Dr. Hive: possible patellar (knee cap) subluxation (popped out and in again) what to do?

[Pen]

Ds age 13 has a swollen knee following nothing happening except that after moving from resting position he said it felt like it dislocated and later popped back into place by itself. Might have been related to running yesterday, but he says he did not fall or twist his leg.

 

Any thoughts for him for now, for avoiding reinjury, for other things that could have happened?  It turns out he says it feels often like it pops out and back in again, but has never hurt or gotten swollen before this.

 

He is currently resting with it somewhat elevated. It has not been iced, but did have a sports gel, which is somewhat cooling applied.

[Pen]

adding: he has a lot of popping and cracking from joints, a thumb that seems "double jointed," and he says he feels like his leg that has the swollen knee is longer than the other one and that that is part of the problem.

 

Anyone btdt?

[Seasider]

In our experience, pain continued with use, and there was swelling after overuse, so dd's doc referred to a orthopedic specialist. He ordered an MRI to make sure there was no permanent damage (ie, torn meniscus). She eventually had to have about 8 months of physical therapy, wore a knee brace and became experienced in taping that knee for support. The therapy was helpful in targeting areas that needed strengthening to provide better support to the knee.

[Robin M]

I had my knee dislocate several times over the years and it still will if someone hits me in the back of my knee or I flex,the wrong way. If his knee is totally dislocating and locks out, it will cause excruciating pain until it can be popped back in. Which is immediately or you are screaming on the floor until the leg is straightened. Btdt. Yes, there will be swelling. If it is just slipping, it is still painful but very temporary. If therapy doesn't strengthen the muscles and cartilage surrounding his knee, then surgery may possibly be need. Especially if he has torn ligaments. He really needs an X-ray to determine the condition of his knee. Keep icing and elevated. If still painful and hard to walk on, he needs to go to the doctor.

[Pen]

Thanks. I'll see how it looks when he wakes up and decide if he needs an urgicare or maybe ER if that would be better with more access to Xray etc. this morning or a scheduled appointment for whenever that can be.

[Jan in SC]

I wouldn't waste time at urgent care or the ER. If your son isn't fully grown, go to a pediatric orthopedist. I have a ds who has battled this for years. He has a patellar tracking issue. His knees would partially dislocate many times a week. It was very painful. We saw an orthopedic surgeon who told him to be patient and after puberty he would be strong enough for his leg muscle to control it.

 

That was a big mistake. The pediatric orthopedist realized that his muscle wasn't able to get bigger, so he did a simple lateral release in each knee and put him in PT for several months. It helped tremendously. His knees are much more stable, though every growth spurt requires more PT to maintain strength. He does wear knee braces, or he tapes it for competitive sports.

 

His knees might need major surgery when he's fully grown to correct the issue for good, but he is so much better. After surgery, the doctor said that he already had some arthritis in his knee, and he was 12 at the time.

[ktgrok]

Agreed that urgent care is a total waste of time. Er probably too. You need to see an orthopedist. In our area one of the big orhtopedic clinics has it's own walk in"convenient care" clinic. It's like urgent care but only for orthopedic stuff. Bonus is that means you aren't in a waiting room with people with strep and the flu!  But you really need a specialist. Kids joints are so different, and a regular run of the mill doctor at the urgent care won't be able to help and may cause more problems. 

[Only me]

My daughter (almost 21 but 13 when she started to have the problem) had a severe problem with this. Her knee would pop out constantly and it would be quite painful and she would have trouble walking. I would definitely recommend going to an orthopedic surgeon to have this evaluated. Usually it is a case of needing physical therapy to strengthen certain muscles but it's something that you would want to have taken care of since the more it pops out the more irritated it gets and then more swelling etc.

 

Unfortunately my daughter's situation was a lot more serious and rare. So I'm sure this would not pertain to your son but just something to think about if he does therapy and does not get better.

 

My daughter did several months of therapy and had her knees taped constantly to help keep them stable. Unfortunately it didn't help and got to a point where it would dislocate constantly and the same thing was starting to happen in her other knee because of gait problems caused by her other leg. We went to another orthopedic doctor and finally got answers. In her case her femur was over rotated and as she grew it got worse. She grew very fast. She is 5-9 1/2. Because her femur was rotated it didn't allow her knee to track correctly and caused it to constantly dislocate. That also changed her gait and caused her other knee to start having problems. She ended up having surgery to derotate her femur and that fixed her knee tracking. Like I said what she had was pretty rare and I doubt your son has this but it's something to keep in mind if other things don't work. I wish we knew earlier although she had to wait until her leg was done growing around 15 1/2. Btw, she is doing great now and even plays hockey.

[zoobie]

Pediatric orthopedist or possibly rheumatologist if he has any other symptoms of hypermobility.