Today a patient came to see me with knee pain that she’s had for over 6 months. She had been to see a variety of care providers at different locations around the globe. Radiological imaging was performed and the resounding result of all her previous exams and imaging was “Nothing Found.”
Why this Plica makes me sad…
Usually I get defensive when a patient with this background comes in, as it triggers my “scammer alert” instincts. Upon interviewing this patient it immediately became clear that she was in legitimate pain and was frustrated that “no one can see it, feel it or tell me what’s wrong, but I just know it hurts.” Game on!
The interview revealed she could run 2 miles very quickly, but has some pain after, stairs frightened her, and sitting in meetings really hurt. My physical exam lasted all of about 3 minutes, including several special tests to rule out any injuries not suggested by her history. She had a patella plica. (And here.)
This is a small fold of soft tissue that everyone has between the kneecap and femur. In some cases, it becomes angry and hurts. It is not uncommon and is really a simple diagnosis to make. Her treatment would include some basic stretching and strengthening, and a referral to an orthopedist for a steroid injection. With any luck we can avoid surgery. Her prognosis is good.
So what makes me sad about this plica? The fact that no less than 5 physicians examined this knee without findings and this poor girl was labeled as a scammer. This story underscores the importance of seeing a musculoskeletal expert for musculoskeletal pain.
Who are these experts? Physical Therapists and Orthopedic Surgeons. That’s it.