Knee pain is one of the most common symptoms that bring a patient to consult a knee pain doctor Singapore. There are many causes for knee pain. Anatomically, the knee is a complicated joint which consists of bone, cartilage, ligaments, and tendons. A torn cartilage, strained ligament, or wear and tear on the knee cap can happen over time. These are some conditions that can result in knee pain. Besides that, trauma to the knee is usually the first thing we think of when a patient comes with knee pain. A fall or direct blow to the knee can cause pain, bruising, or swelling. In more serious injuries, it is possible to tear a ligament or cartilage. In elderly patients, knee pain is often caused by wear and tear of the joint or ‘Osteoarthritis’. This is a degenerative joint disease. Another common cause of knee pain is ‘gout’ and pseudo gout, which is a crystal-induced arthritis. Infection and inflammation of the knee can also cause pain and swelling. Knee pain can be categorized as acute or chronic. Acute knee pain is the one that has a sudden onset. This can be caused by a twisting injury, a fall, or an acute blow to the knee. Obvious damage usually occurs to the structure of the knee. The patient will experience pain, swelling, and inability to fully extend the knee. In a complete ligament rupture, the patient will feel the knee giving way. Chronic knee pain is the one that has been present for months. This is more often associated with dull aching pain. Patients with chronic knee pain often cannot pinpoint the exact site of pain. This type of pain is more difficult to diagnose and treat.
Signs and Symptoms of Knee Pain
Common signs and symptoms that will lead you to seeing a knee pain doctor in Singapore are knee swelling, knee instability, knee giving way, knee pain, and knee tenderness. Knee swelling is an accumulation of fluid within the knee joint. The knee can become swollen for many different reasons such as trauma, overuse, or underlying disease processes. The location of the swelling can give clues as to what may be causing the swelling. If the swelling is located inside the knee, it may be a torn meniscus. If the swelling is located in the front of the knee, it may be an indication of arthritis. If the swelling is the result of an injury, the knee is likely to be painful. A painful swollen knee is a common problem and is usually the result of a traumatic injury or an overuse injury. Atraumatic or degenerative causes for a painful swollen knee are more difficult to diagnose. Another common problem that can lead to the consultation of a knee pain doctor is knee instability. This is often described as a feeling that the knee may give way. It may be caused by a ligament injury. If the ligament injury is severe, then it may have caused the knee joint to become misaligned. The knee joint is supported by the ligaments, and if they fail to function correctly, the joint may not move as it should. If the knee joint is misaligned, then it will not track correctly as the knee is flexed and extended, therefore giving a sensation of knee instability.
Reasons to Consult a Knee Pain Doctor in Singapore
Knee pains at times can lead to difficulty in mobility. If the pain is causing difficulty in walking or standing, it is a clear sign of a functional limitation and a more serious problem. This can lead to a reduced quality of life as functional limitation will affect your ability to perform simple and leisure activities, further leading to more frustration. This frustration may psychologically affect the individual, and he may become more and more sedentary, which will further deteriorate his knee problem and health in general. With today’s vast improvement in the field of medical science, treatment is widely available to treat most knee problems, thus there is no need to unnecessarily suffer from knee pains. A knee pain doctor is the best person to seek help from if you are facing difficulty in walking or standing due to knee pain.
There are numerous causes for chronic knee pains. Common causes include an improper or inadequate recovery from a knee injury, the lack of muscle flexibility or strength to provide support for the knee, or certain forms of arthritis. A thorough examination of the knee by a knee pain doctor is the first step to finding the underlying cause for the chronic knee pain, from which a suitable treatment plan can then be prescribed.
Knee pains are common nowadays. In today’s fast-paced society, most of us do not have the luxury of time to nurse an injury for too long, and chronic knee pain is something that should not be taken lightly. If you are constantly feeling some form of discomfort or pain in your knees during sitting, standing, walking, or running, it is advisable to seek the help of a knee pain doctor.
Chronic Knee Pain
When to Consult a Knee Pain Doctor in Singapore for Chronic Knee Pain: It can be difficult to know when to seek treatment for chronic knee pain. As a general rule, if the pain is affecting your quality of life by changing the way you do your usual activities and is causing you to take pain relief medication often, then it should be investigated. A visit to the primary care physician would be the first step. The doctor would take a history of the problem and perform a physical examination. An x-ray would usually be arranged. If the problem is related to the soft tissues, an MRI may be needed. If the test results are inconclusive or do not match the patient’s symptoms, he would usually be referred to a specialist.
Chronic knee pain can be a result of injury. It can also be worsened by the fact that as we age, we are likely to develop osteoarthritis. The same weight-related factors that lead to disease of the knee can also lead to overuse and chronic pain. A less common cause of chronic knee pain is a past history of a fracture to the bones around the knee or a torn meniscus or ligament injury. This is particularly pertinent when a patient has had a surgical repair or removal of the torn fragment and has found that the pain has not resolved.
Difficulty in Walking or Standing
It is a very vague symptom and can arise from a variety of knee joint disorders across different age groups. It may start as pain in the front of the knee. For instance, it sometimes occurs in adolescent girls with patellofemoral pain and in middle-aged to older adults with knee osteoarthritis. In the patellofemoral pain population, this can be due to the inability of the quadriceps muscles to produce enough force to sufficiently lift the thigh and lower the leg during walking. In older adults with knee osteoarthritis, the major cause of slowness in walking is knee weakness, and the major cause of knee weakness is atrophy in the quadriceps muscle. In some cases, the slowness is so significant that it has been identified as a major risk factor for developing physical disability among the elderly. Other patients may feel as though their knee gives way, causing them to stumble or change their gait pattern. This can be due to pain, weakness, or buckling of the knee due to damaged ligaments or loose particles in the joint. These patients are also at a higher risk for falls and injury. Decreased activity will also lead to muscle atrophy and loss of strength, which will, in turn, further reduce the ability to perform functional tasks. All of these scenarios can be significantly limiting and impact one’s quality of life. A detailed explanation of the history of onset and specific movement-related issues will often allow the physician to narrow down the possible diagnoses and generate an appropriate differential. The severest degree is the inability to bear weight on the leg. This is often referred to as pseudo paralysis of the leg as the muscles are not strong enough to support the body, despite the fact that there is no physiological damage to the nerve. This can be a very disabling scenario and often drives patients to seek medical help.
Limited Range of Motion
Limited range of motion means that you cannot move your knee as far in one direction as you can normally. It may be difficult to get out of a chair, climb stairs, or walk. It can be difficult to judge how much your range of motion is affected. So one way to measure it is to try to determine how much the limitation affects your ability to do everyday activities. If your knee movement is not as good as it needs to be, there might be no exact way to make it normal again. But you can get used to it. If the possibility to improve your range of motion in the future is not that important to you, no measures like physical therapy would be needed. If you think that it is not acceptable for you to have any limitations in your knee movement, you should consult a physical therapist or an orthopedic doctor.
Swelling and Redness
The occasional mild swelling of a well-functioning knee is not cause for great concern. This is because small amounts of fluid are always being produced within the joint, and in a normal knee, the same amount of fluid comes out. Things change when the production of the fluid increases or when there has been bleeding in the joint. This can be due to an acute injury, an exacerbation of a chronic injury, or at times for no obvious cause. When the knee begins to swell with increasing regularity, the patient may feel a tightness within the knee and stiffness when bending it. Over time, there will be an observable increase in the size of the knee. If a patient begins to experience any of these symptoms, it is a clear sign that something is wrong and should consult a knee specialist immediately. An increase in the size of the knee, tightness, stiffness, and difficulty in bending it are all pointers to the presence of a larger than normal amount of fluid within the knee joint.
Swelling and redness are typical signs of injuries that normally happen during athletes who return to full activity following an injury too quickly. In medical terms, this is known as acute swelling. When an injury causes bleeding within the joint, the body’s inflammatory response is to “mop up” the blood, and this results in the symptoms of swelling and often warmth. If an ACL tear is suspected, it is a good idea to consult a knee specialist. ACL tears can cause bleeding within the joint, and if the blood is not drained off, it can cause chronic inflammation and damage to the joint surface. This will then result in a poor outcome, such as early osteoarthritis. Studies have shown that the longer the swelling persists, the worse the outcome for the knee.
Persistent Knee Pain after Injury
The clinical indication for arthroscopic meniscectomy in patients with knee pain and a degenerative meniscal tear is less clear. According to current evidence from several randomized controlled trials, those with coexisting mild or moderate osteoarthritis in the knee will gain some benefit in pain relief and increased function in the short term from partial meniscectomy compared with non-operative treatment. These patients typically have pain on a loaded knee and restricted knee joint range of motion and often present with joint line tenderness. This is in contrast to those with an acute onset of knee pain after new mechanical symptoms such as a catching or locking episode, even with MRI evidence of a concomitant meniscal tear. In this latter group of patients, early arthroscopic surgery for a recent meniscal tear is not indicated, and early outcome is usually very good with arthroscopic meniscectomy after a subsequent recurrent effusion and pain and an inability to settle the knee.
A common problem of a general practitioner or orthopaedic surgeon is to manage patients whose knee pain persists after an injury. Mechanical symptoms such as giving way and swelling are common presentations. Typically, an MRI of the knee will be ordered, and it is important that the radiologist knows exactly the clinical scenario so that the most appropriate imaging study will be performed. With new technologies and treatments in ACL reconstructive surgery, we can sometimes find an isolated tear of the anterolateral or posterolateral ligaments on advanced MRI imaging studies. These isolated tears can result in rotatory instability of the knee, which can be a difficult clinical diagnosis. An accurate clinical diagnosis, together with advanced radiological diagnostics, is essential to plan the correct surgery for these patients.
Treatment Options for Knee Pain in Singapore
Physical therapy for knee pain can be just as effective as medications but may take longer before benefits are actually felt. This typically involves strengthening the muscles around the knee, which can alleviate much of the stress on the knee joint itself. Strong quadriceps muscles, in particular, have been shown to help reduce pain from knee osteoarthritis. Exercises may vary from simple ones that can be done at home to more complex ones that are taught by physiotherapists. Other forms of physical therapy that have been shown to relieve knee pain are weight loss in individuals who are overweight and the use of ambulatory aids such as knee braces and insoles, which can improve knee function and reduce pain in osteoarthritis.
Medications are often prescribed by the doctor to relieve acute pain symptoms. Commonly used ones include paracetamol, NSAIDs, glucosamine, and chondroitin. Paracetamol is a simple painkiller that is generally safe with minimal side effects but is also the weakest in terms of effectiveness. NSAIDs are more effective as they have anti-inflammatory effects as well but have more potential side effects, particularly on the stomach, kidney, and heart, and may not be suitable for all patients. Glucosamine and chondroitin are oral supplements that can provide pain relief for knee osteoarthritis, and there is some evidence to suggest that they can slow down joint space narrowing.
Treatment options for knee pain can be broadly classified into 4 categories: medications, physical therapy, minimally invasive procedures, and surgery. Medications and physical therapy generally form the first line of treatment and will be discussed in more detail here, whereas the other two categories are usually reserved for more severe cases of knee pain.
Medications and Pain Management
NSAIDs stands for Non-Steroidal Anti-Inflammatory Drugs. This is a large group of medications that have painkilling and anti-inflammatory effects. In general, for arthritis, they are more effective for pain than paracetamol. They can be very effective, but the response to these medications can vary greatly between individuals. If one type of NSAID is not effective, then another type may be. Common side effects of NSAIDs include indigestion-type symptoms and, for certain types of NSAIDs, an increased risk of cardiovascular disease. People with a history of peptic ulcer disease or cardiovascular disease should not take NSAIDs without first seeking medical advice. Recent evidence also shows a potential harmful effect of NSAIDs on the healing of acute muscle and ligament injuries (certain types of NSAIDs have been found to delay tendon healing in animal studies). High doses are not recommended due to the high risk of adverse effects, and all NSAIDs should be used at the lowest effective dose. If there is an inadequate response to standard NSAIDs, a type of prescription-only NSAID called COX-2 inhibitors can be considered as they have a lower risk of gastrointestinal side effects and do not interfere with blood clotting. However, they are more expensive than standard NSAIDs.
Paracetamol (Panadol, Tylenol) is usually the preferred initial medication as it has minimal side effects for most people. It is also cheap and can be obtained without a prescription. Paracetamol is most effective for mild to moderate pain. High doses of 4g a day (in divided doses) are safe.
In some cases of knee pain, simple medications can help to relieve the pain. There are 3 major groups of oral medications that are effective in reducing the pain of knee arthritis: established over-the-counter painkillers, prescription-only NSAIDs, and specific medications for inflammatory arthritis. The use of any of these medications will depend on the severity and nature of the knee pain, and you should seek the advice of a doctor or pharmacist before commencing these medications.
Physical Therapy and Rehabilitation
Physiotherapists generally teach clients relevant exercises that can be repeated at home to help continue and speed up the recovery process. These may include strengthening, stretching, and range of motion exercises. Pain can be relieved using various electro-physical agents such as TENS, ultrasound, or pain management recommendations. Functional exercises and job-specific training can be utilized to assist in returning to normal work, leisure, or sport activities. Coaching and education have been shown to be effective in changing health behaviors. This is often a longer process of care where physiotherapists and clients collaborate to set realistic goals and action plans to improve overall health. This may be helped by improving physical fitness, weight loss, stress management, and lifestyle change. This may prevent the recurrence of an injury or address other health problems not connected to the musculoskeletal system. Treatment success may be measured both subjectively and objectively by the patient. This may include simply feeling better or being able to perform a specific function or activity pain-free. A more objective measure may be using a specific test or measuring a particular functional task.
Physical therapy programs may be the initial treatment choice for treating a knee problem. Programs may vary from doing a couple of exercises at home to formal guidance with a physiotherapist over several weeks. A number of patients are provided self-directed exercises. This might include exercises taught by a physiotherapist or basic leaflets or online advice. Some patients are referred to a physiotherapist for a formal course of recommendations and exercise. Physiotherapists use various methods and treatments to treat clients who have pain and restricted movement as a result of injury, illness, or disability. Essentially, the goal is for patients to return to the level of function they had before the knee issues or as close as possible. This may involve correcting an impairing condition, minimizing symptoms, improving function, or learning to compensate for an irreversible loss of function. Physiotherapy includes taking a comprehensive history and specific assessment followed by physical intervention to relieve pain and stiffness and restore movement and function.
Minimally Invasive Procedures
Another option for arthritis sufferers is viscosupplementation. This involves the injection of hyaluronic acid into the knee joint. It is thought that the acid may act as a lubricant and shock absorber, as well as having some anti-inflammatory effects. Studies of the effect of viscosupplementation on knee pain have been conflicting. It is suitable for patients in the early stages of arthritis.
Arthritis, the wearing away of the articular cartilage, is a common cause of knee pain. When conservative treatment options are not effective and the patient’s pain and disability become severe, then there are several minimally invasive treatment options that can be considered. One of the newest procedures is the use of mesenchymal stem cells to regenerate the articular cartilage. This procedure is only suitable for patients in the early stages of arthritis in which the damage is not too severe. Current indications are for patients less than 50 years of age.
When simple painkillers and physical therapy are not relieving your knee pain, that might be the time to see your knee specialist to find out what you are having pain for. Knee pain is a common symptom from which people suffer. There are many possible causes for the pain, including arthritis, torn meniscus, or ligament injuries. These can all be diagnosed by your specialist, and each has different treatment options. When conservative treatment options for knee pain have failed, some patients may require a minimally invasive procedure to treat the intra-articular component of their knee pain.
Surgical Interventions
Surgical interventions are considered when other approaches have failed to improve the health of the joint. Your doctor may recommend knee replacement to treat advanced osteoarthritis. Total knee replacement is the procedure most commonly done for this condition. The knee joint is replaced with artificial material. It helps many people with severe osteoarthritis pain and disability. In recent years, mini-incision surgery has been used successfully for knee replacement. It is a smaller procedure and is less invasive. However, it is not for everyone and is limited to those without complicating factors. Occasionally, the surgeon will only replace part of the knee joint. Unicompartmental knee replacement is when only one of the three knee compartments has damaged cartilage; the surgeon will replace only that compartment. The osteotomy is a surgical procedure in which a bone is cut and realigned. It is most often used to realign the leg to shift weight from the damaged part of the knee joint. However, procedures to fix damaged cartilage have better results than osteotomy and it is now rarely used.
