Dr Harjeet Singh a/l Puran Singh Consultant Orthopedic Surgeon
Columbia Asia Hospital, Bukit Rimau, Malaysia
MBBS (India), MS Ortho (UKM) MRCS (Edinburgh)
Fellowship in Orthopedic Sports Medicine & Arthroscopy (German)
CMIA (NIOSH)
drharjeetsingh@gmail.com
blog: orthopaedicsandsportsmedicine.blogspot.com
web: sportsorthopaedics.org
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Malaysians are getting increasingly active as the benefits of sports and exercise for general health and chronic disease control becomes apparent.
Sports and exercise no longer remains the bastion of the younger population with older age groups getting increasingly involved. The term ‘recreational athlete’ was coined particularly to refer to the weekend athlete who exercises at a more social or leisurely level, though not less competitively.
Whether it is the young elite athlete, the older athlete or the recreational athlete, knee pain is a common complaint found in sports’ forums and discussion groups. Fortunately, knee pain can be well managed by understanding the possible causes, particularly those causing the most potential damage; scenarios in which immediate medical attention is prudent and most importantly, preventive strategies to avoid recurrences.
Causes of knee pain are multiple and varied. They differ between the younger and older patients. The common causes in the young active person usually involve the ligaments, meniscus and tendons – both occurring after an acute injury or overuse of the knee. In the older patients, arthritis is a common cause - both degenerative arthritis or traumatic.
Knee pain produces mind-boggling symptoms for patients and clinicians alike. For a treatment to be effective, an accurate diagnosis is crucial. This requires accurate clinical history, thorough examination and appropriate imaging.
More often than not, the clinical history points to the most obvious diagnosis.
Pain occurring acutely after sporting activity often points to a ligament, cartilage or meniscal injury. Knee swelling often confirms this diagnosis. Associated symptoms of instability – often described as a wobbly knee - denotes severe injury and warrants immediate specialist consultation. The inability to straighten the knee adequately is also a worrying symptom – the locked knee and is a surgical emergency.
Knee pain progressing and worsening over a longer duration, especially in the older age group, particularly if associated with stiffness during inactivity, points to arthritis as a possible cause of the problem. Pain associated with stair climbing or standing up from a seated position suggests the patella femoral (knee-cap joint) as a target pain generator.
Inability to place one’s weight (weight-bearing) on the painful limb warrants immediate medical attention. However, in children, any type of knee pain would warrant an early visit to the treating physician.
It is also prudent to keep in mind that knee pain can even result from problems of the lower back or hip joint.
A good examination of the patient in general and knee in particular is done to evaluate the severity of the knee pain or injury, confirm the structures involved and rule out possible associated conditions which modify treatment decisions.
Imaging is guided by a clinical diagnosis and is best done after history taking and clinical evaluation. Radiographs are particularly effective in picking up fractures, evidence of overuse injuries and arthritis. The magnetic resonant imaging (MRI) allows for better delineation of cartilage, ligament and meniscal pathology.
Management of knee pain depends on diagnosis. Self-care techniques can be undertaken if the injury is mild.
GENERAL CARE
Immediate care strategies include:
1. Rest – to prevent worsening of pain.
2. Cryotherapy – the use of cooling techniques – this aids pain relief and also reduces any associated swelling.
3. Compression of the knee with a bandage – this offers some support to the knee.
4. Elevation of the affected knee – keeping the knee above the level of the hip.
5. Simple analgesics such as Paracetamol at a regular appropriate dosing.
Pain that is not resolving/getting better within the first 24 hours warrants a medical consult. Guidelines have been created to suggest immediate medical consult in the following instances:
1. Persistent knee swelling in spite of appropriate rest and care.
2. Instability symptoms – signifying possible major ligament injury.
3. Locking of the joint.
4. Inability to bear weight.
5. Knee pain in children.
6. Additional systemic signs such as fever, loss of appetite – which may signify an infection.
