Weird knees!
March 18, 2007 11:25 AM   Subscribe

It feels like the cartilage behind my knee cap is slipping out of place. I don't have health insurance. How serious is this & what's the wisest response?

For the past few years every once in a while I've been able to feel something like the cartilage behind my kneecap slipping out of place. It's never hurt, and I can massage it back in place. I've never thought to worry about it because it happens so rarely.

In January I fell off my new bike in the most stunning display of clumsiness ever, and fell straight down onto my knee. Now, suddenly, my knee's started to... slide out of place more often, sometimes many times a day, and massaging it back into place doesn't always work immediately. It's also started to ache behind the knee cap even when I'm not putting any stress on it.

I'd go to the doctor now, but without insurance I'm afraid I'll need some incredibly expensive procedure which I can't afford, and the knee issue will then be on my record. I know MeFi Is Not A Doctor, but can anyone offer conjecture on what's wrong with my knee? Should I get insurance ASAP and 'suddenly' develop a knee problem? Yoga teachers or physical therapists, are there any stretches that might make me feel better? Should I be wearing a knee brace or something?

Please don't make moral judgments about this--and please also don't tell me I should have had insurance all along. I simply can't afford it right now unless absolutely necessary, and because I've had excellent health my entire life, the few times I have had insurance it's just gone towards routine annual check-ups.
posted by soviet sleepover to Health & Fitness (8 answers total)
I'll make all the moral judgements I want, but I'll also say that I had the same issue last year. You're almost certainly looking at an MRI, a knee X-ray, and an orthopedist visit before you'll be diagnosed. If nothing is too messed up, the next step is physical therapy to strengthen whatever it is that's not pulling the patella (knee cap) back into place.

You can try to figure out what to strengthen on your own, but a lack of treatment may lead to a lifetime of pain and impaired mobility. Weight-bearing joint injuries have a tendency to snowball -- you can't move as well, so you put on weight, so you move even less well, etc. Thus, I would strongly encourage you to find some non-fraudulent way to get it treated.

(Let me emphasize the "non-fraudulent" part -- even though I had had the same health insurance for four years, it took a lot of letters to convince them that my injury was neither pre-existing [which didn't even MATTER, coverage-wise, but they wouldn't pay until it was settled] nor work-related.)
posted by backupjesus at 12:17 PM on March 18, 2007

a lack of treatment may lead to a lifetime of pain and impaired mobility

I'm no doctor, but in my experience, this seems likely. I know multiple people with knee injuries that have severely impacted their quality of life, even years and years later, after multiple surgeries. That means No Hiking. No Biking. No Long Walks. . . A sedentary, ice-pack life. I know I'm not providing you with a remedy to your situation, but I implore you to find a way to get actual medical help, no home remedies, no procrastinating. I feel for you.
posted by changeling at 1:04 PM on March 18, 2007

What would it cost you to see a physiotherapist privately?

In a similar situation with a cycling related knee injury I was passed from pillar to post by a series of NHS doctors (I live in the UK) over a period of around eight months, throughout which I was unable to ride my bike (unbearably frustrating!)

A private appointment with a physiotherapist resulted in some treatment to deal with the pain and swelling plus a regime of exercises to strengthen the muscles in my leg so they better supported the kneecap. Two months later, no more problems....

The cost of the two sessions with a physiotherapist specialising in sports-related injuries was minimal at around £80.
posted by arc at 1:21 PM on March 18, 2007

At least call a doctor and ask if there are any low cost options like a training hospital or prorated service for low income individuals. Best of luck to you.
posted by chairface at 3:53 PM on March 18, 2007

arc, some states in the US require a doctor's prescription in order to consult with a physical therapist. Even in those that don't, finding a PT who will deal with an undiagnosed knee problem may be difficult. It's definitely worth checking into, though.

I think chairface is right on about calling around, although I would start with hospitals rather than individual doctor's offices. The finance people at a hospital are going to know every trick in the book regarding government programs, free clinics, charity relief, and the lowest-cost providers in town -- it's what they do.
posted by backupjesus at 5:18 PM on March 18, 2007

I'd go to the doctor now, but without insurance I'm afraid I'll need some incredibly expensive procedure which I can't afford, and the knee issue will then be on my record.

Where are you? Sometimes there are places where you can get free or discounted treatments.

With the record issue: Just pay cash and don't give your SSN.

Don't f..k around with this. Have a professional have a look on your knee!

Good luck and all the best.

posted by yoyo_nyc at 7:38 PM on March 18, 2007

Bear in mind that surgeons want to cut. Don't get surgery without a 2nd and maybe 3rd opinion.
posted by callmejay at 8:12 PM on March 18, 2007

I sympathize. . .I recently did some major damage to my knee while skiing. The diagnostic procedures involved in the process are pretty expensive - when you add together my emergency room visit, MRI, and doctors visits, etc. I'm well over $8000 (fortunately covered in large part by insurance).

I am not a doctor. . .but I've been reading a lot about knee stuff since my own injury.

Here are some thoughts. . .

Do you know anyone who is an orthopedic resident/doctor who can give you a quick "once-over" free of charge? There are a few simple manipulations they did on my knee (looking for "laxity", or tendency to slip out of place) that told them a lot about the ligaments and tendons involved.

Did you hear a pop when you injured your knee? That's usually a sign that there's some ACL damage.

If the knee is giving out on you, strengthening quads/hamstrings is your best nonsurgical bet. Many people with ACL tears "do OK" without reconstructive surgery if they work to strengthen those muscles to make up for the lax/torn ACL.

My current pre-surgery physical therapy regimen involves bracing the knee, limiting weight-bearing, and then doing the range of motion exercises described here. Your injury may be very different, though.
posted by sherlockt at 9:34 PM on March 18, 2007

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