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What Does Anterior Subcutaneous Edema From An MRI Report Indicate?

Posted on Wed, 14 Sep 2016

Question: Hello. Two and a half months ago a tripped over the baby gate and landed directly on my knee, without putting my hands down. The urgent care took an x-ray and showed no break. I returned two weeks ago and an MRI revealed no ligament tearing, but they told me there were shadows in my original x-ray on the sides and front and that the MRI showed "anterior subcutaneous edema". I'm now in a knee stabilizer. I'm not improving and still have a lot of swelling under and around my knee cap and burning pain below my knee cap. I've been using the RICE method and trying to bend it a little each day to keep the blood and fluids flowing. Yet that always causes further pain and swelling, even if I do just a little. I'm not sure what to do next. And I'm not sure what edema means other than fluid build up (swelling). Do you have any information or advice for me? I'm at a loss at this point since the nurses assistants (no "real" doctors have seen me) just keep telling me to rest. It seems like it's been to long to just keep resting.

Thank you.

Answered by Dr. Dr. Pradeep Kumar Jain (56 minutes later)

Brief Answer:
Continue RICE method,consult a orthopedic surgeon

Detailed Answer:
Hello

Thanks for asking on this platform

I have gone through the detail and do understand your concern.
In case of minor trauma the pain and swelling usually subsides within a week.
Severe trauma has been ruled out in your case as MRI is not showing any major damage.
In some cases the swelling,pain along with burning sensation may persist for longer called Reflex sympathetic dystrophy syndrome (RSDS) and usually happens due to damage to small nerves.
In most of the cases of RSDS the symptoms decrease with RICE method,analgesic,some anti inflammatory and medication for mood stability (as in this condition psychological component is also there).
With proper care the symptoms subside after 3-4 weeks.
I suggest you to not to get overly worried (as MRI is normal) and consult a orthopedic surgeon for evaluation and prescription of medication accordingly.

I hope this helps.
Please let me know if you have any more query.
Wishing for your speedy recovery.
Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Pradeep Kumar Jain (15 minutes later)

I must say that I am a bit dissappointed with this answer. I do appreciate your response. I'm still not sure what edema really means beyond what I've read on the internet. I was hopimg for some further explanation. I realise that you can't give a full diagnosis wothout an in-person consultation. I would like some sort of explanation on this diagnosis. Have you seen anything like this, going on this long, in yiour practice? I've been in twice and haven't been given any advice beyond RICE.

Thank you for your time,
Dr.XXXX, Ph.D., Psychologist

Answered by Dr. Dr. Pradeep Kumar Jain (4 hours later)

Brief Answer:
M extremely sorry,but still would like to rule out RSDS

Detailed Answer:
I am really sorry.
I agree with you that a confirmed diagnosis can be made after clinical examination/in person consultation.But still after going through your detailed history and from my past experience I would like to rule out Reflex sympathetic dystrophy syndrome (also know as complex regional pain syndrome).
In this condition even after trivial injury symptoms like pain,swelling or burning sensation may persist for months depending on the severity.
I am again apologising,if I have hurt you unintentionally.
I request you to consult your doctor again and to discuss regarding the possibility of this RSDS.

With regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Pradeep Kumar Jain (51 minutes later)

I would like to apologize. I am iufamiliar with this service and I responded when I had seen the brief answer, thinking that was the full response. After I had read your full answer I tried to weite back to applogise. I appreciate your time and your advice. Il'll be making an appointment with an ortho today

All the best,
XXXX.

Answered by Dr. Dr. Pradeep Kumar Jain (2 hours later)

Brief Answer:
please let me know about the further proceedings

Detailed Answer:
Hello madam

Please don't embarrass me by saying sorry.I would request you to be in touch and let me know about the further proceeding.

Wish you all good health.
Regards

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Dr. Pradeep Kumar Jain (38 hours later)

The oerthopedic surgeon that I met with said it was unlikely to be CRPS since my knee and leg do not have redness; just a lot of swelling. He also pointed out that I've lost quite a bit of muscle mass in my right knee. He walked me through the MRI and there is considerable swelling in my anterior bursa below my patella. Does redness need to be present for CRPS?

Answered by Dr. Dr. Pradeep Kumar Jain (15 hours later)

Brief Answer:
CRPS can be there without redness

Detailed Answer:
Hello

The MRI shows swelling of the anterior bursa also known as prepatellar bursitis and is a common entity after trauma.
The symptoms of prepatellar bursitis are also swelling,pain,redness and restriction of movement.
CRPS is a clinical diagnosis when the pain,swelling and/or redness are not explained by investigations.
There are various types of CRPS and also having different stages.As far as I know redness is not an essential criteria for the diagnosis.
I also agree with your doctor that the CRPS is less likely as the MRI shows the bursitis.
The management is same here (RICE method with physiotherapy and analgesic/antiinflammatory).

Wish you all good health.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar