Severe Pain Behind the Knee: Possible Causes and Solutions

Q: Severe Pain Behind the Knee: Possible Causes and Solutions

Ms. <br>Hsiao： I recommend that you visit a large hospital to see an orthopedic or neurology specialist. <br>If necessary, undergo an MRI scan to identify the cause of your condition, so that appropriate treatment can be provided. <br>Changhua Hospital, Geriatrics Department, Dr.

Severe pain in the calf behind the knee?

Hello, doctor.
I am asking on behalf of my mother, who is 66 years old.
Recently, she has been experiencing unexplained pain in the back of her right knee, which has become severe enough today that she is unable to walk and has collapsed to the ground.
She has visited multiple clinics and had X-rays taken at an orthopedic clinic, where the knee specialist said there were no issues.
She was given a B vitamin injection along with steroids, but there has been no improvement.
The pain is not in the front of the knee joint but rather in the back of the knee and calf.
Another doctor at a different clinic suggested it might be due to spinal compression, but she has only been prescribed pain medication, which has also not helped.

My mother has a medical history of unexplained anemia (she has been hospitalized for blood transfusions twice), chronic gastritis, and irritable bowel syndrome.
She does not have diabetes or require dialysis.
There is a family history of diabetes and kidney disease on her mother's side.
I have searched for information online regarding degenerative joint disease, rheumatoid arthritis, and chronic kidney-related conditions that could cause excessive pain, but none seem to match her situation.

I suspect that her poor dietary habits, which include a lack of nutritional awareness and the consumption of expired food, may have led to malnutrition and possibly sarcopenia.
However, most literature indicates that sarcopenia is associated with weakness rather than severe pain.
We are both worried and feel lost without direction.
I kindly request your guidance on possible avenues to explore.
Thank you very much.

Xiao Xiaojie, 60~69 year old female. Ask Date: 2023/08/02

Dr. Liang Yinpan reply Geriatrics

Ms.
Hsiao: I recommend that you visit a large hospital to see an orthopedic or neurology specialist.
If necessary, undergo an MRI scan to identify the cause of your condition, so that appropriate treatment can be provided.
Changhua Hospital, Geriatrics Department, Dr.
Liang Yin-Pan, August 3, 2023.

Reply Date: 2023/08/02

More Info

Severe pain behind the knee can be a complex issue, especially in an older adult like your mother. Given her age and medical history, there are several potential causes for her pain that need to be considered.
1. Musculoskeletal Issues: The pain behind the knee could be related to musculoskeletal problems such as tendonitis, bursitis, or even a tear in the meniscus. These conditions can cause localized pain and may not always show up on X-rays. An MRI might be necessary to get a clearer picture of the soft tissues around the knee.

2. Nerve Compression: The mention of spinal compression by another physician is also significant. Conditions such as a herniated disc or spinal stenosis can lead to nerve compression, which may manifest as pain radiating down the leg. This type of pain can sometimes be felt behind the knee, and it may not respond well to standard treatments like corticosteroids or B vitamins.

3. Vascular Issues: Given her age and the sudden onset of severe pain, it’s also important to rule out vascular issues such as deep vein thrombosis (DVT). DVT can cause significant pain and swelling and is a medical emergency. If there are any signs of swelling, redness, or warmth in the leg, immediate medical attention is warranted.

4. Nutritional Deficiencies: You mentioned concerns about her nutritional habits. Malnutrition can lead to muscle weakness and may contribute to pain, but it typically does not cause acute, severe pain. However, deficiencies in certain vitamins and minerals (like Vitamin D, calcium, or magnesium) can affect muscle and bone health, potentially leading to discomfort.

5. Chronic Conditions: Given her history of anemia and gastrointestinal issues, it’s also worth considering whether there are underlying chronic conditions that could be exacerbating her pain. Conditions like rheumatoid arthritis or osteoarthritis can lead to joint pain, but they usually present with more generalized symptoms rather than isolated pain behind the knee.

Recommendations:
1. Further Imaging: Since the X-rays did not reveal any issues, I recommend discussing the possibility of an MRI with her physician. This imaging can provide a more detailed view of the soft tissues, including ligaments, tendons, and cartilage.

2. Pain Management: While waiting for further evaluation, it may be beneficial to manage her pain more effectively. This could include a combination of over-the-counter pain relievers (like NSAIDs) and possibly physical therapy to strengthen the muscles around the knee and improve mobility.

3. Nutritional Assessment: Given her poor dietary habits, a consultation with a nutritionist could be beneficial. They can assess her nutritional status and recommend dietary changes or supplements that may help improve her overall health and potentially alleviate some of her pain.

4. Specialist Referral: If her pain persists despite conservative management, consider asking for a referral to a pain management specialist or a rheumatologist. They can provide a more comprehensive evaluation and treatment plan tailored to her specific needs.

5. Monitoring Symptoms: Keep a close eye on her symptoms. If there are any changes, such as increased swelling, redness, or if she develops a fever, seek immediate medical attention.

In summary, the pain behind your mother’s knee could stem from various causes, including musculoskeletal issues, nerve compression, vascular problems, or nutritional deficiencies. A thorough evaluation, including advanced imaging and possibly a referral to specialists, will be crucial in determining the underlying cause and appropriate treatment.

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