Knee pain

Knee pain is one of the most common problems treated by all doctors and therapists at The San Francisco Multi-Specialty Medical Group (SFMMG). It is estimated that nearly 30% of the adult population suffers from some type of knee pain. Some estimates imply San Francisco residents may have higher knee problems due to the amount of walking within the city. Knee pain is one of the most common reasons why people visit SFMMG doctors. The knee is a complex joint and has many ligaments, tendons, nerves and blood vessels surrounding it. Moreover, the knee is in use constantly. Injury to anyone of the above structures can lead to knee pain. Most minor cases of knee pain can be managed at home but the knee can also suffer from serious ligament or tendon injury and these need to be looked at by a physician .

It is impossible to prevent all the different knee injuries, especially if you are active in sports but one can take steps to reduce the chances of injury. Unlike other joints, the knee is required for ambulation and injuries to the ligaments or tendons often require surgery.

Symptoms

The doctors of SFMMG will do a complete evaluation of all the symptoms of your knee pain. The knee is surrounded by many structures and the symptoms depend on what structure is damaged. Some of the more common knee injuries include the following:

1) Ligament injuries are common. The knee ligaments play a crucial role in stability of the leg and assist in flexing and extending the knee. When the ligament is damaged, one will feel immediate pain and may even hear a popping sound if there is a full rupture. Most people with ligament injury of the knee will not be able to walk and will find that the knee is very loose or unstable.

2) Tendon injuries of the knee are common in athletes and workers who are doing excessive work with their lower extremities. Tendons are thick cord like structures and often get inflamed. Tendonitis of the knee joint can present with pain in one or both knees, swelling in front of the knee, excess pain while jumping, running or climbing stairs. Many people with tendinitis of the knee will have difficulty extending or straightening the leg.

3) Meniscus injuries are also quite common athletes. Menisci are C-shaped pieces of cartilage that play a vital role in cushioning the knee joint from injury. When menisci are torn, there is immediate pain in the joint. This is followed by mild to moderate swelling that often is delayed for 24-48 hours. When menisci are injured, one cannot straighten the knee completely. Moreover, the knee will feel locked during walking.

4) Bursitis is fluid collection in the small sacs of the joint. Bursitis typically occurs after overuse of the knee joint. Bursitis may present with a swollen warm knee and difficulty with bending or extending the knee. Pain during bursitis is mild to moderate and usually occurs during ambulation. Occasionally bursitis may present with fever and intense pain while going up and down the staircase.

5) Loose bodies often occur in the knee due to broken pieces of bone or cartilage. These tiny pieces of cartilage may interfere with knee movements and occasionally cause pain.

6) Dislocated kneecap (patella) occurs when the small bone in front of the knee slips out of place. The dislocation of the patella is obvious and may move to the side. Signs of a patella dislocation include joint pain, swelling of the knee joint, difficulty walking and straightening of the knee.

Other cases of knee pain include:

1) Osgood-Schlatter disease that primarily affects teenagers

2) Iliotibial band syndrome occurs when the ligaments on the outside of the pelvic bone starts to rub on    the lower bone of the leg. This disorder is most common in long distance runners

3) Hyper extended knee may occur after minor trauma and may lead to a tear of the inner knee ligament

4) Septic arthritis, rheumatoid arthritis, osteoarthritis and gout are all common causes of knee pain.


When to see a SFMMG doctor

The knee is a very important joint and even though many injuries may sound trivial, the injury can quickly lead to disability and chronic pain. It is wise to see a doctor if there is

1) intense pain

2) inability to bend or extend the knee joint

3) fever,

4) Feeling of a weak or loose knee

5) a popping sound when one walks and

6) an obvious deformity.



While waiting to see a physician one can do the following:

1) apply ice

2) elevate the leg, and

3) avoid weight bearing on the knee.

If you do not have any improvement in the knee over the next 3-7 days, it is recommended that you see a physician soon as possible.


Risk factors for knee pain include

1) excess weight,

2) overuse or repetitive activity

3) sedentary lifestyle

4) structural defects

5) high risk sport acclivities

6) previous knee injury and

7) advanced age.

Not all types of knee injuries are serious but some knee disorders can progress to osteoarthritis after many years.
 

Tests and diagnosis

The diagnosis of knee pain is based on history and physical examination. Most individuals undergo X-rays, MRI and a CT scan to get a more detailed look inside the knee. If an infection is suspected, the fluid from the joint will be aspirated and analyzed.

Treatments

The treatment of knee pain depends on the diagnosis and severity of the injury. While waiting for specific medical or surgical therapy, the knee injury should be

1) protected with a compression bandage, crutches, or a splint,

2) rest is important after any type of knee injury

3) ice can help reduce swelling and

4) elevation.

Anti-inflammatory medications are the mainstay for pain control. Often these drugs are required for long periods. Other drugs may include disease-modifying drugs if you have rheumatoid arthritis or antibiotics if you have septic arthritis.


Physical therapy is vital after any type of knee injury. The exercises can help restore muscle function, regain range of motion and build strength. The type of physical therapy exercise for the knee may range from bicycle, treadmill, weight machine or swimming. Once the pain and swelling have completely disappeared one can resume a regular rehabilitation program to prevent further injury.

Other options for knee pain include use of

1) orthotics and bracing (e.g. arch supports),

2) Corticosteroid injections to help decrease inflammation and pain

3) Hyaluronic acid Injections can provide lubrication and ease pain and

4) topical painkillers can be applied on the knee joint to help relieve pain.


Surgery

Sometimes surgery is required to treat knee problems. The type of surgery depends on the knee injury and severity. All consumers should understand that surgery has limitations and in some cases may not be able to restore original knee function. The types of knee surgery available include

1) arthroscopic surgery, which involve using a small camera to look inside the joint and repair the tendons/ligaments

2) Partial knee replacement surgery if you have mild to moderate osteoarthritis and

3) Total knee replacement is done when the entire knee has been destroyed.

Alternative medicine  treatments may help relieve knee pain but they do not work in everyone. Before embarking on such therapies one should speak to an SFMMG physician. Some of the alternative therapies that are marketed for knee pain include

1) glucosamine and chondroitin and

2) Acupuncture. Acupuncture may work in some people with knee pain but there are no controlled studies to determine its efficacy. If you do decide to seek acupuncture, seek a therapist with experience.


Prevention

It is not possible to prevent all types of knee pain but one can take steps to limit the chances of damaging the knee. Some of the suggestions for keeping the knee healthy include

1) reducing weight

2) exercising or walking regularly

3) stopping exercise when one has intense pain

4) wearing protective gear when one is playing sports

5) wear appropriate fitting shoes and

6) warming up prior to any exercise.


San Francisco Knee Pain Multi-Disciplinary Approach

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for your Knee Pain. Our physicians and staff members represent a number of specialties including:

• Orthopedic Medicine
• Podiatry
• Physiatry Chiropractic
• Physical Therapy
• Acupuncture

Being able to offer appropriate, comprehensive and timely Knee diagnosis and treatment in one place speeds recovery and reduces costs. Please call to schedule an appointment with our physicians at one of our locations.