Dear Ask The Doctor: I have a large bump below my knee cap. I fell on stage during an opera rehearsal and cut up my knee pretty badly. They were bruised and bloody for a couple weeks. I'm in my late 20's and a dancer, so I figured they would heal--no problem. They didn't. My right knee pain continued for 6 weeks and I developed a large bump below my knee cap on the right side. I saw an internist--she didn't even look at it. Just told me it was tendonitis and gave me arthritis medication. This medication made no difference. It hurt to walk, dance, stand, and I couldn't kneel or bend the knee without pain. I started wearing a brace for about a month and it reduced the nerve pains that caused the problems with walking and standing. But the large bump is still there and it still hurts to the touch and to kneel and bend. I went to an orthopedic doctor who looked at an x-ray of the knee cap. There was no crack in the knee cap, thankfully, so he thought there wasn't anything wrong with it. I told him I didn't fall on the knee cap--he didn't believe me. I demonstrated my fall for him. Then he said it was soft tissue and gave me a cortisone shot in my knee cap. But, I feel really uneasy about the bump it is as hard as a bone. I just want someone to take the time to explain to me what the bump is. It is about a half inch raised and I'm really worried that if I ignore it for much longer (it's been 3 months) that I won't be able to dance anymore. My hmo doctors tend to ignore symptoms, not look at medical histories, and try to shove you out the door before you ask the questions. It took them a year to be willing to diagnose my stomach problems-which turned out to be celiac disease. Most of the time they refused to see me because they thought I was making it up. I just want a straight answer. Can someone tell me what they think it might be and explain what would cause a bump like that? My right knee is flat--in that area.
Dear Patient: Possibly you are experiencing a post traumatic bursitis, which is an inflammation of the knee bursa caused by repetitive use, trauma, infection, or systemic inflammatory disease, in your case, caused by trauma. Bursae are flattened sacs that serve as a protective buffer between bones and overlapping muscles (deep bursae) or between bones and tendons/skin (superficial bursae). These synovial-lined sacs are filled with minimal amounts of fluid to facilitate movement during muscle contraction. Deep bursae, such as the subacromial (shoulder) and iliopsoas (hip) bursae, are located in the fascia. Superficial bursae, such as the olecranon(elbow) and prepatellar bursae(knee), are located in the subcutaneous tissue. Symptoms of bursitis may include localized tenderness, swelling, redness, and/or reduced /limited movement. Most patients with bursitis are treated conservatively to reduce inflammation. Conservative treatment includes rest, cold and heat treatments, elevation, nonsteroidal anti-inflammatory medication (“Motrin”, “Aleve”), bursal aspiration, and intrabursal steroid injections (with or without local anesthetic agents).