Ask the Doctor: My x-rays were clear but the knee pain is unbearable. What could it be?

Question: I am an avid gardener in my late 50’s but recently have been unable to do anything due to knee pain. I’m very slim and active and my GP sent me for an x-ray, which was normal. I use knee pads in the garden and always have. Do you have any ideas what it could be? I feel I cannot go back to my GP as he was dismissive after the x-rays and I would like advice on further testing.

dr Grant answers: It’s great news that the x-rays of the knee were back to normal. This means that it is highly unlikely that you have sustained a significant fracture and that you do not have a significant degree of arthritis.

The cause of your knee pain is most likely due to the repetitive strain you put on them while gardening. The most common cause of knee pain (with or without slight swelling in the front of the knee) from prolonged kneeling is prepatellar bursitis (PPB), also known as maid’s knee.

A bursa is a small, fluid-filled sac that sits between bone (in this case, the patellar bone or kneecap) and surrounding soft tissue, tendons, or muscle. There are about 160 bursae in the adult body, found around joints or where ligaments and tendons cross bones. The role of the bursa is to reduce friction and allow maximum range of motion around the joint. One of the most common causes of hip pain is bursitis.

Five bursae protect the knee joint. They are all susceptible to the inflammation that leads to bursitis, but the bursa just in front of the kneecap is the one affected in PPB.

The prognosis in PPB is generally very good unless there is an underlying secondary cause of the pain, such as B. a joint infection or an inflammatory disease such. B. rheumatoid arthritis. Rarely does gout or pseudogout cause bursitis – it may be considered especially if there is a family history.

With simple PPB, plenty of rest, some anti-inflammatory medication, application of ice, and elevating the knee as much as possible will result in complete resolution of knee pain and swelling within about a week.

There’s a lot you can do to reduce bursitis recurrence, and most of it is common sense. Stretch and warm up the muscles for about 20 minutes before you start gardening. A simple walk or a gentle yoga class will do this for you.

Be sure to strengthen the muscles surrounding the knee joint as much as possible. Some strength training a few days a week helps to protect the knee joint in the long term. Weighted squats, lunges, and even using a jump rope improve muscle strength.

When gardening, take regular breaks and change position as often as possible to avoid repetitive strain injuries. You may also consider seeing a physical therapist for a full evaluation and further recommendations.

If an X-ray cannot detect an underlying problem with a joint, the next obvious exam is usually an MRI scan, as it can detect bone infection, fluid buildup, or damage to the cartilage, meniscus, ligaments, tendons, etc. muscle. Small bone fractures or early arthritis changes that aren’t apparent on plain X-rays are often detected on an MRI scan. If any problems are identified, you may be referred to an orthopedic surgeon.

dr Jennifer Grant is a GP at Beacon HealthCheck Ask the Doctor: My x-rays were clear but the knee pain is unbearable. What could it be?

Fry Electronics Team

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