Pain and swelling in an unstable knee

Patient

Q: I had a pain in the back of my knee for about a day and then it began to swell and had some warmth to it. I took Aleve and elevated it. It went down that day but when ever I climb stairs or walk and stand for long periods, it is unstable. Do I have a torn ligament or muscle?

Thanks in advance

Doctor

A:   According to your description and with no history of knee trauma, it is important to rule out any infectious, metabolic or degenerative process, also determine if this is the first episode of such symptoms or you have had more in the past. The other important process to rule out is the Patello Femoral Syndrome. Knee pain is the most common presentation of patellofemoral syndrome in young and active people. The pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (ei, during squats, ascending/descending stairs or pendants). Pain may be worsen by sitting with the knee flexed for a long period of time, such as while watching a movie, hence leading to the terms theatre sign and movie-goer's knee. The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint.The suggested strategy for conservative treatment should be as follows: Physical therapy program (exercises and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory drugs (i.e.: Aleve, Advil), education of the patient so he/she understands which activities avoid because those can aggravate patellofemoral syndrome.Also,and very important, remark the need for extended adherence to the exercise regimen. The patient's physical therapist should educate the patient about a home exercise program Allow time for these conservative measures (ie: exercise program) to have an effect in patients with patellofemoral syndrome, usually 4-6 weeks is adequate for some resolution of symptoms.

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