Weird issue with my knee

[Red Squirrel]

The other day I woke up with a sore knee. I figured I just slept funny on it and it would go away. A week later it still feels the same way. It's not so much that it's sore, it just feels awkward, almost like the knee cap is loose or something, and it seems swollen. I cannot make my heal touch my butt, usually I can, but I can't anymore, it just locks. It also hurts if I force it. Also when I'm standing, if I stand in a way that feels natural, my foot is actually 45 degrees off. If I put it straight it feels unnatural.

Putting it the knee completely straight to stand up also feels awkward. I did not physically injure it or anything, I literally just woke up like this. If I put it straight such as when standing up, if I move the knee cap with my hand it moves, while the other knee it does not. Could it have popped out or something? Or would this be very painful? I'll probably go see a doctor, but it just seems weird something like this would happen overnight.

 

[SociallyChallenged]

Sounds like pretty straight forward patellofemoral joint dysfunction (knee cap). The position of your thigh/hip can affect the way muscles and ligaments pull on your knee cap. If you slept funny, I could see how it could get aggravated, swell up, and feel off. If it's bothering you enough to go to the doctor, get a prescription for physical therapy. What's happening to you is likely chrondromalacia patellae due to improper mobility of your kneecap. A PT can fix that and improve your movement patterns. The doctor will likely just prescribe antiinflammatories and have you come back in 4 weeks. I'd push for the PT prescription because it's something we see regularly and is typically pretty easy to treat.

 

[Red Squirrel]

I did indeed get antiinflammatories so I'll see how that works out. The doctor told me to try to keep it straight as well so I'll try that out. The nice thing with the anti inflamatories is that they have drowsiness as a side effect so hopefully I can fall asleep faster without tossing and turning. I always have trouble falling asleep, I'm always wired at the times when I should really be going to bed.

 

[SociallyChallenged]

I did indeed get antiinflammatories so I'll see how that works out. The doctor told me to try to keep it straight as well so I'll try that out. The nice thing with the anti inflamatories is that they have drowsiness as a side effect so hopefully I can fall asleep faster without tossing and turning. I always have trouble falling asleep, I'm always wired at the times when I should really be going to bed.

Antiinflammatories that make you drowsy? That's pretty uncommon, unless you got more powerful painkillers. Those meds aren't going to fix the condition long-term. Keeping the knee straight is great, but that doesn't affect the mobility of the knee cap, which is likely causing the problem in the first place. You'll likely get this again at some point. When you do, just ask for PT. Antiinflammatories almost always just treat the symptoms and not the cause.

 

[Red Squirrel]

It's Naproxen 275/20mg (not sure what those numbers mean, never seen /20 before, it says it on the pills too). The pharmacist warned me they would make me drowsy though I did not really feel any effects. I'll see how my night shifts go.

It's already feeling slightly better but still can't bend it all the way. I will look at PT if it does not go away, I've been wanting to make a general checkup appointment with my family doctor so I can probably see if it can be done at same time.

 

[SociallyChallenged]

It's Naproxen 275/20mg (not sure what those numbers mean, never seen /20 before, it says it on the pills too). The pharmacist warned me they would make me drowsy though I did not really feel any effects. I'll see how my night shifts go.

It's already feeling slightly better but still can't bend it all the way. I will look at PT if it does not go away, I've been wanting to make a general checkup appointment with my family doctor so I can probably see if it can be done at same time.

Naproxen/Naprosyn is prescription aleve. That is not a common side effect - honestly, I've never even seen that listed (and still haven't after more research). It may be reducing your pain (or other aches/pains) that may be resulting in better sleep.

 

[Red Squirrel]

Naproxen/Naprosyn is prescription aleve. That is not a common side effect - honestly, I've never even seen that listed (and still haven't after more research). It may be reducing your pain (or other aches/pains) that may be resulting in better sleep.

Could be the pharmacist was mistaken in saying that then. Like I said I did not actually feel drowsy when I took it.

Another thing, it feels more natural to have my foot at an angle than straight especially when walking. Should I be forcing it straight in order to help the knee heal or should I be leaving it how it feels natural? It does not hurt to force it, it just feels odd.

The doctor also told me to avoid stairs, I figured I should actually be trying to exercise it more, but guess I'll go by what he said.

 

[SociallyChallenged]

Could be the pharmacist was mistaken in saying that then. Like I said I did not actually feel drowsy when I took it.

Another thing, it feels more natural to have my foot at an angle than straight especially when walking. Should I be forcing it straight in order to help the knee heal or should I be leaving it how it feels natural? It does not hurt to force it, it just feels odd.

The doctor also told me to avoid stairs, I figured I should actually be trying to exercise it more, but guess I'll go by what he said.

The pharmacist could be right, as they are the expert in that field. I've just never heard that and suspect they maybe mixed it up with another drug.

To be perfectly honest, almost nobody walks with their foot straight forward. There's a reason for that. There can be differences in the angles of torsion at your hip joint, femur (thigh bone), tibia (shin bone), and even the ankle itself. It's silly for your doctor to tell you to walk with it straight, as you're trying to avoid symptoms by turning it out. This is one reason why I said to go visit a PT. They can measure the angle of your hip's torsion and can alleviate the kneecap immobility issue. Because of that, your knee will likely start to feel more natural in any position. I've frequently had patellofemoral pain patients describe what you're experience and it has alleviated with mobilization, strengthening, and neuromuscular re-training.

There is never a time that you should be told to avoid something without a plan to get you back to that activity. If stairs bother you, then yes, avoid them if you can in the meantime. If not, they're fine. Stairs are frequently aggravating to patellofemoral pain, but if you don't feel pain, you're fine. Like I said though, this is something that probably needs to be treated with physical, hands on interventions - not pharmacology alone.

 

[interchange]

They package some rx naproxen with esomeprazole to protect from ulcers. Naproxen can cause drowsiness/dizziness.

Regarding the issue in general I would always see a physician if this were the first time I had an effusion (fluid in the joint). Although the most likely cause is musculoskeletal you don't want to miss a septic knee or gout etc. SociallyChallenged will probably say that if it's something like that you would know but we see people every day who shrug off other symptoms and sometimes things are a bit more subtle. Granted the atot population is generally young, educated, and without significant health issues, but you can't make those assumptions.

 

[SociallyChallenged]

They package some rx naproxen with esomeprazole to protect from ulcers. Naproxen can cause drowsiness/dizziness.

Regarding the issue in general I would always see a physician if this were the first time I had an effusion (fluid in the joint). Although the most likely cause is musculoskeletal you don't want to miss a septic knee or gout etc. SociallyChallenged will probably say that if it's something like that you would know but we see people every day who shrug off other symptoms and sometimes things are a bit more subtle. Granted the atot population is generally young, educated, and without significant health issues, but you can't make those assumptions.

I don't disagree with you at all, but I will say that the likelihood is very low. He has a mechanical presentation that alleviates with rest, doesn't have cycles of flaring, etc. In addition, he hasn't expressed any other signs of infection, such as fever, malaise, etc. When working, I'm more than happy to refer back to a doctor when necessary, but I'll say that happens less than 30% of the time in active, healthy individuals. I mean, I've referred back to doctors for suspected gout/pseudogout, RA, potential pancoast tumor, etc. I definitely wouldn't say that either I or a patient would know if it were something more serious, but I would say that if the mechanical symptoms did not start to alleviate within 3-4 weeks of conservative care, I would refer back to the MD for imaging (especially to rule out something like osteoid osteoma, osteosarcoma, or multiple myeloma).

Granted, your logic behind seeing a doctor prior to PT is sound, but it is rare that a doctor does anything but write a prescription. I've had pts who go to the doctor, don't get examined, don't get imaging, and get diagnosed with something like calf when the pt presents with clear S1 radiculopathy. Nobody in either profession is perfect, but PT is up and coming with screening knowledge. I wouldn't hesitate to send someone to a doctor if their pain was 1) not alleviating in a timely manner, 2) presenting abnormally such that I could not rule in a specific tissue, 3) not mechanical pain (i.e. worse at night without mechanical reason, signs of intermittent claudication, etc).

 

[Red Squirrel]

Now it started to hurt too. I have one more night shift to go, then I'll be able to go to the ER to have it checked. I hate to do that for a non emergency but it's the fastest way to have someone truly look at it, and possibly get an Xray etc... Anything else requires an appointment that is months down the line and I cannot stand this any longer.

I really hope it's nothing serious, but I'm starting to wonder if it is. Like cartilage wearing out or something.

 

[SociallyChallenged]

Now it started to hurt too. I have one more night shift to go, then I'll be able to go to the ER to have it checked. I hate to do that for a non emergency but it's the fastest way to have someone truly look at it, and possibly get an Xray etc... Anything else requires an appointment that is months down the line and I cannot stand this any longer.

I really hope it's nothing serious, but I'm starting to wonder if it is. Like cartilage wearing out or something.

The ER isn't gonna treat you very well, IMHO. If you're not bleeding, dying, hurting a LOT, they may just x-ray you and send you on your way. The problem? Much like the heart, the body isn't a static structure. To learn about function, you don't take a picture of something, you analyze it as it moves. Chondromalacia patellae is not visible on x-ray, nor is patellar immobility. The doctors might give you more anti-inflammatories and tell you to rest it, but that's not a great option for you. Resting is almost always worse than guided activity. I mean, if you're gonna go that route, request a prescription for PT, find one in your area covered by your insurance, and go.

 

[Red Squirrel]

So just went to the ER today as I'm done my night shifts and I'll be off for a while, so I'll just stay up for the rest of the day and can go to bed tonight. BTW best time to go to ER is super early in the morning. 15-20 minutes and I saw the doctor.

I forget what the doctor said exactly, but the jist of it was that somehow the tishue under the knee cap was torn, or something to that extent. Vertice or something like that? I should have wrote it down. She got me setup with physio and I got an appointment for next Tuesday. So hopefully that goes well.

I'm just hoping that the root cause was some freak thing that wont happen again. Kind of bothers me that I have no idea what caused it and that I just woke up that way.