It is common to see elderly people say their knees hurt, making it difficult for them to walk. People around them will probably tell them it is due to cartilage wear and tear causing degenerative arthritis, and that apart from taking painkillers or having surgery to replace the joint, there is no other way. Hearing such opinions, many patients become discouraged.
In fact, there are many causes of knee pain, and having knee pain is not a terminal illness. If treated appropriately, patients have a good chance of regaining sufficient mobility.
Causes
The structure of the knee is very complex. Besides the bones and cartilage that people generally know about, it also includes various surrounding tissues to ensure the knee can move normally. To hold the bones of the thigh and lower leg in place, the body needs ligaments. The knee has four major groups of ligaments, of which the cruciate ligament is a well-known example. Around the knee are muscles that control its movement; the tissue connecting muscle to bone is the tendon. To reduce friction between the tendons, the body has special tissues that secrete lubricating fluid — these tissues are the synovium.
Whether it is the bones, cartilage, ligaments, tendons, or synovium, any of them can be the source of pain. Different causes can also make these tissues produce pain, such as acute strains, bruising, long-term wear and tear, inflammation, bacterial infection, autoimmune diseases, and the accumulation of uric acid.
The medical community names different conditions, and those related to knee pain include arthritis, joint wear and tear, ligament or tendon tears, ligament or tendon strain, meniscus injury, and synovitis. Treatment plans generally consist of a trilogy: diagnosis, treatment, and rehabilitation.
Diagnosis
To diagnose the cause of knee pain, the doctor will generally first understand the origin, location, and characteristics of the pain, then perform a clinical examination, in order to identify the tissue causing the pain and its cause. When necessary, tests such as ultrasound, X-ray, or MRI are used to assist the diagnosis. If the problem is suspected to be caused by an underlying systemic condition, a blood test is needed to confirm it.
Treatment
With an accurate diagnosis comes a corresponding treatment. Treatment methods can broadly be divided into non-drug treatment, medication, injection therapy, and surgery.
Non-drug treatment includes weight loss. In fact, regardless of the cause of chronic knee pain, losing weight helps, because excess body weight increases the load on the knee.
For acute trauma or inflammation, the RICE method (Rest, Ice, Compression, Elevation) can be used in the first two days — that is, rest, applying ice, using a compression bandage, and elevating the affected area.
For arthritis, in addition to oral medication, injection therapy can also be considered, injecting medication directly into the joint. Commonly injected drugs include steroids and hyaluronic acid, and the doctor will choose based on the condition. Many doctors now use B-mode ultrasound to guide and visualize the injection site, increasing the precision of the injection and improving the treatment outcome.
If the arthritis is very severe, the doctor may recommend joint replacement surgery.
For problems with the synovium, ligaments, or tendons, the doctor can also use B-mode ultrasound equipment to inject medication directly into the affected area.
Besides medication and injection therapy, some people also choose vitamin supplements such as glucosamine and chondroitin to improve the pain of degenerative arthritis. However, the medical community has no consensus on the effectiveness of these supplements.
For certain serious conditions such as meniscus injury, the doctor may recommend arthroscopic examination and treatment.
In recent years, a treatment called prolotherapy has attracted attention. The concept of prolotherapy is to inject substances such as serum to stimulate the regrowth of degenerated or strained tissues. However, because this treatment is relatively new, there is not much research in the medical community on its application to the knee. But because medical evidence shows that this treatment is effective for similar problems such as tennis elbow, some doctors use it to treat more stubborn knee pain.
Rehabilitation
Rehabilitation therapy is one part of the overall treatment plan; it makes the effects of the treatments mentioned above long-lasting. Usually, physiotherapists help patients train the muscles around the knee to strengthen protection of the knee and improve the uneven distribution of load. For severe knee pain, prescribing walking aids such as crutches or a walking frame can effectively improve the patient’s mobility.
Conclusion
Knee pain has many different causes. As long as there is an accurate diagnosis and corresponding treatment, the condition can be greatly improved.
Information provided by Dr. Lee Yuk-ming, Specialist in Pain Medicine
Published in “Happy Monthly” October issue
