Friday, August 20, 2010

The knee diagnosis.

I had to get to the bottom of this reoccuring left knee annoyance. This is what slowed me down during Marine Corp last year, so it was instant worry when I began to feel the same signs and symptoms last week.
With no running x 3 days, pool running, ice, and NSIAD's the knee is much happier currently. I was able to run 9 min paced-3 miler on Monday, 6 miler at same pace on Tuesday. ( I had decided to skip track even though the knee was feeling good.I didn't want to push my luck.) I still iced for precaution after each run, though the knee did not feel bad during the runs...and I will continue to do so from here on out to race day.

I did end up heading to the Ortho Doc on Thursday to get to the bottom of this. I wanted to make sure it was nothing that would hold me back from Chicago, or slow me down during Chicago. ( or worse cause an even worse injury to happen).
After some x-rays, and range of motion check, the doc came to a conclusion. Plica syndrome! What?...Doc says it's rare; he only gets 1-2 cases of it in a year! Imagine my worry when he said that to me! :) lol
Below is an explaination of Plica. I have never heard of this before, and had to do what I tell my patients not to do...I googled it.:)

What is plica syndrome of the knee?
The plica on the inner side of the knee, called the "medial plica," is the synovial tissue most prone to irritation and injury. When the knee is bent, the plica is exposed to direct injury, and it may also be injured in overuse syndromes. When the plica becomes irritated and inflamed, the condition called "plica syndrome" results.

Often called "synovial plica syndrome," this is a condition that is the result of a remnant of fetal tissue in the knee. The synovial plica are membranes that separate the knee into compartments during fetal development. These plica normally diminish in size during the second trimester of fetal development. In adults, they exist as sleeves of tissue called "synovial folds," or plica. In some individuals, the synovial plica is more prominent and prone to irritation.

How is plica syndrome diagnosed?
Diagnosis is made by physical examination or at the time of arthroscopic surgery. Plica syndrome has similar characteristics to meniscal tears and patellar tendonitis, and these may be confused. A MRI may be done, but it is often not terribly helpful in the diagnosis of plica syndrome.

"What is the treatment for plica syndrome?
Plica are synovial membranes that separate the knee joint into compartments during fetal development. Problems arise when the plica fail to diminish in size and cause irritation to the knee joint later in life. A plica on the medial (inside) of the knee is most prone to injury/irritation due to repetitive movements such as running and may be commonly misdiagnosed as a meniscus tear or patellar tendonitis.

Symptomatic plica syndrome is best treated by resting the knee joint and anti-inflammatory medications. These measures are usually sufficient to allow the inflammation to settle down. Occasionally, an injection of cortisone in to the knee will be helpful.

If these measures do not alleviate the symptoms, then surgical removal of the plica may be necessary. This surgical procedure is performed using an arthroscope, or a small camera, that is inserted into the knee along with instruments to remove the inflamed tissue. The arthroscopic plica resection has good results assuming the plica is the cause of the symptoms. Often a plica is seen on arthroscopic examination. Unless symptoms are consistent with plica syndrome and the plica looks inflamed and irritated, the plica is usually left alone. Plica resection during arthroscopy is only performed if the plica is thought to be the cause of symptoms." Thank you

Basically I was instructed to continue doing what I have been. I can run, but add in cross training. ( I plan to pool run at least 2 times a week, in place of running), ice, ibuprofen,and stretch! ( guilty of not being consistant on that) I have to listen to my body, but I can continue to train, run, and more inportantly race Chicago!
Dr. Smink wants me back in 3-4 weeks if the annoyance does not subside. At that time he would give me a cortisone shot...but I am feeling good, so I am guessing, and hoping, I will not need that.
It feel good to know what is going on, finally!

1 comment:

  1. I love all of the details in this post. And, even more, love that your knee is ok!