondral defect, stress fracture, or suspicious bone lesion. An incidental small subcortical benign bone lesion is present in the medial tibial metaphysis which may represent an old nonossifying fibroma or bone island.

    7. Other: Superficial varices are present in the posterior medial subcutaneous soft tissues.

    second MRI:

    Markers have been placed over the distal quadriceps tendon and superior patella to indicate
    the site of clinical concern. No soft tissue mass, hematoma, or localized inflammatory process is seen
    in this region. Specifically, there is no evidence of inflammation involving the pre femoral or quadriceps
    fat pads which lie above the patella. The quadriceps tendon appears normal with no evidence of
    tendinopathy. There is mild lateral patellar subluxation, a congenitally prominent lateral trochlear ridge,
    mild chondromalacia patella, and a developmentally high patellar tendon (patella Alta) which likely serve
    as the etiology for the suprapatellar pain, per provided history.

    any input is appreciated. how long does it take to heal and recover from this? what to do for this? How many more weeks of PT is needed for this?

  • #2
    Hi, sorry to hear you've been experiencing some issues with your knee. Based on the imaging findings it's hard to make a lot of recommendations since "patellar subluxation" seems to be referring to the position of your patellar at rest, which is different than an actual patellar subluxation/dislocation that occurs with an acute injury/mechanism during movement. These findings may not represent a recent change in your structure. Beyond that, tendinopathy is not typically diagnosed via MRI findings, but rather by symptom presentation clinically, which is more along with what you're describing. I would ask from here, what kind of activities seem to be limited by your symptoms and what has your physical therapy treatment looked like over the last 6 weeks?

    Comment


    • #3
      Originally posted by MikeAmato View Post
      Hi, sorry to hear you've been experiencing some issues with your knee. Based on the imaging findings it's hard to make a lot of recommendations since "patellar subluxation" seems to be referring to the position of your patellar at rest, which is different than an actual patellar subluxation/dislocation that occurs with an acute injury/mechanism during movement. These findings may not represent a recent change in your structure. Beyond that, tendinopathy is not typically diagnosed via MRI findings, but rather by symptom presentation clinically, which is more along with what you're describing. I would ask from here, what kind of activities seem to be limited by your symptoms and what has your physical therapy treatment looked like over the last 6 weeks?
      Thanks for the reply.
      PT treatment is only focusing on the strength of the hip and knee. It doesn't help me in the burning pain and the swelling above my knee.
      My PT wants me to try dry needling for this. I haven't tried it yet. I am not sure if it really helps me.
      I am not able to keep my leg straight while lying down. It gives me burning pain and also, when I sit in a chair.
      The burning pain and swelling is there for past 4 and a half months. No proper solution given by the doctors.
      I have to try dry needling and see.
      Anyone knows about dry needling? Did it help you?

      Comment


      • #4
        I normally don't recommend dry needling for any specific diagnosis, especially tendon related pain. Focusing on knee and hip strength can be helpful in both the short and long term. What specifically have you been doing in terms of "strengthening", since that can be a wide range of exercises and prescription?

        Comment


        • #5
          Originally posted by MikeAmato View Post
          I normally don't recommend dry needling for any specific diagnosis, especially tendon related pain. Focusing on knee and hip strength can be helpful in both the short and long term. What specifically have you been doing in terms of "strengthening", since that can be a wide range of exercises and prescription?
          Thanks for replying!!
          I did 2 sessions of dry needling. That doesn't help too. I still have the burning pain and the swelling. I will get the pain whenever I sit, stretch my legs straight and stand. It pains throughout the day. I don't know what helps to recover from this.
          I have been given hip and knee strengthening exercises which I have to do everyday. It's a standard PT exercises only.
          I have few more sessions of dry needling. My pt says I need more sessions of dry needling. And pt is also not sure if dry needling would help me.

          Comment


          • #6
            Originally posted by MikeAmato View Post
            I normally don't recommend dry needling for any specific diagnosis, especially tendon related pain. Focusing on knee and hip strength can be helpful in both the short and long term. What specifically have you been doing in terms of "strengthening", since that can be a wide range of exercises and prescription?
            My PT keeps changing the home exercises. She used to remove the exercises which is very difficult for me or it hurts more.
            Currently I have the following exercises. Now, few exercises are added for my hands too. I have some issues going on left hand. Shoulder ,elbow and wrist joints.
            Glute bridge with ball squeeze
            Hip abduction
            Standing hip abduction
            Isometric hip extension ,ball
            Hamstring and calf stretch
            Hip addiction
            Stretching piriformis
            Beginner dead bug
            Stretching upper tap
            Wrist eXtensor stretching
            Scrapular Retraction
            Knee flexion
            Seated hip flexion
            Alternate heel tap
            Stabilization Superman
            Side step with band
            Band pull apart

            Comment

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