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  1. #1
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    Lateral knee pain and popliteal tendon

    I've been stretching my hamstrings pretty good recently to try to aid with some medial knee pain issues I've been battling for awhile. I've always been very limited in one stretch (on the back with tube around ankle of affected leg, pulling leg back) because of a stinging/burning pain i get while doing on the lateral portion of my right knee, kind of where the ITB is, but not really - more towards the back of your knee and top of the calf. My therapist simply said tight outer hamstring that needs to be stretched. So I continued to stretch.

    About 2 weeks ago, I was doing the same hamstring stretch and simply went too far (i couldn't even go far to begin with on this leg) and felt a really bad sting. It hurt a lot, burned, and got a bit puffy on the lateral part of my knee. I iced, Vitamin I'd it, and it seemed to subside after a couple days. I've stayed away from that form of hamstring stretch since. Since then, my lateral knee gets very stiff and achy when my leg is straight - especially as I flex my VMO during other exercises, and at night when I sleep. I suspected ITB pain, so continued to roll my ITB's (which i do almost daily) and do stretching for them. Nothing seems to help. Occasionally it will twinge if I step the wrong way. Light jogging illicits ITB-like pain, but somehow different and not quite in the right place, especially on the downhill portion of a trail. It is quite painful to try to put my right leg into a figure 4 position (i.e., right ankle on left knee) - wowza - immediate lateral pain.

    I have skied since, and aside from achiness and tenderness afterwards, I had no issues with stability, etc. It does hurt quite a bit jogging (and I've had to stop mid-jog due to intense pain), so I've cut that out completely.

    Yesterday, coming back from a day on the mountain, I slipped on the fucking ice walking into a convenience store and went down awkwardly and twisted that knee. White trash couple in a beat up grand am laughed at me as they drove out of the parking lot. Fackers. Today, it feels much worse.

    Anyway, I did some reading online and found out about a link between the popliteal tendon and lateral knee pain. It sounds very similar to what I've been feeling, and I'm suspecting I may have torn it by over-stretching continuously for the past 3 months, and then aggravated it by my little spill to the joy of the WT yesterday.

    Any ideas?
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  2. #2
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    Do you have a torn lateral meniscus? I don't know if I would be able to recognize a problem with the popliteal tendon. This post is the first time I have ever heard of a problem with it, (28 years of orthopaedics) absent having to cut it doing a knee replacement, and repairing an avulsion in a massive lateral knee ligament tear.

  3. #3
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    drmark - don't know about the lateral meniscus. I had an MRI within the last year due to a bike crash and it did not show anything overly evident in terms of a tear in that area - just very deep bone bruising, but mostly concentrated on the medial femoral chondryl, with much more minor bruising on the lateral side.

    This problem really popped out during my rehabbing of the medial knee for a very minor medial tear, pes bursitis, and inflamed medial plica. I don't even know if this is the tendon causing the problem (i.e., vs. the ITB or lateral meniscus), but just read about it when researching it.

    I found this article on popliteal tendon problems, if interested:

    http://ajs.sagepub.com/cgi/content/abstract/33/8/1231
    "A local is just a dirtbag who can't get his shit together enough to travel."

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  4. #4
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    drmark - don't know about the lateral meniscus. I had an MRI within the last year due to a bike crash and it did not show anything overly evident in terms of a tear in that area - just very deep bone bruising, but mostly concentrated on the medial femoral chondryl, with much more minor bruising on the lateral side.

    This problem really popped out during my rehabbing of the medial knee for a very minor medial tear, pes bursitis, and inflamed medial plica. I don't even know if this is the tendon causing the problem (i.e., vs. the ITB or lateral meniscus), but just read about it when researching it.

    I found this article on popliteal tendon problems, if interested:

    http://ajs.sagepub.com/cgi/content/abstract/33/8/1231
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  5. #5
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    I had read that article last year in the Journal.

    Six cases reported in history? I doubt that you are the seventh.

    There is an old saying in medicine. "When you hear hoofbeats, think of horses, not zebras."

  6. #6
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    I would also suspect a lateral meniscus tear based on your description. You can occasionally get pain and swelling in the posterior knee from a meniscus tear. The other thing I would look at is possibly a strain of the lateral hamstring tendon. The over stretch sensation mightbe related to that. That would also cause pain with running and be in the general area of the ITB.
    Last edited by Vinman; 01-30-2007 at 07:18 AM.
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  7. #7
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    Well I finally went to my ortho about the lateral knee pain.

    He doesn't think torn meniscus, but apparently I sprained my LCL with damage to my joint capsule (not sure about what that means) which is what is causing the pain in the lateral/back of my knee. Rest for 4 weeks, with reeval in 3 weeks for possible return to skiing with a brace.

    Does that sound about right?

    He also examined my ankle that's been giving me problems since August when I sprained it. Even though I've rehabbed it, I've been dealing with radiating pain and numbness around the ankle bone and into the lateral part of my foot. He said it's most likely tarsal tunnel syndrome, caused by the tendon behind my ankle bone snapping, getting inflamed, and putting pressure on the nerve. He injected cortisone and said let's see what happens, then discuss other options when I see him in 3 weeks. Anyone deal with that type of injury? Buzz, I know you are going through something similar with that tendon, what's been going on with you?

    Thanks all.
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  8. #8
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    numbess in the lateral part of the foot is not tarsal tunnel. Tarsal tunnel is in the medial foot and ankle.
    When you go back have him check your peroneal nerve. I have worked with one other athlete who had a nerve compression and described symptoms like yours. Th peroneal nerve was being compressed and that caused posterior and lateral knee pain as well as weakness in his ankle.
    fighting gravity on a daily basis

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  9. #9
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    Thanks Vin. Check your pm's too.
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  10. #10
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    Hello. Maybe it is Sciatic Nerve Injury as I am not a doctor this is only a suggestion and you should go see a doctor.

  11. #11
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    Tarsal tunnel is usually from variations in anatomy aggravated by stress. (When you you Google it or whatever, "tarsal tunnel" is not the same as the "sinus tarsi".) And a lot of pathology can mimic "tarsal tunnel syndrome".

    BTW, I see popliteus (not popliteal) muscle strains and popliteus tenosynovitis several times a year.
    Every man dies. Not every man lives.
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  12. #12
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    Wow, this got resurected from the dead!

    I've continued to struggle with the knee. Over all this time, we've finally determined that the injury probably resulted in damage to the lateral hamstring and some ligament that helps hold the fibula. My fibular head at the lateral knee is now quite hypermobile, which irritates the hell out of the peroneal nerve when I'm active, i.e. compressed by the fibular head. Going to do some activity stress-induced EMG test soon to check - it will also help rule out lower back involvement, which I have some issues with and is suspected as well. Fibular taping has helped to some extent.

    The sinus tarsi/ankle nerve thing is on hold until the knee gets figured out.
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  13. #13
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    Stabilizing the proximal tib fib joint is easy to get over an a great opportunity for even me to intall a soft tissue allograft which goes through the lateral tibia around the fibula and tied to itself on the anterior tibia, followed by four weeks in a cylinger cast or locked brace.

  14. #14
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    I've seen a couple hypermobile proximal tib-fib joints this year. nice to know there is a surgical fix for those. Taping helps a little but is only temporary and for some just a P.I.T.A.
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  15. #15
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    Quote Originally Posted by drmark View Post
    Stabilizing the proximal tib fib joint is easy to get over an a great opportunity for even me to intall a soft tissue allograft which goes through the lateral tibia around the fibula and tied to itself on the anterior tibia, followed by four weeks in a cylinger cast or locked brace.
    Thanks drmark. We'd discussed peroneal decompression, but that might not be the root cause - might be the fibular head itself that needs tending to. oh and vin - taping and healthy ultrasound sessions has helped a bunch.
    "A local is just a dirtbag who can't get his shit together enough to travel."

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  16. #16
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    If the fibula head is loose, and you explore and cut the tissue around the peroneal nerve without stabilizing the proximal tib/fib joint, I can assure you the joint will get looser and the peroneal nerve which is the innocent victim of the fibula's migration worse.

  17. #17
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    Quote Originally Posted by drmark View Post
    If the fibula head is loose, and you explore and cut the tissue around the peroneal nerve without stabilizing the proximal tib/fib joint, I can assure you the joint will get looser and the peroneal nerve which is the innocent victim of the fibula's migration worse.
    DrMark - saw my ortho surgeon today, after my stress EMG and NCV studies. Everything was normal except minor slowing in the superficial peroneal nerve above the ankle (I think that's where it is). He does not think reconstruction is the way to go at this point - I have some instability in the fibular head which is causing irritation - but not damage to - the peroneal nerve. He did not think it was bad enough to risk resection, stabilization (through fusion, which apparently can cause lasting ankle issues), or ligament reconstruction of the fibular head at this point. His reasoning was that I can still perform at a fairly high level and just deal with symptoms until it gets really bad. He is aware of my pursuits and relatively high activity levels, and is concerned he wouldn't be able to improve me much more at this point.

    Anyway, PM is going to be sent with some more questions later.
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  18. #18
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    Question popliteus

    Dr. Mark, I'm a 54 year old female with arthritis in my right knee. An orthopedist has said that I have no cartilage left in that knee. Cortisone only works for about six weeks, but Synvisc works at least nine months. I've awaiting an appointment with my orthopedist to see if I can do another year of the Synvisc since I don't want to do a knee replacement. In the meantime, a huge bruise (about 4 in. X 2 in.) has developed from the back of my knee toward the interior lateral surface of my knee. The bruise is now purple and the center inch of the bruise is very tender to the touch. While my son was seeing our family practitioner, I showed it to him and he said it looked like a tear in popliteus muscle. I can't recall any injury. Is this related to the arthritis? What should I do to treat it?
    Last edited by childofthemist; 05-15-2009 at 06:24 PM. Reason: include addressee

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