Patient: Description of condition (time of onset, main symptoms, hospital visited, etc.): Hi Director, I am a senior in high school. Since last August, I have been experiencing synovial crepitus entrapment with soreness and slight ringing. MR was taken and no cartilage problem was diagnosed. Would you say that my six months of synovial fold compression could cause cartilage damage? Can I delay the surgery until after my high school exams in June? (I am afraid that the delay will cause cartilage wear) Thank you!
Patient: I can’t upload the MRI because I am in school right now. I hope the doctor can clear up my confusion first.
Doctor: Hello! What are the clinical signs of your diagnosis of synovial crepitus entrapment? Is there interlocking?
Patient: There is striae, entrapment, soreness, occasional pseudo-coital locking, but no meniscal injury type of interlocking.
Doctor: Hello! If there is interlocking, we still recommend surgical management. If the MRI does not reveal cartilage damage, we recommend minimizing activity and avoiding strenuous activity, which can reduce cartilage damage.
Patient: Thank you, Director! Actually, it’s not interlocking, but there is a noticeable feeling of pressure when flexing and extending, but it’s not “locked”. I have no cartilage damage from the MRI, and there is a sliding sound and swelling from the single leg squatting test, but no pain or friction sounds, so basically my cartilage is fine, right? Also, would you say that I can postpone the surgery until after my high school exams? I’m a little afraid of wearing out the cartilage. Thank you, Director Liu!
Doctor: As long as you reduce your activities and avoid strenuous activities, the cartilage will not wear out soon and you should be able to wait until after the entrance exams.
Patient: Okay, I will do as you say. Do you think there is any good way to avoid wear and tear besides reducing activities and practicing quadriceps?
Patient: By the way, Director Liu, there is sometimes (not often) a crisp popping sound when the joint flexes and extends, which feels like it is caused by friction of the fibrotic synovial folds.
Doctor: You will need to see a doctor for details.
Patient: Thank you, Director Liu! Also, does taking meloxicam have a better control on inflammation? I am not afraid of pain, and I am thinking that if meloxicam is purely analgesic, there is no need for me to take it. Thank you, Director Liu!
Patient: One additional question, you said that if the MRI is not taken, the chances of having damage should be very small, right? Thank you, Director!
Doctor: Meloxicam can eliminate the inflammation, thus relieving the pain, and the MRI diagnosis should be more accurate.
Patient: Thank you, Director, for your patience with me, and hats off to your medical ethics!
Patient: Excuse me, Director Liu, I have one more question for you. What are the typical symptoms of femoral talus cartilage injury? Will the symptoms keep appearing? Thank you!
Patient: I couldn’t find it on Baidu, so I had to bother you.
Patient: To add a small question, can a hyperplastic, fibrotic synovial fold cause a crisp popping sound when flexing and extending the knee joint (which does not usually occur)?
Doctor: The synovial cartilage is part of the patellofemoral joint and the symptom is significant pain when going upstairs. Synovial crepitus can cause a popping sound.
Patient: Thank you for your answer, I wish you well at work and good health!
Patient: Excuse me, Director Liu, I have two more questions for you.
1. I know that synovial fold hyperplasia needs a process, but when the synovial fold is just swollen (the initial disease), does it also hurt when I go upstairs? It was painful when I first had the disease more than a year ago, but I haven’t had much pain in the last year.
2. My ringing: sometimes muffled, sometimes crisp, irregular sound, is it normal? Thank you for your help, Director!
Patient: You said. At present, there is no pain in half squatting on one leg or going up and down stairs, so it should not be consistent with the symptoms of patellofemoral joint cartilage injury, right? I’m sorry for your trouble! Thank you for being such a good doctor!
Doctor: Hello! Normal people have synovial folds, so if there is no pain and other symptoms, you can ignore it, it is a normal condition. Now there are no painful symptoms there should be no cartilage damage, but it is not recommended to always perform such a test.
Patient: Thank you, Director. I had pain going up and down stairs when I first had the problem more than a year ago, but after a few months of rest I have not had any significant pain going up and down stairs. Currently, the medial patellofemoral joint is sore after about 10 minutes of walking, but the pain is not significant when walking up and down stairs or half squatting. The pain and soreness of walking up and down stairs that can be eliminated with adequate rest is a normal manifestation of synovial crepitus syndrome, right? Thank you, Director! Thank you very much!
Patient: According to the information I found about cartilage injury, there are no symptoms when walking on a flat road, but the pain is unbearable when walking up and down stairs, half squatting, or full squatting. I was initially in pain going up and down the stairs, but after 3 months of rest, I was no longer in pain and could resume strenuous exercise, and too much exercise led to a recurrence of synovial folds and aggravated fibrosis. Now I’m fine with half squatting and full squatting, but I’m just sore from walking on flat roads.
Patient: Director, I have a very important piece of information for you. I have done a patellar grinding test and when the patella is pushed near the patellofemoral joint (where the synovial crease is hyperplastic), it sometimes makes a faint rubbing sound, but it does not hurt. Does a fibrotic synovial crease cause friction sounds? Or is it cartilage damage?
Doctor: You are now too psychologically burdened, these examinations are more specialized, ordinary orthopedic surgeons can not accurately grasp if they are not specialized in joints, as long as there is no obvious pain, there is no need to worry too much.
Patient: You are right, I will adjust my mentality. Lastly, if you have chondromalacia patella, even if it is mild, will it be very painful after strenuous exercise like playing basketball?
Patient: If you have chondromalacia patella, you will have pain as long as you exercise vigorously. In contrast to chondromalacia patella, inflammation of the synovial crease will initially cause pain in half squatting and going up and down stairs, and after resting for a period of time to reduce inflammation, it will no longer be painful after exercise when the synovial crease is not inflamed, but it will easily recur and fibrosis after vigorous exercise? Would you say the difference between the two diseases is like this? Thank you, Director Liu, for your patience, and thank you for taking the initiative to give patients the number of times the medical ethics of consultation!
Doctor: You understand pretty much the same, right? The inflammation itself is serious, and rest and medication can subside.
Patient: Okay, thank you very much!
Patient: I’m sorry, sir, but I have one last question: after resting and reducing the inflammation with medication, it is normal to have a slight soreness and pain in the synovial folds during strenuous exercise, right? Thank you!
Doctor: Hello! It is recommended not to do strenuous exercise for the time being!