This knee pain started one year ago after a scout camp trek, carrying
heavy weight on her back, marching.   At first it was only in one knee
and it was
swollen.  Now the pain comes and goes in both knees with no swelling.

The pain is at times severe and limits movement. 
She has seen a family doctor, a knee specialist and has had X rays and
MRI scanning, which have produced no answers. These procedures were
done in Italy where the radiologists are specialists for particular
parts of the body.

Ice packs numb the pain but provide no real relief.

What might this be?  Is there anyone who has had this experience and
who knows what this is?  What should we do to get treatment? 
Help!!!!!

Greetings!  I wish to first clarify that my research is not intended
to provide a diagnosis because I am not a physician.  That stated, I
have found other knee swelling incidents that seem to parallel what
you describe.  Lyme disease is a possibility.

If she has not been tested for Lyme disease, this might be a course to
pursue, especially since you stated she had been in the woods hiking
and camping.  Lyme disease is transmitted by the deer tick, a tiny
tick species.

The Physician and Sports Medicine site describes a few incidents in an
article "Joint Pain and Swelling: Could It Be Lyme Arthritis?" which
states:

"A careful patient history, however, may show that the individual
exercised, hiked, or camped in a region where Lyme disease is endemic.
In such a case, Lyme arthritis may be the initial presentation, and
the physician should proceed with appropriate tests to determine
proper diagnosis and treatment."

The article goes on to show two lengthy case studies, and then covers
transmission, treatment and diagnostic dilemmas, and also ends with:

"Consider All Possibilities
These two cases serve to emphasize that not all joint swelling in
athletes is secondary to injury or traumatic processes. Primary care
physicians should always consider nonathletic causes of joint pain
and/or swelling, such as autoimmune, infectious, neoplastic, and other
inflammatory processes, particularly when the exam or the history
suggests other disease processes."

I have three emails out to other physicians to further address
possibilities for the knee swelling that her doctor may not have
considered.  I would ask you to refrain from rating my answer until I
am able to add the additional information.


SEARCH TERMS and LINKS:

knee swelling pain
://www.google.com/search?hl=en&ie=ISO-8859-1&q=knee+swelling+pain

Joint Pain and Swelling: Could It Be Lyme Arthritis?
http://www.physsportsmed.com/issues/1997/02feb/wang.htm

---

Clarification of Answer by journalist-ga on 15 Aug 2002 18:09 PDT

Thank you for your patience.  : )  I have yet to hear from my email
queries but there was a severe thunderstorm in the area for about four
hours which prevented me from getting online to do further web
research for your question.  I appreciate you understanding in this
matter.

The emails I sent had to do with an interesting placebo surgery that
had to do with knee pain and swelling.  It was presented (most
probably) by the television show 60 Minutes and dealt with one group
of knee pain sufferers being given a knee surgery and another group
being given only the incisions of a knee surgery.  The test was to see
if knee pain could, in any way, be psychological in some instances. 
One gentleman who had had knee pain (for over ten years) was "cured"
of the pain even though he had no surgery, only the incisions to look
like surgery.  I am still searching for this case and hope that one or
more of the emails will provide this information.

The reason I am curious about the psychological study is because I
wondered if there could be any psychological reason for her knee pain.
 The mind is a complex organ and I wonder if there was anything about
her hike/camping that she might have viewed as negative.  Perhaps
having to carry the heavy pack, whatever - I am simply searching for
psychological information that might assist her problem. I am not
suggesting that the young lady in question has any psychological
problems so please do not infer that from my mention.  It is
interesting, however, the results of the knee surgery placebo study.

In other areas, I discovered a condition known as "patellar
tendonitis" in which a woman had a sudden onset of knee pain and
swelling after dancing.  Here is a part of her testimonial:

"I am 29 and in good health, but developed chronic pain and swelling
in my left knee in June 2001. The initial onset occurred during dance
practice one evening. I was a competitive ballroom dancer, practicing
10-15 hours a week, but there was no injury, impact or trauma at the
time to cause the pain. I went though 2 rounds of physical therapy,
including the Protonics device, between June and December with no
lasting results. In December the right knee developed pain and
swelling too, and I started a 3rd round of PT. By March I had so much
swelling and pain in both knees that I ended up in a wheelchair
(couldn't manage crutches until one knee calmed down enough). Blood
test and x rays for arthritis were negative, and MRIs and physical
exams showed no meniscus or ligament damage. After seeing 4 OS and 3
PTs in the state where I live, I flew downt to the Cincinnati Sports
Medicine Clinic. Dr. Noyes was brilliant, pointing out that I had
patellar tendonitis from "kissing knees" resulting from too much
internal rotation in my femurs (congenital)."

As you see, her problem was congenital and apparently not brought on
until she stressed her knee with dancing.  She did experience swelling
but also pain and it may be the pain is the only symptom present with
the problem your young lady is having.  I found this information of
interest and wondered if that had been explored.  Below her story were
links to many other knee-related problems, including a link for "knee
pain"   At that link are various stories.  Perusing those might lend a
clue for you as well.

You mentioned a specialist: have you seen a Sports Medicine
specialist?  If not, I would suggest that avenue as well because much
is being found about stree-related injuries in sports medicine. In an
article I found "The knee, a complex, vulnerable joint, is a common
site of sports injury in children and adolescents (figure 1) (1). The
immature skeletal system is susceptible to a spectrum of injuries
distinct from those in adults. When the growth plates (physes) are
damaged, there is a risk of growth arrest and subsequent development
of deformity, particularly for preadolescent patients who have
significant years of growth remaining."

You mention the girl is 14 so this might also be a possibility.  It
may be she injured her knee at an earlier age as well and this new
stress injury is a result of the physes being damaged then.  Again,
who knows but I looking for anything that might be of assistance to
the diagnosis of her knee pain.

Also, I found an interesting report about training soldiers in the
military and how injuries can happen during training.  The report
mentioned this:

"Overuse injuries occur because body tissues were not ready for the
amount of stress placed upon them. Here is where smart PT trainers can
really help their unit to cut back on PT related profiles. Listed
below are examples of some of the most common overuse injuries among
soldiers.

Anterior Knee Pain - The knee pain we refer to here is not where a
soldier blows out a ligament playing basketball, just the the
run-of-the-mill "it hurts when I run," front of the knee pain. There
are a host of contributing factors, but we could practically take this
off this list with an effective flexibility program, proper shoe
selection, and, most importantly, smart use of PROVRBS and FITT (see
"Applying PROVRBS & FITT Factors to Injury Prevention" below). "

I would suggest you read this entire report because, to me, hiking a
long distance with a heavy pack is akin to a military basic-training
exercise.  The report was very enlightening to me and also stated
"Gender is also a risk factor for injury since women's injury rates
have traditionally been higher than men's for initial entry training.
The current ratio is about two to one. A large basic training study in
'96 showed that women and men of similar fitness levels had similar
injury rates."

I hope this additional information proves valuable to you and I will
post further info if the emails I sent are answered with the
information I seek.

 
SEARCH TERMS and LINKS:

knee swelling pain stress "no injury"  [Google search]
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&q=knee+swelling+pain+stress+%22no+injury%22

Knee1--Complete Source for Knee Information (COMMUNITY: Patient
Stories)
http://www.knee1.com/community/patstory.cfm/2/1479

COMMUNITY: Patient Stories - knee pain
http://www.knee1.com/community/PatStory20.cfm/12


knee pain stress "no injury"  [Google search]
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&q=knee+pain+stress+%22no+injury%22

Training Injury Prevention (Fort Benning report)
http://www.benning.army.mil/usapfs/Training/TrainingInjuries.htm

The Physician and Sports Medicine "How I Manage Physeal Fractures
About the Knee"
http://www.physsportsmed.com/issues/1997/04apr/sherman.htm

---

Clarification of Answer by journalist-ga on 18 Aug 2002 19:04 PDT

Thank you for your comments and your generous rating of my research. 
I sincerely hope it is not Lyme disease-related because my
understanding of Lyme disease is - though it is not normally fatal - a
most annoying disease. I did a quick search for links and found a few
that may be helpful to your friend:

Lyme Disease Network
http://www.lymenet.org/

Center for Disease Control - Lyme disease link
http://www.cdc.gov/ncidod/dvbid/lyme

Lyme Disease Foundation, Inc.
http://www.lyme.org

( from a Google search: lyme disease
://www.google.com/search?hl=en&ie=ISO-8859-1&q=Lyme+disease )

Again, I am not a doctor nor have I ever had any training in medicine
but I will be happy to assist your friend with research in all ways I
am able.

---

Clarification of Answer by journalist-ga on 20 Aug 2002 09:37 PDT

Just a note to let you know I heard back from the emails concerning
the psychological surgery but can post no concrete evidence at this
time.  I'll continue to try and locate a web reference to it.

Dear journalist-ga,
I posted this question for a friend of mine who lives in Italy.  She
and I are very happy with your response.  We think your first idea of
Lyme disease is the correct track to follow.  When my friend returns
to Italy (next week) she is going to organise blood testing for her
daughter for Lyme disease.  She would like to communicate with you
further in the future when they have done all the investigations.

She was very impressed with the speed and detail of your reply.  Thank
you very much.

I'm not a doctor, but the first thing I thought of as well, was Lyme disease.

In a fourteen year old, I'd be thinking of Osgood Schlatter disease:
 <a href="http://www.orthohealth.com/askthedoc/osgood.cfm">click
here</a> for more info