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Pain following injury to the knee.

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Hello Doctor, I am writing in regards to my 17 year old son who presents with painful knees that seem to have a buildup of fluid. (There is a "squishy" area under the patella, and his knee appears slightly swollen.) His dominant side (right) knee is hurting more. This has gotten progressively worse over the last few days to the point where he is having difficulty walking/bending at the knee and the knees feel very stiff. He also is complaining of a feeling of the knees not getting enough circulation and being cold. He does not feel he can find a comfortable way of sitting/laying down.

This has happened once before, and it took about 2-3 weeks for the symptoms to slowly subside.He was not taking any medications at this time nor did he have any other symptoms.
A doctor examined him and said that there seemed to be fluid there but that it wasn't necessarily the best thing to drain it. My son has a bleeding disorder (Von Willebrands, mild) so I did not want to do this procedure unless it was certain to aid recovery.

He is 6'4, approximately 135 pounds and is not currently active in any type of sports, I would say he is fairly inactive. He is not complaining of any other symptoms anywhere else in his body (such as headaches or fever). He has no previously existing conditions besides the Von Willebrands which has not been a problem before. He does not regularly take any medication on a daily basis-however, about 2-3 weeks ago he started on Vitamin D3 Oral (I believe 10 ml per day/5 drops) for a Vitamin D deficiency (for a 6 week period).

Should he be seen in person by his doctor or would it be best to just rest and ice it?


Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello,
Welcome at Doctorspring.
I have read your with due diligence.
Will you please answer me some questions,so that I can help you better.

A.Is there any presence of morning stiffness in his knee and other joints?
B.Does work/exercise aggravates or relieves his problem?
C.Is there any history of locking sensation at his knee?
4. Does he have pain in any other joints ?

Please reply as a followup
Thank you


Patient replied :

Yes he has morning stiffness. (This is not normal for him otherwise.)
Work does make the pain worse (Though right now it hurts no matter what he does)
No history of locking at the knee.
No pain elsewhere.


Expert:  Dr. Mukesh Tiwari replied 3 Days.

Thanks for information.

From the details it is likely that he may be suffering from synovitis. This an inflammation of the lining of knee joint which is generally found in Von Willebrands disease.At present he may benefit from the use of a mild analgesic & anti inflammatory agent.One can have them before draining the knee. You can give him the OTC drug Ibuprofen.
If there is locking sensation(which is present at his posterior part of knee) then he should have a MRI investigation to rule out meniscus injury.Depending on the report of the MRI treatment plan can be decided. .

You can get back to me with the MRI report.
Hope this has helped.
Thankyou


Dr. Mukesh Tiwari
Category: Spine Surgeon
Experience: 
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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