the Difference: Osteoarthritis vs. Tendinitis in Knee Pain

Q: the Difference: Osteoarthritis vs. Tendinitis in Knee Pain

Dear readers： Based on your description, both degenerative arthritis and tendinitis are possible, and they may occur simultaneously. <br>Tendinitis is relatively straightforward; with adequate rest, reduced activity, and the use of heat therapy and anti-inflammatory pain reliever

Is it degenerative arthritis or tendinitis?

Hello Dr.
Chen,
Last spring, I suddenly experienced sharp, needle-like pain on the inner side of my right knee, which occurs intermittently.
I also feel discomfort when going up stairs, and sitting for long periods makes it painful to stand up or squat.
I feel weak and have difficulty standing up on my own.

I initially visited an orthopedic clinic where, after an X-ray, the doctor diagnosed me with "osteoarthritis" and recommended supplements containing glucosamine and chondroitin.
After taking them for two months, I saw no improvement and continued to suffer.
I then sought treatment at National Taiwan University Hospital, where the doctor, a graduate of NTU Medical School with experience in the U.S., reviewed my X-ray and said there was no aging present but diagnosed me with tendonitis.
He prescribed a week’s worth of anti-inflammatory medication.
However, after a week, my condition remained unchanged.
I returned for a follow-up, and the doctor reiterated the tendonitis diagnosis and administered a steroid injection for pain relief.
Yet, within a week, I still experienced intermittent pain.
This situation persisted for 3 to 5 months, and during the Lunar New Year, the pain became so severe that I struggled to stand, significantly impacting my daily life.
To prevent further deterioration, I was referred by friends to Shin Kong Hospital, where the doctor diagnosed me with osteoarthritis again.
Unfortunately, this doctor exhibited poor bedside manner and was not thorough in the examination, quickly prescribing anti-inflammatory medication, which led to stomach pain shortly after starting it.
I am still in pain and unsure of what steps to take next to alleviate my suffering.
I have not sustained any injuries, traveled long distances, or engaged in long-distance running, yet I still experience pain even while sleeping.

Could you please provide guidance and clarification? I would be very grateful.
Thank you.

LION, 60~69 year old female. Ask Date: 2006/03/30

Dr. Chen Xingyuan reply Orthopedics

Dear readers: Based on your description, both degenerative arthritis and tendinitis are possible, and they may occur simultaneously.
Tendinitis is relatively straightforward; with adequate rest, reduced activity, and the use of heat therapy and anti-inflammatory pain relievers, significant improvement can often be achieved.
Degenerative arthritis, on the other hand, is a natural phenomenon akin to the wear and tear of a machine or tire over time.
The rate of degeneration or wear varies among individuals, influenced by factors such as age, physical constitution, activity level, and genetics.
Knee osteoarthritis is classified as a chronic condition and cannot be completely cured; the goal is to maintain or control it in a good state and prevent further deterioration.
It is similar to an old car; if used recklessly, it will soon be out of service, but with proper care and maintenance, it can last a long time.
Therefore, the treatment of knee osteoarthritis should be approached from three levels: protection and maintenance, pharmacological treatment, and surgical intervention.
First and foremost, it is essential to reduce the burden on the knee joint.
Activities that place significant stress on the knee, such as squatting or kneeling, climbing hills or stairs, carrying heavy objects, and prolonged standing or walking, should be minimized to reduce joint wear.
If exercise is necessary, walking on flat or gentle slopes for 20 to 30 minutes is advisable, and the use of a cane or knee brace may be beneficial if needed.
Swimming is also a good option as it provides exercise with less strain on the knee joint.
Regularly applying heat with a heating pad or warm water can help maintain the joint in good condition.
Moderate rehabilitation exercises to prevent thigh muscle atrophy and knee stiffness are also crucial.
In terms of pharmacological treatment, options include non-steroidal anti-inflammatory drugs (NSAIDs), glucosamine, and intra-articular injections of hyaluronic acid.
When the knee joint experiences wear, debris may be released into the joint, leading to inflammation, swelling, pain, or effusion.
In such cases, NSAIDs can be an effective treatment.
Although these medications are effective for inflammation and pain relief, they may cause gastrointestinal discomfort or increase the burden on the liver and kidneys, so it is generally recommended to avoid them if the pain is manageable, aiming to maintain normal knee function with minimal medication.
Glucosamine can aid in the repair of knee cartilage, while hyaluronic acid acts as a high-quality lubricant to protect the cartilage surfaces and reduce joint wear.
Both glucosamine and hyaluronic acid injections typically have minimal serious side effects, but their effectiveness in treating severe knee osteoarthritis is limited.
Currently, it is recommended to administer hyaluronic acid injections weekly for five consecutive weeks to alleviate knee pain and reduce the need for anti-inflammatory pain relievers.
The efficacy of glucosamine varies significantly among individuals; if there is no improvement after 3 to 6 months of use, it is not recommended to continue.
Surgical treatment options include arthroscopic surgery and total joint replacement.
Arthroscopic surgery primarily aims to remove inflammatory debris from the knee joint, often yielding good short-term results, although the duration of these results can vary significantly among individuals.
When conservative pharmacological treatment is ineffective and X-rays show severe joint wear, total joint replacement surgery should be considered to resolve the issue.
Current designs for artificial joints can function effectively for over ten years with normal use.
The purpose of surgery is to alleviate pain and correct deformities to facilitate smooth walking; however, complications such as wound infections, loosening of the artificial joint, and wear can occur, though these are rare, with over 95% of surgeries resulting in satisfactory outcomes.
In summary, pharmacological treatment is only one part of managing knee osteoarthritis; the protection and maintenance of the knee joint are paramount, and total joint replacement surgery is a last resort.
Wishing you health and safety! Sincerely, Dr.
Chen.

Reply Date: 2006/03/30

More Info

Understanding the difference between osteoarthritis and tendinitis, especially in the context of knee pain, is crucial for effective diagnosis and treatment. Based on your description, it seems you have been through a challenging journey with your knee pain, and I appreciate your detailed account of your experiences.

Osteoarthritis vs. Tendinitis: Key Differences
Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage, which cushions the ends of bones in the joint. It typically occurs due to wear and tear over time, leading to pain, stiffness, and swelling. Common symptoms include:
- Pain that worsens with activity and improves with rest.

- Stiffness, especially after periods of inactivity.

- Swelling and tenderness in the affected joint.

- A grating sensation or popping sound when moving the joint.

On the other hand, tendinitis refers to the inflammation of a tendon, which is the tissue that connects muscle to bone. This condition is often caused by repetitive motion or overuse, leading to pain and tenderness around the joint. Symptoms of tendinitis include:
- Pain that typically worsens with movement and improves with rest.

- Tenderness and swelling near the affected tendon.

- Stiffness, particularly in the morning or after sitting for long periods.

In your case, the initial diagnosis of osteoarthritis may have been based on the presence of pain and possibly some joint changes seen on X-ray. However, the subsequent diagnosis of tendinitis suggests that the pain may be more related to inflammation of the tendons around the knee rather than the joint itself.

Why the Confusion?
The confusion between these two conditions can arise because both can present with similar symptoms, such as pain and stiffness in the knee. Additionally, both conditions can coexist, especially in older adults or those with a history of joint issues. The fact that you experienced pain during activities like climbing stairs and after sitting for long periods could be indicative of either condition.

Next Steps for Management
Given your ongoing pain and the lack of improvement with initial treatments, here are some recommendations:
1. Seek a Specialist Opinion: If you haven't already, consider consulting a rheumatologist or an orthopedic specialist who focuses on joint disorders. They can provide a more comprehensive evaluation and may suggest advanced imaging techniques, such as MRI, to assess soft tissue structures around the knee.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can design a personalized exercise regimen to strengthen the muscles around the knee, improve flexibility, and reduce pain.

3. Pain Management: Since you have experienced gastrointestinal issues with anti-inflammatory medications, discuss alternative pain management strategies with your doctor. Options may include topical treatments, corticosteroid injections, or even newer modalities like platelet-rich plasma (PRP) therapy.

4. Lifestyle Modifications: Incorporating low-impact exercises, such as swimming or cycling, can help maintain joint function without exacerbating pain. Weight management is also crucial, as excess weight can place additional stress on the knee joints.

5. Alternative Therapies: Some patients find relief through acupuncture, massage therapy, or other complementary approaches. While these should not replace conventional treatment, they may provide additional pain relief.

6. Regular Monitoring: Keep a symptom diary to track your pain levels, activities, and any treatments you try. This information can be invaluable for your healthcare provider in adjusting your treatment plan.

In conclusion, distinguishing between osteoarthritis and tendinitis is essential for effective treatment. Your symptoms warrant further investigation and a tailored approach to management. Don't hesitate to advocate for yourself and seek out specialists who can provide the care you need. Your quality of life is paramount, and with the right support, you can find relief from your knee pain.

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