When to See a Knee Pain Specialist: Signs and Symptoms for Singaporeans
When knee pain persists, no matter what the level of discomfort, it is important for an individual to seek consultation with a knee specialist who is qualified to diagnose the condition by obtaining a medical history, performing a physical examination, and ordering tests as needed. Specific treatment for knee pain will depend on the diagnosis and can include medication and physical therapy. In some cases, particularly with ACL tears, meniscal tears, or injury to the knee joint, surgery may be required. But how does one know when it is time to seek help? This article will discuss some signs and symptoms whereby one should consider seeing an orthopedic surgeon who specializes in the treatment of knee pain, particularly in the Asian population in Singapore. This is important with the recent study done in 2012 showing that knee pain is a common problem among the elderly and is the 4th leading cause of disability in Singapore. Before seeking treatment with a knee specialist, it is important to first understand the anatomy of the knee and the symptoms that may arise from certain knee conditions. The knee is the largest joint in the body and is also one of the most complex. The knee joint is made up of four bones. The femur is the big thigh bone, and it is the bone that connects the knee to the hip. The tibia is the shin bone, and it is the bone that connects the knee to the ankle. The fibula is a smaller bone that runs alongside the tibia. The patella is the kneecap. Each of these bones has an important role in how the knee functions. The knee is a hinged joint that is held together by the medial collateral ligament and lateral collateral ligament on the inner and outer sides of the knee. The cruciate ligaments are in the center of the knee. The anterior cruciate ligament keeps the tibia from sliding forward, and the posterior cruciate ligament keeps the tibia from sliding backward. The knee joint is surrounded by a capsule with ligaments strapping the inside and outside of the joint. These ligaments provide stability and strength to the knee. The muscles around the knee provide strength and movement. The quadriceps muscles are on the front of the thigh and provide force to straighten the knee. The hamstring muscles are on the back of the thigh and provide force to bend the knee. The calf muscles on the lower leg attach to the tibia and provide additional strength in movement of the knee joint. Osteoarthritis (OA) is the most common joint disorder and is a leading cause of disability in the elderly. It is a slowly progressive disease that is characterized by the breakdown of joint cartilage and underlying bone. It can affect any joint in the body, but it is knees, hips, and hands that are often affected. In knee pain Singapore, OA prevalence has ranged from 35.2% to 44.6% in recent years, with higher rates among Malay and Indian ethnicity. Knee pain was the most common patient-reported symptom, and it was the most severe and disabling when compared to hip and hand pain. OA is a chronic condition for which there is no cure, but the acute flare-ups associated with it can often lead to other symptoms which will be discussed in greater detail later on.
Signs and Symptoms of Knee Pain
If you notice any deformity within your knee, whether the pain is severe or not, a medical opinion should be sought. An inability to fully extend the knee can suggest a quad muscle tear or damage to the bony structures. Locking or “giving way” is a sure sign that there is mechanical damage within the knee joint. This is often associated with meniscus tears or loose bodies within the joint. The feeling of the knee joint “giving way” can be a symptom of ligament damage within the knee. This will be discussed further in the next article on Specific Knee Injuries.
A sharp pain in the knee following a trauma may suggest a serious injury. This could be a broken bone, such as the kneecap, or tearing of the cartilage or ligaments. In this instance, it is probably a good idea to seek medical attention. If the pain is dull and aching, this can suggest a chronic problem, such as osteoarthritis, or an overuse injury.
It can be difficult to tell when an injury allowing for knee pain requires you to watch a knee pain specialist. Here is information on the symptoms of knee pain and the forms of injuries that they correspond to, that should help you on your way in making that decision. The more severe the injury, the more likely you are to experience more than one of these symptoms.
Persistent Knee Pain
– Bone fracture: This is the complete or partial break of a bone. A break of the kneecap, or patella, is one of the more common bone fractures.
– Meniscus tear: The meniscus is a rubbery, C-shaped disc that cushions your knee. Each knee has two menisci. One meniscus is on the outside of the knee and the other is on the inside. The meniscus can be torn during activities that cause pressure or force on the knee, such as heavy lifting or deep squatting.
– Torn ligament: A tear in a ligament can range from being a small partial tear to a complete tear. The more severe the tear, the more instability there will be in the knee. Common ligaments to be torn are the ACL, PCL, MCL, and LCL.
There are several reasons for persistent knee pain. It can be the result of an acute injury, such as a sports injury, or be caused by a medical condition such as arthritis. An acute injury to the knee is an injury that occurs suddenly. This type of injury can be caused by a blow to the knee, improper twisting or pivoting on the leg, extreme extension of the joint, or overexertion. Some examples of acute injuries that can result in persistent knee pain are:
Most individuals experience minor knee pain at one time or another. Oftentimes, this knee pain is a result of overexertion, such as a rigorous workout or a long day of yard work. Many times, this type of knee pain is nothing to be worried about. It will often resolve on its own with some rest. There are some instances, however, in which the knee pain is a symptom of a more serious injury or condition. One such instance is when an individual experiences persistent knee pain. Depending on the injury, this type of pain can range from being mildly irritating to debilitating. If the pain is debilitating, the individual may have trouble walking or bearing weight on the affected leg. In some cases, the individual may find that the knee feels very unstable, as if it may give way.
Swelling and Redness
It is important not to jump to conclusions and assume that all swelling and redness equal something serious. For many young athletes, a soft tissue injury is probably the cause and is relatively minor. However, for adults and the elderly, especially those who suffer from arthritis, a knee which has swelled, even without pain, should be referred to a doctor as this is an indication of a possible underlying condition and should be monitored carefully.
When consuming medication, be sure to check with a pharmacy or a doctor as the wrong medication can worsen the condition, especially if it is an infected or allergic reaction. Usually, people will take NSAIDs (Non-steroidal anti-inflammatory drugs) for arthritis, tendonitis, and other inflammatory conditions. However, in the case of those with asthma, kidney disease, or peptic ulcer disease, we should avoid these drugs and instead use paracetamol as a safe alternative. For those who are diabetic and have an injection of steroid to relieve pain and inflammation, remember to consistently monitor your blood sugar levels.
How to know whether we should go and see a knee pain specialist? Well, if our knee has redness and swelling, these can be due to various reasons. It may be a simple sprain, a torn ligament, or some form of arthritis usually involving inflammation of the inner lining of the knee. Usually, in cases of severe ligament tearing, cartilage injury, and acute injury to the knee, there will be rapid swelling within a few hours due to bleeding inside the joint. This is best treated with R.I.C.E therapy and should be referred to an orthopedic surgeon as soon as possible. This therapy involves rest, ice, compression, and elevation. Apply ice, wrapped in a cloth, to the affected area in 20-minute intervals for the first 48-72 hours. Use an elastic bandage or compression to wrap around the affected area and elevate the leg as much as possible to reduce pain and throbbing.
Difficulty in Walking or Climbing Stairs
Knee specialists have advanced with time. The techniques they use for detecting a patient’s pain have increased a lot. I remember my dad had a motorcycle accident a long time ago. He complained to me that he cannot ride a motorcycle anymore because of too much pain and asked me to bring him to a knee specialist. After the doctor examined him and did some x-rays, the doctor said that the pain is already at level 3. The doctor didn’t ask anything, but he knew the pain my dad had was correct. A long time ago, when my dad was still a teenager, he was also involved in a motorcycle accident. It was a major accident when the motorcycle hit a cow and he flew through the cow, hitting a wire fence. But never once did my dad complain about the pain he had a long time ago, until now. Although the pain today is more severe, he still manages to walk. So this is why the doctor said this after examining my dad.
When to Consult a Knee Pain Specialist
Failed Home Remedies
Should doubt exist, the individual is best advised to consult a doctor. But if the pain is not severe or the result of an injury, one should be able to understand and manage the problem. If you have had an obvious injury and the diagnosis is clear, the need for medical consultation is obvious. This is also necessary for access to physiotherapy or other treatment.
Let’s review the best information for you to know about when to consult a knee pain specialist. You could save unnecessary pain and money rather than going to a specialist immediately. It costs less to use information about your symptoms or problems as a ‘best practice’ and a more cost-effective way of utilizing the resources of the medical profession. Being familiar with your knee problem helps you to know when and who to ask for help. Usually, the worse the injury, the sooner you should see a doctor to determine the appropriate treatment, especially if the pain was the result of a traumatic event.
Impact on Daily Activities
Your ability to bend and straighten the knee is vital. The more you are able to bend and straighten with minimal pain, the less likely it is that a serious problem exists. If you have difficulty getting out of a chair, climbing a flight of stairs, or getting up from the floor, this indicates a functional limitation. Any limping or favoring one leg over the other suggests that pain or weakness is restricting normal movement. Stiffness, swelling, and pain often prevent the completion of everyday activities. If pain and swelling are of an acute nature, this may prevent simple tasks such as getting the newspaper from the driveway or carrying a bag of groceries. If it is more chronic in nature, it may affect job performance and the ability to participate in recreational activities. Lifting, carrying, and pushing are activities that we often take for granted. Problems associated with these activities can seriously restrict one’s independence. Finally, if pain and/or swelling have increased after an activity, there is a likelihood of it affecting the performance of that activity in the near future.
The ability to work, play, and live a normal life demands healthy knees. It often puts immense pressure on Singaporeans who struggle with knee pain. This is often a major factor in prompting medical consultation. For an accurate diagnosis, the specialist will need to know the extent to which pain, stiffness, or inflammation affects your ability to complete everyday tasks. Often, people change their lifestyle to compensate for an injury without even realizing it. If you are finding it difficult to perform some of the following common tasks, it is advisable that you consult a knee specialist.
History of Knee Injuries or Surgeries
With chronic pain, it is very common for people to have seen many different types of practitioners in search of relief–only to find that the treatment they were receiving was not benefiting them or was making the condition worse. This can be very frustrating. Orthopaedic specialists are authorities in musculoskeletal conditions. They know the right questions to ask, the right tests to run, and how to interpret the results. With this information, the specialist can determine the best course of treatment. This may involve working with other practitioners to coordinate care. In the worst case scenario, surgery may be recommended. Though many people view surgery as a last resort, there are times when it is the best option for a return to an active lifestyle. Remember, the goal is always to restore function, whether it is to walk around the block or return to competitive sports.
In the case of an acute injury, the first thing a person should do is to see a doctor. A physician can refer the patient to an orthopaedic specialist. For chronic pain or an injury with chronic pain as its primary symptom, seeing an orthopaedic specialist is the best choice. Orthopaedists are trained to thoroughly investigate the problem to find out what is wrong. This often involves getting x-rays and perhaps an MRI. An appropriate diagnosis is the first step to a successful treatment plan.
Patients with knee injuries or a history of knee surgeries should not ignore their knee pain. Knee pain is not normal; it is the body’s signal that something is wrong. If a knee is painful, swollen, or stiff, it is an indication that an injury has occurred. An injury can be acute (result of a specific event, such as a torn cartilage or a broken bone) or chronic (develops over time, often as a result of overuse; an example is the pain of osteoarthritis).
Recurring Knee Pain
A common problem, especially for people who have previously had a knee injury, is the feeling of the knee giving way. Buckling can be due to weakened muscles or an underlying problem with the knee joint. An ACL (anterior cruciate ligament) injury often presents with a feeling of instability in the knee and episodes where the knee has given way. If what you are experiencing falls under any of the above symptoms or injuries and it is affecting you on a regular basis, it is time to seek a diagnosis from a knee pain specialist.
Recurring knee pain can be due to a number of factors: overuse of the knee joint or an underlying injury. Patellofemoral pain syndrome is an overuse injury, as is iliotibial band syndrome. Both of these injuries can produce pain at the front of the knee or at the side of the knee. A patient with patellofemoral pain syndrome may have difficulty pinpointing exactly when the pain started. It generally has a gradual onset and can often be related to an increase in a particular activity or an increase in the amount of time spent doing the activity. The patient may have been told that they have a muscle imbalance around the knee or weakness in the muscles that support the knee. This can be a cause for a number of knee injuries and is usually related to pain occurring when the muscle has been fatigued.
Recurring knee pain can be the most frustrating pain of all. It can come and go without any real pattern. Pain is usually experienced under the knee cap and can be accompanied by a grinding sensation. The location of the pain can move about, but most commonly it is found just under the knee cap and at the inside of the kneecap. The pain often occurs during extended sitting, such as a long car journey or when watching a movie. On bending after the knee has been stationary, the pain can be sharp.
If you or someone you know is considering a visit to a knee pain specialist, take heed of any of the signs and symptoms mentioned above. Know that ignoring knee pain, waiting for it to resolve on its own or through self-medicating, are not appropriate long-term solutions for a problem. If anything, it could actually be doing more damage to the knee joint and surrounding structures. If pain persists beyond a few days or a week, seek a medical evaluation. This is especially important if an injury has occurred, as the earlier a problem is accurately diagnosed and treated, the better the long-term outcome usually. Remember that early signs of knee pain can be very subtle, and it is important to listen to your body. Often times, the difference between a mild problem and a severe one is early appropriate intervention. Lastly, treatment for knee pain does not necessarily mean surgery. Much can be done to help, and taking a proactive step in assessing the problem will be beneficial in the long run.
