Knee Pain When Descending Stairs: Should You Seek Medical Advice? - Orthopedics

Dr. Luo Zhaozhong reply Orthopedics

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Hello!
1.
Regarding the first question, it may be due to joint degeneration.
Here are two articles for your reference.

2.
For the second question, it resembles median nerve compression, and further physical examination would clarify the situation.
As people age, do their joints also age?
The clinic door slowly opened, and an elderly man, approximately 70 years old, entered, accompanied by a middle-aged man in his forties, who held the X-rays of the elderly man's bilateral knee joints and a referral form.
The preliminary diagnosis was bilateral knee joint degeneration, and the X-rays indeed showed severe degenerative arthritis, with the joint spaces almost nonexistent.
General conservative treatment may not be effective.
After a detailed examination, the treatment plan was explained, and the patient left the clinic with a prescription in hand.
Upon hearing the term "degeneration," the patient seemed deflated, as if he would never recover.
Does joint degeneration necessarily require long-term medication, and if medication is ineffective, does it mean joint replacement is inevitable? These questions have troubled many people.

"Degenerative arthritis" is not like a sore throat, which is acute and transient; it is a slowly progressing, gradually worsening joint disease.
Imagine the joint as a vehicle tire; if the tire wears out quickly, the joint degeneration accelerates.
However, tires do not repair themselves, while human cartilage can self-repair.
When the repair rate of cartilage is far less than the wear rate, joint degeneration occurs! Generally, obesity, uneven joint surfaces, ligament injuries causing joint instability, genetic factors, bone necrosis, gout, infections, etc., are all causes of degeneration.

The initial symptoms usually include pain, tightness in the muscles around the joint, and decreased mobility.
Patients may find it difficult to climb stairs or squat.
As symptoms worsen, daily life can be severely affected, not to mention work.
Treatment methods can be progressively adjusted based on symptoms.
For early-stage degenerative arthritis, conservative treatment is recommended to reduce joint load, similar to alleviating the burden on a tire.
If overweight, it is essential to find ways to lose weight, reduce activities like climbing stairs, and avoid hiking or jogging.
If one wishes to exercise, swimming can reduce joint load while achieving fitness goals.
It is advisable to avoid walking on uneven surfaces and to take protective measures for the joints, such as wearing knee braces and avoiding direct exposure to cold air, especially since many people are accustomed to air-conditioned environments.
Additionally, simple rehabilitation physical therapy can alleviate symptoms.

If these methods remain ineffective, it is necessary to consult a physician! The physician may provide the aforementioned advice and recommend medication.
Besides traditional pain relievers, some new treatment methods are gradually being adopted.
For example, glucosamine and chondroitin sulfates, which are popular cartilage supplements, have been used.
Furthermore, intra-articular injections of hyaluronic acid (a component of synovial fluid) have shown some efficacy.
In terms of medication, in addition to traditional analgesics and anti-inflammatory drugs, new pain relievers (COX-2 inhibitors) have minimized gastrointestinal side effects, alleviating concerns about long-term use causing gastrointestinal discomfort.

In a small number of patients, if conservative treatment fails and pain persists, surgical intervention may be necessary.
Currently, the simplest surgical method is arthroscopy, which allows for the removal of debris from the joint cavity, with small incisions and quick recovery, and can be performed repeatedly.
This type of arthroscopic surgery is commonly used for knee joints.
For severely deformed and worn joints, joint replacement surgery may be required.
The technology for joint replacement in Taiwan has matured and is almost on par with global standards, but caution is needed regarding indications, and a comprehensive rehabilitation plan post-surgery is essential for optimal recovery.

In recent years, as life expectancy has generally increased, the incidence of degenerative arthritis is bound to rise.
The more one takes care of their body, the lower the likelihood of future issues.
If problems do arise, it is crucial to seek a qualified specialist to ensure health is safeguarded!
Knee pain, a common ailment, can affect both children and adults, leading many to seek medical attention, take medications, and receive injections.
If immediate relief is not achieved, patients often resort to alternative remedies in hopes of temporary relief.
Patients may not realize that if a condition is not treated appropriately, delays can exacerbate early symptoms into severe issues.

In simple terms, from a diagnostic perspective, many factors can contribute to troublesome knee pain.
However, with careful clinical examination, X-rays, ultrasound, CT scans, or MRIs, over 90% of causes can be diagnosed.
Common symptoms of knee pain in middle-aged and older adults typically include bilateral, dull pain that worsens with prolonged sitting, climbing stairs, or walking on uneven surfaces.
Some individuals may experience sudden pain in specific areas, known as "patellar tendinopathy," which often occurs below the knee in the proximal tibial tuberosity after exercise, leading to sudden swelling and pain, sometimes making walking impossible.
This osteochondritis is related to trauma or overactivity.

Clinical examination can assess the stability of the knee joint's appearance and check for localized tenderness, as well as evaluate the patella's alignment during flexion and extension.
In most cases, sufficient answers can be obtained through these physical examinations.
However, for other conditions such as bone lesions, degenerative joint disease, osteochondritis dissecans, or patellar dislocation, X-rays or CT scans may be necessary, and sometimes arthroscopy is required for a definitive diagnosis.

Regarding various conditions such as patellar tendonitis, quadriceps tendonitis, bursitis, neuromas, or patellar dislocation, early treatment may involve 3 to 6 months of strengthening rehabilitation for the quadriceps, lifestyle adjustments, or simply taking non-steroidal anti-inflammatory drugs.
Most patients can achieve satisfactory results.
Only in a small number of cases, when conservative treatment is ineffective, is surgical intervention required.
Therefore, if knee pain can be appropriately diagnosed and managed, over 90% of patients can achieve satisfactory outcomes with simple conservative treatment, avoiding surgery is not a dream.

Best wishes for health from Dr.
Luo Zhao-Chung, Orthopedics, Taoyuan Hospital, Department of Health, Executive Yuan.

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Reply Date: 2003/02/25