Knee Pain in Stroke Patients: Causes and Solutions

My father had a stroke about 20 years ago and is now completely unable to walk?

Dear Doctor,
I apologize for taking up your valuable time.
I have a question regarding my father, who has suffered from a stroke for many years, resulting in difficulties with his right hand and right leg (edema and atrophy).
He has been able to walk slowly until two weeks ago, when he began experiencing severe pain near his left knee and has since been completely unable to move.
Two weeks ago, I took him to an orthopedic outpatient clinic, where he had X-rays taken.
The orthopedic doctor indicated that there is no significant degeneration in the joints and suggested that it is likely just fasciitis, recommending anti-inflammatory pain medication for improvement.
I would like to ask the following questions:
1.
My father has been taking pain medication for two weeks but is still in severe pain and remains unable to walk.
Is it possible to identify the underlying cause?
2.
Can an MRI of the knee joint or fascia help determine the cause of the pain?
3.
Given that my father has been using his left leg to walk and dragging his right leg after the stroke, and he insists on not using a walker, could this long-term usage be the reason for the pain in his left leg?
Thank you for your patience in reading my questions.
My father also suffers from geriatric depression, and he has recently expressed feelings of worthlessness due to needing assistance with bowel movements.
He even attempted to crawl out of the house to commit suicide, but was brought back by the police.
If his leg can be treated and he can use the restroom independently, it may alleviate his suicidal thoughts.
I appreciate your help with this matter.
Thank you once again!

Mr. Lu, 40~49 year old female. Ask Date: 2016/10/06

Dr. Shi Guozheng reply Orthopedics

You should continue medication treatment and use rehabilitation as an adjunct.
If there is no improvement, consider consulting a different physician for further evaluation.

Reply Date: 2016/10/06

More Info

Knee pain in stroke patients can be a complex issue, often arising from a combination of factors related to the stroke itself, changes in mobility, and potential musculoskeletal problems. In your father's case, the pain in the left knee, which has rendered him immobile for the past two weeks, is particularly concerning and warrants a thorough evaluation.

Understanding the Causes of Knee Pain in Stroke Patients
1. Muscle Imbalance and Weakness: After a stroke, patients often experience weakness or paralysis on one side of the body. This can lead to compensatory movements and increased strain on the unaffected side. In your father's case, using the left leg more due to the right leg's weakness may have led to overuse injuries or strain in the knee.

2. Fasciitis and Inflammation: The orthopedic doctor mentioned that the pain could be due to fasciitis, which is inflammation of the fascia (the connective tissue surrounding muscles). This condition can be exacerbated by abnormal gait patterns and prolonged immobility, leading to pain and discomfort.

3. Joint Issues: While the X-ray indicated no severe degeneration, it is still possible for there to be underlying issues such as early osteoarthritis, bursitis, or even meniscal tears that may not be visible on an X-ray. These conditions can cause significant pain and limit mobility.

4. Neuropathic Pain: Stroke can also lead to changes in how pain is processed in the brain, potentially resulting in neuropathic pain, which may not respond well to standard anti-inflammatory medications.

Diagnostic Approaches
1. Further Imaging: While X-rays are useful for assessing bone structure, an MRI (Magnetic Resonance Imaging) can provide a more detailed view of soft tissues, including ligaments, tendons, and cartilage. It can help identify issues such as tears, inflammation, or other abnormalities that may not be visible on X-ray.

2. Physical Examination: A thorough physical examination by a healthcare professional, ideally a physical therapist or a specialist in rehabilitation medicine, can help assess the range of motion, strength, and specific areas of tenderness in the knee.

3. Blood Tests: In some cases, blood tests may be necessary to rule out inflammatory conditions or infections that could be contributing to the pain.

Treatment Options
1. Medication: If the current anti-inflammatory medications are not effective, it may be worth discussing alternative pain management strategies with your father's healthcare provider. This could include stronger pain medications, muscle relaxants, or even topical treatments.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and correct gait abnormalities. A physical therapist can also provide modalities such as ultrasound or electrical stimulation to alleviate pain.

3. Assistive Devices: Although your father is resistant to using a walker, it may be beneficial for him to consider using one to reduce strain on the knee and improve stability while walking. This could prevent further injury and allow him to regain some independence.

4. Psychological Support: Given your father's struggles with depression and feelings of self-worth, addressing his mental health is crucial. Engaging a psychologist or counselor who specializes in chronic illness or disability can provide him with coping strategies and emotional support.

Conclusion
In summary, the knee pain your father is experiencing could stem from a combination of factors related to his stroke and compensatory movement patterns. A comprehensive approach involving further diagnostic imaging, physical therapy, and possibly a reassessment of his medication regimen is essential for effective management. Additionally, addressing his mental health concerns is equally important to improve his overall quality of life. Please ensure that he receives the necessary support from healthcare professionals who can provide a multidisciplinary approach to his care.

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