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Dr Basu
Dr Basu, Experienced Specialist
Category: Orthopaedics
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Experience:  Board Certified Internist
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I have been having pain suddenly, for the last 3 or 4 weeks,

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Hi. I have been having pain suddenly, for the last 3 or 4 weeks, in both lower legs (back of calves and shin bone areas) and both knees. Sometimes it feels like nerve pain, or like my legs have been twisted.I am 53 yr old female, not overweight, relatively active, and I have osteoarthritis in both knees.The pain started one evening with sudden extreme pain in lower inside (medial) side of my left knee, with pain also down the lower part of the leg as well, in the back calf and shin bone areas. It brought tears to my eyes.Since then, I now have similar pain occurring in the right leg as well (same areas, lower part of knee (medial) also back of calf and shin bone). The pains are now there all day every day - it eases off a bit during the day, so I can walk, but every evening while sitting, and particularly in bed, both legs 'stiffen' like 'seized' or cramp pain, it's extremely painful. -I have to keep moving my legs - stretching them out, then back again, to get some relief. Walking about helps. I sit with an ice pack every evening, but it doesn't seem to do much really.The pain is always moving about - one night the pain didn't come in my legs, but instead went to both knees - agonising pains all night long, could hardly' move them. Some nights the pain is only in my legs (always just the lower leg, calves and shin),
other nights I go to bed with one knee worse than the leg pain.Every morning I wake up wondering what pain will I wake up with today! It is hard to get out of bed and walk in the mornings, I hobble around painfully, but it does ease off a bit during the day, so I can walk around.A couple of weeks ago, my left knee swelled a bit (there's never usually any swelling) and I had extreme pain; -again, just below the kneecap, medial side -when I touched the spot, it felt painful, like it was bruised.
My doctor suspected maybe a torn meniscus. However, a few days later the pain went - it now just reoccurs randomly, just like the pains in the other knee and both lower legs.Also, sometimes I can feel my legs get very tired and weak after just a short walk to town (about 8 minute walk)I walk quite a lot despite my arthritis, but lately it has become difficult. I don't even know if I will be able to go back to my job - (it involves walking around outside for just an hour every day, with some stairs involved).I have had blood tests a year ago for possible RA (pains in fingers and toes and wrists) and the results were that RA Factor is present, and inflammation levels were raised. (I have no more info than that)I had an XRay last week, and another blood test also last week for RA, but haven't heard anything back yet. The doctor has given me Codipar tablets to help with the pain. At the moment the pain is much more bearable during the day, -though if I sit for too long, my legs start to 'seize' . - so I only take two Codipar tabs at night before bed, to help with pain during the night. - I now sleep with a pillow between my knees as well.Please have you any idea what may be happening to me?(Sorry I haven't got any results back yet, but it will be at least another 2 weeks before I will hear anything from my Doctor and I'm getting worried.) - Just some ideas of what it might be would be helpful to me - Thank you!
Submitted: 3 months ago.
Category: Orthopaedics
Expert:  Dr Basu replied 3 months ago.

Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

Thanks for detailed information.

Your pain does radiate from your knee downwards.

You also experienced left knee swelling once.

However your pain mainly seems to be cramp like.

Pain is more pronounced than swelling and mostly bilateral.

These factors suggest you likely have some degree of nerve compression as well.

Nerves supplying the knees and legs can get compressed either at your lower spine or at the back of knees.

Chronic osteoarthritis can cause development of baker's cysts at the back of knees and often can cause nerve compression.

Nerve compression can also result in leg weakness.

Another possibility can be blood circulation problem.

Reduced blood flow to the legs can also cause pain and weakness especially after walking some distance.

Xrays will not be diagnostic in such cases.

MRI scan of the knee, lower spine to look for nerve compression, ABI index and duplex ultrasound of the leg arteries should be considered for further evaluation.
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Customer: replied 3 months ago.
Thank you for your quick reply!I haven't got any pain at the back of the knees, or swelling - would these have to be present if it was Bakers cysts?I have always had lower back pain - but it hasn't caused me any problems for a couple of years now
Expert:  Dr Basu replied 3 months ago.

The swelling may not be apparent in case of Baker's cyst at the back of knees, but still can cause symptoms radiating to lower legs.

Lower back problem can sometimes cause only pain fro knee downwards due to the involvement of Lumbar 4th or 5th vertebral level.

hence that will be another explanation if knee scans are normal.

Best wishes

Customer: replied 3 months ago.
I don't feel any pain though, behind the knees
Customer: replied 3 months ago.
Sorry I forgot to mention, no redness anywhere if that helps
Expert:  Dr Basu replied 3 months ago.

But do you have any pain at the back of your legs?
If yes, then baker's cyst is still a possibility.

However, lower back arthritis related radiculopathy will be more likely explanation in that case.

Customer: replied 3 months ago.
The pain in the back of the calves doesn't go up as high as the knees., its further down.
I also get pains in the shin bones towards the inside (medial) edge of my legs- they feel like they're stiffening, like my legs are getting bowed inwards as I walk.-Another thought I was wondering could it be an arthritis flare up?, or maybe Fibromyalgia a possibility do you think? -
Expert:  Dr Basu replied 3 months ago.

Medial and back of the legs are supplied by the nerves coming from 4th and 5th Lumbar vertebral space.

hence problem there is more likely.

Also flare up of knee arthritis can also cause inflammation of the nerves around the joint.

Fibromyalgia is unlikely as it does not involve calf muscles commonly first.

Customer: replied 3 months ago.
Do you mean that my spine nerve compression is more likely the cause - like sciatica?
Could knee arthritis flare up cause pain to radiate to the calves / lower legs?- Thank you for your patience!
Expert:  Dr Basu replied 3 months ago.

Yes that is correct like sciatica.

Yes knee arthritis flare up also can cause radiating pain to the calves from nerve involvement.

Best wishes

Customer: replied 3 months ago.
Thank you - can a knee flare up last as long as 3 or 4 weeks?
Expert:  Dr Basu replied 3 months ago.

Yes it can-- as the arthritis worsens the healing may take longer and longer.

Also day to day walking or other physical activities can delay the healing as well.

Customer: replied 3 months ago.
That sounds like the problem then! - so perhaps I should rest more and not walk about too much... :(
Expert:  Dr Basu replied 3 months ago.

That is correct during flare up phase.

Customer: replied 3 months ago.
I will get my doctor to check out the possible sciatica cause as well.
- Thank you so much Dr Basu- you've been really helpful! :)
Expert:  Dr Basu replied 3 months ago.

Very welcome

Best wishes,
It was my pleasure to help you today.
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Customer: replied 3 months ago.
Will do! -Thanks again !