Joint Pain – Knee Knee Pain The knee is the largest joint in the human body. It acts as a “hinge” allowing you to sit, squat, stand, jump, and walk. A thin layer called cartilage, which absorbs shock, covers the knee and helps glide the bone. Every year, approximately 18 million people of all ages visit the doctor for knee pain. Causes of Knee Pain Acute type of knee pain involves injury. This may include the knee being hit, fallen on, or twisted.
It may also involve ligament tears or muscle strains. Chronic types of knee pain include constant stress on the knee and arthritis. For example, bending, lifting, running, or climbing. There are hundreds of different types of arthritis, osteoarthritis being one of the most common to hurt the knee. Other causes of knee pain include excess weight, tight or weak muscles around the knee, and structural problems like one leg being longer than the other or flat feet.
Signs and Symptoms of Knee Pain Signs and Symptoms of knee pain include: • Stiffness • Swelling and redness to the knee • Warmth to the touch • Instable or “gives out” • Cracking noises • Unable to straighten the knee fully • Unable to bear weight Self Care before Calling to the Doctor Unless you have an acute injury needing immediate surgery, self care for your knee is recommended.
Ideas to try for the knee pain involve:• Rest – Resting will help with the repeated strain to the knee · Ice – Ice will decrease the inflammation of the nee. It is recommended only to use 20 minutes of ice on the knee at a time, as well as wrapping the icepack in a thin towel. If used longer, it may damage the nerves and skin. • Heat- Heat can be used after swelling is gone to relax and loosen the muscle. Avoid too hot of a heating pad to avoid burning the skin. • Compression – Using compression (for example a brace or wrap) can help prevent fluid build up in the knee as well as aligning the knee for stability.
If you are using this method it is helpful to consult with a physical therapist to help wrap the knee for stability. • Maintain a healthy weight – Too much pressure on the knee will make the cartilage wear away. Loosing weight will decrease pressure and strain on the knee decreasing the risk for arthritis. · Exercise – Build up the muscles around the knee as well as stretching, and flexibility into your exercise routine. Think about doing a lower impact exercise like swimming. Wear proper shoes and run on soft surfaces.
When to Call the Doctor for Knee Pain Reasons to consult a doctor for knee pain include: • Unable to bear weight • Noticeable knee swelling (one knee looks bigger than the other) • Cannot straighten the knee • Deformities to the knee or leg • Redness or swelling to the knee with a fever • Knee gives out • Painful cracking Questions to Ask the Doctor A medical history will be obtained first when you see the doctor. The doctor will then perform a physical exam, this may be touching of the knee.
The doctor may ask the following questions about your knee pain: 1. What are your symptoms? Describe the knee pain 2. Where exactly is the pain in your knee? 3. What makes your knee pain worse or better? 4. When did it start? 5. Do you family members have arthritis? Diagnosing Knee Pain Imaging Tests • X-Ray (radiography) – An X-Ray may be ordered by your doctor to show deterioration or injury to the bones of the knee. • MRI (Magnetic resonance imaging) – An MRI shows a more in depth look at the soft tissue of the knee, like cartilage.
Cat Scan (computerized axial tomography) – Cat Scan shows “slices” of images for a 2-Dimentional and 3-Dimentational look at the knee • Ultrasound- An ultrasound may be used by your doctor to view the knee and watch while it’s moving. Lab Testing – Blood work • Knee aspiration (arthrocentesis) – After numbing the knee, the doctor may need to aspirate fluid from the knee with a needle and syringe to test the fluid for a condition called gout, or an infection. • Rheumatoid Factor Test – a blood test may be performed to test for a rheumatoid factor, detecting rheumatoid arthritis.
Treatment of Knee Pain • Physical Therapy – After the diagnosis of knee pain, many doctors recommend physical therapy as the first line of defense. Exercises recommended by the physical therapist may help strengthen the muscles around the knee. Strengthening the muscles around the knee and in the front of the thigh has even shown to help reduce the progression of osteoarthritis and decrease pain. • Pain Medication – Pain medication may help you become more comfortable. Anti-inflammatories like Aleve and Ibuprofen are recommended.
Long term use of these medications are not recommended. Injections – If therapy is not helping, pain medications are not helping, the next step may be injections. Corticosteroids (steroids) are injectable medications the doctor may use to relieve the arthritis and pain in the knee. This procedure may last a few months. Be aware, it may not work for everyone and, with any procedure involving an injection of a needle, there is a small risk for infection. This treatment is recommended for a short time, long term may actually break down the cartilage further in the knee. Another injectable relief is called a viscosupplementation, which can also last months.
Injection of a lubricant into the knee allows the bones to glide easily with reduced cartilage in the knee. • Surgical Options – If a candidate, surgical options are available if previous options fail. Unless it is an acute injury, or recommended by your doctor, surgery is usually the last option. Arthroscopy – Arthroscopy is when the surgeon places a scope into the knee to repair the tissue or to “clean up” the bone/ cartilage fragments. Who is a candidate for arthroscopy surgery? – Those who have had cartilage wear and tear, or those who have had injury to tendons.
Benefits to arthroscopy surgery? Small incision and a quick recovery are the benefits to this surgical option. Risks of arthroscopy surgery? – Risks from arthroscopy surgery involve infection, continued knee problems, blood clots, swelling, stiffness, and bleeding. How long is recovery after arthroscopy surgery? Recovery from an arthroscopic procedure is usually only a week from work and a month or two from the normal life. Physical therapy will also be prescribed to help regain normal function. O Focal Knee Resurfacing- Focal Knee Resurfacing is a newer procedure which involves replacing only a specific area of the knee’s cartilage surface.
Metal will be inserted as an implant after broken cartilage is removed. Who is a candidate for focal knee resurfacing? – This surgery is best for active patients where osteoarthritis has only damaged one or two compartments of the knee. Benefits of focal knee resurfacing? – Benefits of this surgical option compared to a total knee placement are that it will feel more natural, it is less invasive, and there is a shorter recovery as well.
This type of surgery will last 10-15 years. Risks of Focal Knee Resurfacing? Risks of this surgical option are fairly low but include blood clot, infection, implant loosening, fractures, and nerve or blood vessel damage. How long is recovery after focal knee resurfacing? – Patients are usually able to drive after a week or two after surgery. Physical therapy will be important to gain motility back to the knee overtime. O Partial Knee Replacement- Partial knee replacement is needed if a patient has no injury or disease, but used if only one of the three parts of the knee are damaged.
Remaining cartilage and bone are shaved away and replaced with an implant. Who is a candidate for a partial knee replacement? Patients who suffer from osteoarthritis after self-care measures like the use of antiinflammatories and maintaining a healthy weight are attempted. Benefits of partial knee replacement? – This procedure lasts around 20 years. Risks of partial knee replacement? – Risks of this surgical option are the same as knee resurfacing. They include blood clot, infection, implant loosening, fractures, and nerve or blood vessel. How long is recovery from a partial knee replacement? – Recovery is about 1 month. O Total Knee Replacement-It is estimated that by 2030, 3 million people a year will receive a total knee replacement.
A total knee replacement is similar to a partial knee replacement because of an implant. The different is that the whole knee, instead of a part of the knee, is replaced with an acrylic cement or a press-fit type of implant, mimicking the knee. Who is a candidate for a total knee replacement? Those patients who have tried other means to fix their knee problems like self care measures, injections, therapy, and other surgeries may resort to the total knee replacement. Benefits of total knee replacement? Approximately 85% of knee replacements will last 20 years.
Risks of total knee replacement? : Risks of a total knee replacement include infection, blood clots, implant problems, nerve or blood vessel damage, or continued pain. How long is recovery after total knee replacement? – You will recover a couple days in the hospital. Recovery for a total knee replacement is 6 months of rehab to full function. Takeaway of Knee Pain Knee pain is a condition that can be fixed or relieved if caught early. Trying self measures may help, but if you notice you need pain medication to get through your day and other self care help is not working, call us at Lake Health.