Outdoor Medicine

Q: Dear Dr. Julia,

I am 91 years old and discovered a slight pain on the inside of my knee last month after swinging from a hanging vine and landing on the back of a running deer. Because of my knee pain, I was unable to stay on the deer and fell off.  After being discovered by a survey crew on Day Ten and after a short helicopter ride home, I decided to take it easy around the house.  What can a girl like me do and how long do I have to sit around the house watching re-runs of Melrose Place?”

Thanks,
Deer chaser

A: Hi Deer Chaser,

Given your name and experience, I applaud your method of aerobic exercise and am sorry to hear of your injury. You may need some physical therapy before you return to your full exercise program. Yes, make an appointment with your doctor so that he or she can diagnose your knee pain as I am unable to do that without a physical exam, However, I can give you some general information about knee injuries.

The knee is a complex hinge joint that consists of bones, tendons, cartilage, synovial membrane, ligaments, menisci, and bursa. Injury to any of these can cause pain. You were hurt on the inside of
your knee, which we call the medial side. Even though your method of aerobic exercise is rather uncommon, your injury is quite common.  The most frequently injured knee ligament is a medial
collateral ligament and the most frequently injured knee meniscus is a medial meniscus.

In general, these injuries, as well as a fracture of the top of the tibia, (tibia plateau fracture) cause pain at the medial joint line. Pain below the medial joint line can be an inflamed bursa or even a low grade medial collateral ligament strain. All of these injuries can cause swelling of the joint. If your doctor diagnoses a medial meniscus tear, then you can give this some time to see if it heals.  If it continues to cause pain, surgery is an option. A tibia plateau fracture will need immobilization and time to heal.  Once your doctor diagnoses you by your history, his physical exam, and possibly also an x-ray or MRI, you might ask if physical therapy would benefit you. The objective is to get you back in the field chasing those deer with a smile on your face.

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