Pre-patellar bursitis
Back in January, I tripped over a ledge in the sidewalk on Brand Blvd. near my work, and fell onto my right knee. It hurt, and had a bruise and some abrasion, but after a week or so it seemed to have healed up normally.
When I got back from my motorcycle ride to British Columbia near the end of June, I noticed that the knee was swollen. I had no pain or even discomfort, but the top of the knee cap was noticeably puffy — about the same diameter as a tennis ball, and about an inch deep. I didn't think much of it, thinking it would go down on it's own, and I didn't think about it much until mid-August.
Justin was going to see Dr. Ackerson, the orthopedic specialist, about his collar-bone. Everyone in the family, except for me, has been going to Dr. Ackerson for years, pretty much since Jason broke his wrist playing U-12 soccer. Justin said he'd ask Dr. Ackerson about my knee at his next appointment.
Dr. Ackerson told Justin that I should have it looked at promptly, and said he was the man for the job. I called up the next day, and got an appointment scheduled for the following day.
Now, Dr. Ackerson has been around forever, and has seen it all, so when he told me to wrap it in an Ace bandage for a week to see what happens, I did as I was told. After the week was up, he said it the swelling had reduced about 10%, and told me to keep it wrapped for another two weeks — he was reluctant to open it up unless absolutely necessary. The biggest hassle was his instruction to avoid exercising - I had lost about 25 pounds in the last couple of months, and was walking almost every day.
I came back last Wednesday after the two weeks were up, and it had not gone down much more at all. Dr. Ackerson shot my knee up with something to numb it, and made a small incision in the skin right above the knee cap. A combination of semi-clear fluid and blood came out when he squeezed my knee. His R.N. Carla — who puts up with a lot from the doctor — bandaged me up, and I was told to come back the next morning. I couldn't get the dressing wet, so no showering allowed.
On Thursday, he decided to go in with no numbing first. He stuck the tip of a Kelly clamp into the incision, and dug around in there for half a minute or so, then he squeezed more gunk out. Decidedly uncomfortable. Again, I was told to come back the next morning. Again, no showers allowed.
On Friday morning, he numbed me up again, did his probe with the clamp, and had Carla swab out a sample for a culture. Then he inserted a wick - basically a medicated strip 1/4" wide and about 4" long. He packed it into the incision, with about an inch hanging outside. Because of the long weekend, he told Carla to tape up the dressing really well, and I was asked to return on Tuesday. Still no showers.
When I woke up Saturday morning, the knee was really sore. I think he did an especially good job with his probing on Friday. A few Advil and some rest made it manageable. We went to Rick's house for a family birthday thing, which was fun.
Sunday and Monday were uncomfortable. The soreness in the knee itself was mostly gone, but the tape was irritating my skin a lot. I wasn't sure how the wick would work out if I re-dressed it myself, so I grinned and bore it as best I could.
Tuesday morning's appointment was bright and early at 8:00am. He numbed it up, lengthened the incision from 1/4" to about 1", did his sadistic probing with the clamp, and inserted a new wick. He told me to let it drain for 10 minutes, but I clot pretty fast, and it was stopped up within 2-3 minutes. Carla used only a single piece of tape to hold the dressing on, and hooked me up with more gauze and tape so I can redo it myself if need be.
When I go back on Thursday, they should have the results back on the culture they took on Friday. Based on the results of the culture, I'll either be good to go, or I might need surgery to remove the pre-patellar bursa. I really hope I don't need surgery.
Follow-up: Thursday was more of the same - clean-up, probing, inserting the wick, re-dress, and come back tomorrow. He said it's looking better, and he doesn't think it will need surgery, but he can't know for sure until the culter comes back.
Follow-up 2: On Friday, Dr. Ackerson first had them take an x-ray, which came back good. When he looked at it, he said it looked good, and told Carla to re-dress it without any probing or anything. He said they got the results back on the culture, and there was no infection. He told me to take it easy over the weekend, and if things look good on Monday we'd be done, except for check-ups every couple of weeks for a while. I've been working hard to take it easy, and am really looking forward to taking a real shower on Tuesday morning.