Knee joint pain
Dear Dr.
Lee,
I have been experiencing knee pain for the past two years, which has caused significant inconvenience in my daily life, especially since I used to enjoy walking and hiking as forms of exercise.
I have sought medical attention multiple times, but the opinions have varied, and my pain has not improved.
My mobility is now quite different from when I used to move freely.
I need to hold onto railings when going up and down stairs or taking the bus, and I require support from my hands to sit down or get up from a chair or bed.
Squatting, in particular, causes noticeable pain.
During my orthopedic consultations, I had X-rays taken, which showed no issues with the bones.
One doctor suggested trying "Calcium and Bone Health" supplements for maintenance, while another diagnosed me with ligament inflammation through physical examination and recommended using a knee brace and taking anti-inflammatory medication.
My current condition remains unchanged, and the knee pain persists.
Should I continue taking the calcium supplement and anti-inflammatory medication, or are there other treatments or rehabilitation methods that could alleviate my symptoms and help restore my natural mobility?
I would greatly appreciate your guidance on what steps I should take next.
Thank you!
Xiao Chang, 40~49 year old female. Ask Date: 2005/06/14
Dr. Li Wenlin reply Orthopedics
Hello: In response to your question, based on your description, possible diagnoses include patellar chondromalacia or subluxation, avascular necrosis of the femoral condyle, and degenerative arthritis.
The diagnostic tools should be utilized in the following order: 1.
Standing knee X-rays.
2.
Oblique patellofemoral joint X-rays (axial view or Merchant view).
3.
Magnetic resonance imaging (MRI).
4.
Arthroscopy.
Given your age and symptom description, the likelihood of patellar chondromalacia is the highest.
Diagnosis can typically be concluded through X-ray examination and physical examination.
If uncertainty remains, the next step could involve MRI or arthroscopy; the difference being that arthroscopy is an invasive procedure akin to surgery.
Treatment will depend on the final diagnosis.
Based on your description, general outpatient recommendations may include: 1.
The patient should reduce load, such as avoiding weight gain, minimizing squatting or climbing, and using knee braces.
2.
Strengthening the quadriceps (under the guidance of a physician or physical therapist) or engaging in rehabilitation exercises.
3.
Taking pain relievers, muscle relaxants, or glucosamine (such as Osteo Bi-Flex), and considering hyaluronic acid injections (such as Synvisc or Hyalgan).
4.
If the above measures are ineffective, surgical options (such as arthroscopic surgery) may need to be considered.
It is advisable to first undergo appropriate diagnostics, after which a physician can recommend the best treatment.
Pain does not develop overnight, nor is it typically resolved quickly.
Observing during consultations is also the best way to differentiate between various causes, so patience is required, and multiple follow-up visits may be necessary.
I believe your condition will soon become clearer, and you will recover swiftly! Wishing you well!
Reply Date: 2005/06/14
More Info
Managing persistent knee pain can be a complex issue, especially when the underlying causes are multifactorial and may involve joint degeneration, inflammation, or previous injuries. Based on your description, it seems that you have been experiencing knee pain for the past two years, which has significantly impacted your daily activities and mobility. Here are some effective strategies to manage your knee pain and improve your quality of life.
Understanding the Causes
First, it's essential to understand the potential causes of your knee pain. Given that you have undergone X-rays that showed no bone issues, and considering the symptoms you described (pain during activities like climbing stairs, sitting down, or squatting), it is possible that you are dealing with soft tissue problems such as ligament inflammation, cartilage wear, or even patellofemoral pain syndrome.
Comprehensive Treatment Approaches
1. Physical Therapy: Engaging in a structured physical therapy program can be highly beneficial. A physical therapist can design a personalized exercise regimen focusing on strengthening the muscles around the knee, improving flexibility, and enhancing overall joint stability. This can help alleviate pain and prevent further injury.
2. Medication Management: Continuing with anti-inflammatory medications as prescribed by your physician can help manage pain and reduce inflammation. However, if you are experiencing side effects or if the medications are not effective, it is crucial to discuss alternative options with your healthcare provider. Supplements like glucosamine and chondroitin (such as "維骨力") may also provide some relief, but their effectiveness can vary from person to person.
3. Use of Braces or Supports: Wearing a knee brace can provide additional support and stability, especially during activities that exacerbate your pain. However, if you experience discomfort while wearing a brace, it may be worth exploring different types or consulting with a specialist to find one that fits well and offers the necessary support without causing pain.
4. Activity Modification: It is essential to modify your activities to avoid movements that trigger pain. This might mean reducing high-impact activities like running or jumping and opting for low-impact exercises such as swimming or cycling, which can help maintain fitness without stressing the knee joint.
5. Weight Management: If applicable, maintaining a healthy weight can significantly reduce the load on your knees, alleviating pain and preventing further joint damage. A balanced diet combined with regular, low-impact exercise can help achieve this.
6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, massage therapy, or chiropractic care. These methods can help manage pain and improve function, although results can vary.
7. Injections: If conservative measures fail, corticosteroid injections or hyaluronic acid injections may be considered. These can provide temporary relief from inflammation and pain, allowing you to engage more effectively in physical therapy.
8. Surgical Options: In cases where conservative treatments do not yield satisfactory results, surgical options such as arthroscopy or even knee replacement may be considered, especially if there is significant cartilage damage or other structural issues.
Follow-Up and Monitoring
Regular follow-up with your healthcare provider is crucial to monitor your progress and make necessary adjustments to your treatment plan. Keeping a pain diary can help track your symptoms and identify triggers, which can be valuable information for your healthcare team.
Conclusion
Managing persistent knee pain requires a multifaceted approach tailored to your specific situation. By combining physical therapy, medication management, lifestyle modifications, and possibly alternative therapies, you can work towards alleviating your pain and restoring your mobility. Always consult with your healthcare provider before making any significant changes to your treatment plan to ensure that you are taking the safest and most effective steps towards recovery.
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