Case report of patient with knee pain from a cross trainer treated with simple local injection of cortisone
I reviewed a 42 year old lady in the Pain Clinic who had been using a cross trainer at home. Over the last week she had had increasing left knee pain, which had got steadily worse to the point where she was unable to use the cross trainer. Over the next few days, after stopping using the cross trainer, the pain got increasingly worse and was unresponsive to over the counter analgesic medication.
Knee examination findings
She came to the Pain Clinic complaining of very severe pain. On examination of the left leg, the inferior insertion of the medial collateral ligament of the knee was exquisitely tender on palpation. We discussed the various treatment options including anti-inflammatories and minimally invasive pain management techniques. In the first instance, she was put on a course of Celecoxib 200 mg twice per day and Paracetamol 1 g four times per day for a 2 week period and given a knee support.
Local injection of medial collateral ligament with cortisone
She took the anti-inflammatory medication for 2 weeks and had some benefit. However, unfortunately on stopping the medication, the pain came back. We therefore decided to go for a minimally invasive local injection. This was performed with aseptic technique with Chlorhexidine and gloves. The left leg inferior end of the medial collateral ligament was prepped with Chlorhexidine Lignocaine 1% 2mls was administered to the skin and a total of 6 mls of 0.5% Levobupivicaine and 60 mg of Depo-Medrone were carefully instilled locally into the most tender points. Plasters were applied and the patient wore a knee support for approximately 4 weeks following this.
Two month review appointment in pain clinic
The patient was seen 2 months later. There had been a complete resolution of symptoms. She was given further advice as to avoiding certain movements on the cross trainer and she was discharged from the clinic.