Ask a doctor on the topic of Orthopedics

Severe pain in the lateral collateral ligament of the knee.

May 5, 2012 | 20,00 EUR | answered by Dr. med. Michael Schröter

Hello,
I am moderately desperate.
For 5 weeks now, I have been experiencing strong pain in the outer band of the calf muscle after overstretching it on a steep hill while walking.

Just as a note, I am not a sports runner.

Especially at night, it hurts a lot and I haven't been able to sleep properly for 3 weeks.

I have seen 3 orthopedists, had an MRI of the knee done, but the area that is causing the problems was not examined. The MRI only showed slight degenerative conditions in the knee. The initial interpretation by the MRI doctor mentioned that there were fine hairline cracks in the outer band, but this was not included in the final report.

So, I went to a rheumatologist, who, after 2 minutes of ultrasound, said that the outer band is watery, swollen (inflamed), and shows fine fissures. However, he said there is nothing to be done except rest.

Yesterday, I saw a good physiotherapist who also noticed a blockage in the fibula, but the pain remains unchanged after treatment.

The worst pain is when going downstairs, I can only do it with a stiff leg. Also, during certain activities, I have pain in the back of the thigh muscles, sometimes feeling like a slight cramp. When I completely rest in my apartment, the nights are more bearable, but I have been on sick leave for the third week now and nothing seems to be improving.

Night after night, I toss and turn, waking up because of the pain and it then becomes unbearable at the outer band and radiates out. Even during the day, moving without any weight, I experience stabbing pain. Walking completely straight is almost painless. I usually work in a kindergarten, constantly on my feet, up and down, children sitting on my lap, etc. This is not possible in my current condition.

I have tried using Voltaren gel, ibuprofen, ice packs, elevating my leg, and wearing a knee brace I had from before. At this point, I am not sure if it is only the outer band that is causing the pain, as it extends towards the back of the knee up to the thigh. I have weak ligaments, that's a known fact.

I want to be able to work again and walk at least somewhat comfortably. The orthopedist I saw shrugged his shoulders after the MRI (which only shows a minimal area under the knee) and said that it doesn't explain the pain, and that further investigation, such as ultrasound, is irrelevant.

What can I do to better support the outer band so that the inflammation heals, and what could be causing the pain in the back of the knee and thigh? I have considered tendons, but even if they were inflamed, what should I do? How many more weeks can I go without sufficient sleep?

Thank you for your help,
Best regards

Dr. med. Michael Schröter

Good morning,

You have already been examined from top to bottom. Thank God, you have no major defects in or around the knee. But what I understand from the described findings is that there is indeed a certain inflammation in the lateral ligament, which was clearly caused by incorrect/overloading. There may have been small fissures and swelling seen as markers of inflammation. Due to the protective posture and altered movement patterns, you are now experiencing pain in the surrounding tissues, such as the back of the knee/thigh. These are normal reactions of the body. And the pain at night is also a reaction to the altered and incorrect movement pattern. Conservative therapy with cooling, Voltaren creams, and a knee brace is recommended. Additionally, I recommend a consistent longer-lasting anti-inflammatory treatment with Voltaren (Diclofenac) or Ibuprofen in tablet form. You should also take a stomach protector (e.g. Omep) to protect the stomach lining.

This is one aspect, investigating the causes and treatment is another. As a second step, you definitely have a good opportunity with a physiotherapist to loosen or strengthen the surrounding "tense" structures. The question is, why did the overloading occur? My advice is for you to have a so-called "gait analysis" done. Visit an orthopedic specialty store and have yourself examined to see if you need insoles that support the correct structures in the knee and other joints while walking. Based on the footprint from below, it is determined how you step and where the main pressure is, where there may be incorrect pressure, and how to compensate for it. (I have had very good personal experiences with this). If all these conservative measures do not help, the possibility of looking inside the knee joint should certainly be considered, which is called knee arthroscopy. But first try the insoles.

I wish you a speedy recovery and some patience.

Sincerely,

Dr. Schröter