After more than a dozen visits to different specialists over the course of three years to try to find the solution to her pain, Natalie Ryals was no closer to finding the reason behind her knee problems. Photo provided by Natalie RyalsIn 2021, Natalie Ryals, 20, playfully jumped off some stairs, something she had done many times before. Later that day, Ryals gradually started noticing some pain in her knee. As the weeks continued, the gradual pain turned into radiating pain, numbness and tingling in her foot. She soon experienced limited mobility in her knee and began to develop low back pain. Ryals began using a knee brace and crutches on a regular basis to be able to move around throughout her daily life.

She visited dozens of different specialists over the course of three years to try to find the solution to her pain. Ryals had undergone multiple courses of physical therapy, extensive testing including several MRIs, and numerous medications and injections. Unfortunately, she was no closer to finding the reason behind her knee problems. Ryals could no longer straighten her knee and had no sensation in her foot. Additionally, Ryals began to experience chronic pain in her hips and lower back due to the way her body had to adjust to her knee injury.

“This injury not only affected my physical health, but my mental health as well,” Ryals said. “It was extremely painful to walk. However, no one could find the actual cause of that pain, so sometimes, people would not believe me, and that was really difficult for me. There were days when I was so discouraged that I would just sit and cry.”

After seeing multiple specialists, Ryals visited a primary care doctor who referred her to Dale Colorado, D.O., associate professor, vice chair of Education, and chief of Sports and Musculoskeletal Medicine in the University of Alabama at Birmingham Department of Physical Medicine and Rehabilitation.

In addition to a thorough history and physical examination, Ryals’ visit with Colorado at UAB Medical West included evaluation with electrodiagnostic testing and diagnostic ultrasound. The electrodiagnostic testing identified nerve injury coming from the knee. However, this did not readily explain why she had difficulty extending her knee or why she had low back pain. The ultrasound examination showed some mild abnormalities of the nerve at the knee, but more importantly, identified a cyst in the back of her knee adjacent to the nerve.

“When we were reviewing the ultrasound, we realized that the cyst may be the root cause of all of her symptoms,” Colorado said. “It was pushing on the nerve, which caused the radiating pain and numbness/tingling. The location of the cyst also made it difficult to extend her knee. Since she could not extend her knee, her hamstring muscles became tight, which caused imbalances in her pelvis, and increased stress on her low back.” 

Ryals’ visit with Dale Colorado, M.D., at UAB Medical West included evaluation with electrodiagnostic testing and diagnostic ultrasound. The electrodiagnostic testing identified nerve injury coming from the knee. Photo provided by Natalie RyalsColorado recommended an ultrasound-guided aspiration of the cyst followed by focused physical therapy. After the procedure, Ryals noticed a difference right away. After a few sessions of physical therapy, she regained full range of motion of her knee and resolution of her low back and right leg pain.

“As soon as Dr. Colorado drained the cyst, I immediately felt the pressure come off my knee,” Ryals said. “My mom and I were very emotional, because for the first time in three years, I was able to extend my knee and actually stand up straight again. I knew this meant that I was finally going to be able to run, walk and play sports again.”

After the cyst was drained, her crutches were gone, the medications and injections were no longer necessary, and her symptoms were completely resolved. Ryals completed two months of physical therapy and completely regained full mobility in her knee. Next month, she will walk across the stage during her graduation from Itawamba Community College. She will continue pursuing a degree in communications at Mississippi State next fall.

“I want to say thank you to UAB,” Ryals said. “I went from having a knee that was not functioning properly for three years to having it fully fixed after one day at UAB Medicine,” Ryals said. “Before my appointment at UAB, I fully expected to have to go another three years without having any answers, and now my life has truly been changed.”

Almost a year after her visit at UAB, Ryals’ knee function is completely back to normal, and she is able to participate in all the activities she enjoyed prior to her injury.

“I’m so thrilled we were able to help Natalie,” Colorado said. “This is a great example of something we try to emphasize to our medical students, residents and fellows. Different body parts can be interrelated. Understanding how one abnormality can cause pain or dysfunction in another area is essential to addressing musculoskeletal problems effectively.”