Injured patella in a marathon runner

Patient

Q: I received a severe blunt blow to my shin yesterday. At about the place where the petalla tendon attaches to the shin I immediatly had swelling a small hard lump appeared about the size of a quarter. Now the pain is mostly confined to the very tip of the knee cap. My entire leg is sore from just above the ankle to halfway up my thigh, but concentrated in the pettella. I hurts just to touch the tip of the knee cap. I can't lift or straighten my leg (i have had pettella tendinitis years ago and it is very simliar to that only worse). I am 46 year old male, run marathons and iron-man triathlons and am concerned i may have fractured my tibia or done something to the petella. Don't have health insurance and am wondering if i need to break down and spend the money to have this looked at.

Doctor

A:   Patellar injury, fracture and dislocation are more prevalent in individuals who participate in certain sports and activities as you. Anterior knee pain is the most common initial manifestation, along with the limitation to flexion extension movements as you described. I strongly recommend, in the view of your history of a precedent traumatism in the area, that you get an evaluation: clinical and imaging (X-rays, MRI) to determine exactly the nature and extension of the lesion and in that way decide the best treatment option for you.

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