X-rays: These are useful in looking at changes in the bones and narrowing of the joint spaces. This is typical in osteoarthritis.
Physical examination: The doctor will check for tenderness in the knee by moving and pressing the joint with his or her hands. Often the location of the pain can indicate the source of the problem. For example, pain on one side of the knee can suggest an injury to the meniscus. Swelling may indicate inflammation or damage to the ligaments or a fluid-filled cyst.
Chronic knee pain affects as many as 25% of adults over the age of 50. Knee pain can stem from many sources; it can be caused by an old injury or the simple wearing and tearing on the joints. Obesity is also a major contributor to knee joint pain. “Knee Osteoarthritis” is the common disease that plagues people with chronic knee pain. It is the wear and tear on the joints that causes the bones to rub together and result in a slow, painful degradation of the joint. This is a disabling condition that affects many people and can severely reduce mobility and quality of life. Osteoarthritis affects around 20% of people over the age of 50. Recent research has shown that 30% of individuals with knee pain have BMIs above normal. Obese individuals have a 4-5 times greater risk of developing knee osteoarthritis. This makes Singapore a high-risk area for knee osteoarthritis due to rising obesity rates. Chronic knee pain has many causes. A detailed evaluation of the symptoms is required so that there can be directed treatment to the cause of the pain.
Understanding Knee Pain and Arthritis
Knee pain is a common problem and a frequent cause of discomfort in the human body. Over 25% of people above the age of 50 years are known to be suffering from knee pain at any one time, with the prevalence of arthritis increasing with age. Besides this, knee pain comprises about 14% of consultations in a primary care setting, with about 20% of those visiting seeking consultation for arthritic problems at the age of 65. Pain in the knee can be attributed to a number of factors, which include acute injuries, overuse injuries, and medical conditions. Injuries from the past can lead to degenerative diseases such as osteoarthritis, while overuse can cause tendinitis. Medical conditions, which include gout and various infections, can also lead to pain in the knee. Arthritic pain occurs in a joint when there is degeneration of the cartilage surface lining. As the joint is used, the thin layer of cartilage can wear down and become frayed, or it can be torn loose by an injury. This process, over time, can lead to the complete loss of cartilage in the joint, thus causing a situation where bone is rubbing on bone. This is a common cause of pain and disability and can be most troublesome in the knee with an effusion. This is a general term to describe increased swelling within a joint, generally resulting from an inflammatory reaction to an injury or disease. With an effusion, there is increased production of synovial fluid into the joint, and often the body is unable to reabsorb the added fluid, resulting in swelling. This can be quite uncomfortable and often inhibits the full range of motion of the knee.
Prevalence of Knee Pain in Singapore
The prevalence of knee pain in patients above 60 years of age attending a primary care clinic in Singapore was 49.2%, of which 23.3% had severe pain. Knee pain was found amongst 63% of those with self-reported doctor-diagnosed OA. Another clinic-based study also showed that knee pain was the most commonly reported location of pain amongst 47.3% of the older Singaporeans interviewed. This is contrasted against prevalence of knee pain in one year being 12% for the general elderly population in the West. The prevalence of knee pain has increased steadily with indications that it may continue to rise. The Singapore Health Promotion Board survey found that for the year 2000 to 2001, chronic pain affected 11.8% of the population, an increase from 6.9% in 1992. It is expected that with an aging population and rising obesity rates, the prevalence of knee pain in Singapore will only continue to rise.
Knee pain remains a common symptom experienced by Singaporeans. A National Health Survey conducted in 1998 determined that the prevalence of chronic pain was 26.9%. Knee pain was the most common complaint, accounting for almost 40% of chronic pain. In 2005, the Workforce Development Agency conducted a survey involving 2900 respondents working in various economic sectors. The study found that 25% of the respondents reported some form of musculoskeletal pain. The most common pain site was the knee, with a prevalence of 7.2%. More recent data has shown similar results.
Importance of Comprehensive Care
Comprehensive care is a term used to describe the integration of multiple treatment modalities to target the multiple factors that play a role in the progression and symptoms of knee arthritis. This approach is designed to be flexible, not formulaic, to use all treatment options judiciously, and to help the patient self-manage their condition. A comprehensive management plan will consider the patient’s preferences and needs and will be coordinated within a shared care model involving other health professionals and the patient themselves. An effective comprehensive management plan for knee arthritis will include education and self-management, exercise therapy, weight loss, use of allied health services, and a review of other treatments including surgery.
Modern management of knee arthritis has shifted its focus from the traditional medical model of disease-centered care to a patient-centered multimodal approach. This has been largely driven by emerging evidence that knee arthritis is a multifactorial condition. Patients with knee arthritis have been shown to have a higher prevalence of other joint problems, a higher than normal BMI, weakness of the knee musculature, and other comorbidities. These factors play a significant role in the progression of arthritis symptoms, and it is now recognized that a disease-centered approach with sole reliance on unimodal treatments such as intra-articular corticosteroid injections or medications alone will not lead to resolution of symptoms or improvement in functional capacity in many patients.
Diagnosis and Treatment Options
Before we dive into knee pain symptoms, it is important to understand the anatomy of the knee joint to better grasp what the symptoms are telling us. Basically, the knee joint is where the end of the thigh bone, top of the shin bone, and back of the kneecap all come together. The ends of these bones are covered with articular cartilage, a smooth substance that cushions the bones and enables them to move easily. Between the two sides of the joint, there are two crescent-shaped cartilage pads called the meniscus. These act like shock absorbers. The rest of the joint is encased in a capsule-like ligament and tendons. In the joint, there is also a synovial membrane which secretes synovial fluid to lubricate the joint. Lastly, there are large ligaments that hold the knee joint together, with the four major ones being the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament. With this basic knowledge of knee anatomy, we can move on to understanding the signs and symptoms of knee pain and/or arthritis.
Knee pain occurs in different parts of the knee. Knee pain is a common problem for many people. It hinders activities such as walking, running, climbing, or bending. Knee pain can also be the result of diseases like arthritis or injuries such as torn cartilage or a ruptured ligament. Generally, there are two types of knee pain: acute and chronic. Acute pain is the result of an injury, such as a torn ligament or a broken bone. Usually, acute pain is accompanied by swelling and bruising. Chronic pain usually comes on gradually and occurs in older adults. It often gets worse after physical activity or prolonged periods of weight bearing and can be the result of osteoarthritis. People feel knee pain in different ways, depending on the cause of the pain and individual factors. The location and severity of knee pain may vary. It can be a sudden onset sharp pain or a constant dull ache. In some knee injuries, there may be popping or crunching noises.
Common Symptoms of Knee Pain and Arthritis
There are over 100 different forms of arthritis that can cause similar yet distinct symptoms, and one particular type is gout. This is a type of arthritis that can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe, and is more common in the early hours of the morning or even an attack during the night. Another symptom that is normal with all types of arthritis is an acute or chronic pain. This occurs due to inflammation from joint damage and is a key symptom to show that you may have arthritis.
The section that I am about to explain is the early detection of knee pain and arthritis. This is incredibly helpful for those who think that they may have the early signs of arthritis. You may be diagnosed as having arthritis or other rheumatic diseases. To detect if you do or do not have arthritis, there are different things that you might do. You may or may not have medical conditions visible to the naked eye, but if you feel discomfort, swelling, or stiffness around your joint, especially in the early mornings or infrequent times, you should see a knee pain doctor Singapore for arthritis may be the cause. Another way to tell is the limitation of movement on joint. This is very difficult to notice if not paying attention to what you do. It may not hurt or feel unpleasant, but over time it will get worse. One sure way to tell is if there is any misformation of the joint. It may not be the laying equipment for it may be felt in the hand.
Diagnostic Procedures for Identifying the Underlying Cause
The first stage of the diagnosis is to take a comprehensive history of the patient’s symptoms and their impact on life. Your doctor will then complete a physical examination of the knee to look for obvious swelling, the presence of any deformity, and to assess the range of movement and any instability of the knee. The doctor may suggest investigations to confirm the diagnosis or to aid assessment. Plain x-rays are usually taken to confirm the diagnosis and to look for any associated conditions. Occasionally it is necessary to take fluid from the knee to aid diagnosis. This can be easily performed within the clinic environment. If the above measures still leave doubt, the doctor may perform further tests including MRI or CT scans. These can establish the diagnosis and assess for involvement of the meniscus or ligaments within the knee. The idea is to perform tests that are progressively invasive. This ensures an accurate diagnosis is made while avoiding unnecessary procedures or investigations.
Non-Surgical Treatment Approaches
The type of arthritis must first be identified since treatment is very much specific to the individual and the type of arthritis they have. In most cases of significant arthritis in the knee, a referral to an orthopedic surgeon is necessary. However, it is widespread knowledge that surgery should be a last option; other forms of treatment should first be attempted. A common regime would be a combination of one or more of the following: weight loss, exercise, specific physiotherapy to strengthen the muscles around the knee joint, the use of walking aids, or a change to a less demanding job or recreational sport. These are methods of unloading the pressure from the knee joint, and studies have shown these to effectively reduce pain and improve function of the knee. If this fails to improve symptoms, the next step would be a more invasive treatment to the knee joint.
It is well recognized that there is no cure for arthritis. However, in the majority of cases, it is a condition that does not cause considerable disability. In most cases, it is possible to effectively manage the symptoms and lead a normal life. If degeneration in the knee joint has occurred, some form of long-term treatment will be necessary. This is the stage where effective treatment of the arthritis can be effective to control further joint damage and relieve pain and stiffness.
Surgical Options for Severe Cases
While in some cases, surgery is the best option, it is certainly not the first option to be considered. Most surgeons feel that knee surgery should be a last resort. There are several types of knee surgery for arthritis. The most common is an arthroscopy. This is a procedure where a small telescope is inserted into the knee joint. This is an effective way to wash out the knee joint and improve symptoms. There are differing opinions as to how effective this surgery is, but it is generally agreed that it is quite successful in the short term. The other type of surgery is a total knee replacement. This is usually done on patients with severe arthritis who are not helped by other treatments. The knee is replaced with an artificial joint. This is quite an effective treatment, giving good pain relief and excellent long-term mobility to most patients. However, this surgery can be quite demanding for the patient and carries a risk of complications. Patients must be carefully selected for this surgery, and it is generally best for older patients who have low demands on their knee.
Comprehensive Care for Knee Pain and Arthritis
This wide range of medication options highlights the need for a carefully considered and individualized approach to pain relief for knee OA.
Topical NSAIDs and capsaicin may be effective for providing local pain relief and have a lower risk of systemic adverse events. Opioids are generally avoided due to their potential for addiction and serious adverse events, although they may be appropriate for short-term use in patients with severe pain that is not responsive to other analgesics. Finally, some patients may benefit from the use of medications which can reduce neuropathic pain such as amitriptyline or pregabalin.
There are many classes of analgesic medications available for OA pain relief, and patients should consult their doctor to determine the most appropriate type and dose for their individual needs. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their ability to reduce nociceptive pain. However, they are associated with a range of adverse effects which may limit their long-term use in some patients. Paracetamol is often used as a first-line oral analgesic because of its lower risk of adverse events compared to NSAIDs.
Inadequate pain relief can lead to a range of undesirable outcomes including poor physical function, psychological distress, sleep disturbance, and a range of compensatory pain relieving strategies. Analgesics remain an important tool in the management of knee OA, and the correct use of them is an essential part of comprehensive care.
Patients with knee osteoarthritis (OA) often receive inadequate pain relief, despite the frequent use of both non-prescription and prescription analgesics. Knee OA pain is a complex and subjective phenomenon. It is the result of a combination of nociceptive pain (pain caused by tissue damage) and neuropathic pain (pain caused by damage to the nervous system). The relative contributions of these two types of pain can vary between patients and may also change over time.
Medication Management and Pain Relief
Non-drug pain relief methods have also been well researched and deemed beneficial for arthritis patients. Transcutaneous electrical nerve stimulation (TENS) is a portable device that produces electrical signals to the nerves to reduce pain. It is a safe method with no side effects. However, TENS is not recommended for those with pacemakers as it can interfere with the device. Acupuncture is another method that provides pain relief by releasing endorphins, the body’s natural pain-relieving hormones. Although the results are variable, the side effects are minimal and the risk is low when done by a trained acupuncturist.
Commonly used pain relief medication includes paracetamol, opioids, and non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol is effective in relieving mild to moderate pain, but has no anti-inflammatory properties. Prolonged use of paracetamol is not recommended as it may cause liver toxicity. Tramadol is a weak opioid that is effective in reducing pain. However, opioid therapy is often discouraged as it has many side effects and the risk of dependency. NSAIDs are the most commonly prescribed medication for arthritis. It effectively reduces both pain and inflammation. However, NSAIDs may cause side effects such as stomach irritation, gastric ulcers, and perpetuation of renal impairment. In recent times, use of NSAIDs is becoming less trendy due to the potential long-term side effects on the cardiovascular system.
Physical Therapy and Rehabilitation
Physical therapy can offer a number of strategies and treatment options for people with knee OA. A physiotherapist can provide a tailored program that includes a range of activities designed to improve the range of joint movement and strength of the muscles. Hydrotherapy may be an effective way to exercise, particularly in the early stages of rehabilitation, with the warm water helping to relieve stiffness in the joints. A walking aid, such as a cane or a brace, may be useful in helping to unload the affected compartment of the knee. Devices such as braces can improve stability by shifting weight away from the damaged part of the knee. Instructions on the appropriate use of a walking aid will be given by a therapist, who can also teach patients how to alter their activity patterns to achieve painless joint movement. This step may involve weight loss if the patient is overweight, as excess weight can cause further damage to weight-bearing joints. Finally, a physiotherapist can provide education and support for those undergoing total knee replacement. Preoperative therapy can effectively unload the joint to be replaced and improve muscle strength, thus speeding up postoperative recovery. Therapy which involves minimal joint stress and muscle strengthening may also be suitable for people with severe pain and disability due to OA, for whom surgical intervention is not a viable option.
Lifestyle Modifications and Self-Care Strategies
Arthritis often causes severe limitations in the range of activities that can be comfortably performed. These limitations are a result of avoiding activities that may cause pain, stiffness, or joint damage. Maintaining good physical health through regular exercise has been shown to be an effective self-management strategy for people with arthritis. Exercise has been proven to reduce symptoms of arthritis and it can also delay the onset of disability. A well-rounded exercise routine will include a combination of range-of-motion, strengthening, and endurance exercises. Range of motion exercises maintain normal joint movement and increase flexibility. Endurance exercises improve the health of the heart and blood vessels, increase muscle strength, and reduce fatigue. Sticking to a regular exercise regimen can be difficult, as people often have difficulty in remaining motivated. Behavior change techniques can be used to promote exercise adherence. These will be registered as a cluster of exercises which has a direct effect on the pain and mobility of knees. This will be followed by an immediate relief cluster which concentrates on methods of reducing pain and stiffness after running or cycling. Other techniques will delay structural changes in joints which can often be accelerated by high-impact exercises. Long-term successful adherence to exercise is highly reliant on minimizing the number of exercise dropouts. A majority of dropouts occur due to pain, lack of time, and lack of motivation.
Physical activity
Self-management refers to the ability for an individual to manage the symptoms, treatment, physical and psychosocial effects of a chronic disease. It also involves the process of making lifestyle changes and adopting healthful behaviors. One of the aims of self-management is to help control pain and prevent it from taking over a person’s life. Techniques involve learning about the disease, setting attainable goals, problem-solving, making decisions and taking action, using cognitive-behavioral strategies and techniques to support changes in health behavior.
Self-management techniques
Good nutrition and regular exercise are important to maintain a healthy lifestyle. For those with arthritis, making changes to a healthier lifestyle can be among the hardest to adopt, but it is the most sustainable long term. Maintaining a healthy weight is also important in the management of arthritis. Weight loss can reduce stress on arthritic joints and can improve pain, function, and mobility. Weight management should include a combination of a well-balanced diet and regular exercise. Maintaining a healthy weight is achieved through the energy balance of calories consumed and calories expended. The benefit of weight loss is particularly noticeable in slowing the progression of arthritis of the knees.
Complementary and Alternative Therapies
Relaxation techniques, though the terms are used loosely to describe a variety of approaches to take it easy, the actual skills of relaxation and the way it can affect the body is a lesson of recurring event (e.g., meditation), tai chi, and yoga have been mentioned and shall be discussed in their respective sections.
Acupuncture is a complementary medical practice that entails stimulating certain points on the body, most often with a needle penetrating the skin, to alleviate pain or to help treat various health conditions. The development of acupuncture started in China more than 2500 years ago.
Tai chi is an ancient Chinese movement form. Originally developed for self-defense, it has evolved into a graceful form of exercise that is now used for stress reduction and a variety of health conditions. Often described as meditation in motion, tai chi promotes serenity through gentle, flowing movements.
Yoga is a mix of specific postures, breathing exercises, and meditation that has been practiced for more than 5000 years. There are several forms of yoga, each differing somewhat in its movements and postures. Some forms are slow and gentle, while others are fast and vigorous. In the west, yoga is primarily practiced to attain physical fitness and relaxation, but it is also part of an entire philosophy of promoting a balanced development of mind, body, and spirit.
Complementary and alternative therapy is another way to relieve pain, although some of these methods haven’t been scientifically validated, they have been shown to be effective for some people. These methods include yoga, tai chi, acupuncture, and relaxation techniques. Each of these methods has a unique approach towards the introduction of wellness to knee arthritis sufferers.
Choosing the Right Knee Pain Doctor in Singapore
Remember, the best health outcomes are always the result of a partnership between patient and doctor. Always take the time to make sure that you feel comfortable with the doctor. Such a relationship builds over time, so do not rush your decision. Finally, you should always find out what resources are available to the physician to help educate you or support your decision-making. This helps ensure that ongoing education (for the physician) and good communication are maintained. This quality interaction between patient and doctor far enhances the likelihood of better health outcomes.
When deciding on a healthcare professional, it is essential to find someone who is both capable and caring. Professional competence is as vital as a good relationship. This is because a physician who is easily approachable and possesses good communication skills is able to effectively involve their patients in understanding and making decisions about their conditions. This addresses the dimension of emotional support given by the doctor. This is particularly important for arthritic conditions where long-term care is expected.
Factors to Consider When Selecting a Knee Pain Doctor
It is important to keep in mind that the listing of a physician’s name in a commercial online service does not necessarily mean that the physician is board certified. Be aware of this, and if you are interested in a particular physician, learn more about their credentials. Board certification, while not a guarantee of the doctor’s competence, is a measure of a physician’s training and education. This information can be verified at the websites of the Singapore Medical Council and the Ministry of Health. Board certification is attainable in pain management and in several subspecialties closely related to pain management. Board certified physicians have completed additional training and have generally met more stringent standards.
One of the most crucial steps in finding an appropriate doctor for help with your knee pain is research. At some point in the research process, you will likely use the internet to find information on physicians. Many patients also obtain names of potential physicians from friends, family, and other healthcare providers. At present, there are numerous online resources that can help you learn more about a specific doctor: you can read about their credentials, where they went to school, what their special interests are, and what their philosophy of care is. A wealth of information can be obtained from internet physician locator sites that are now widely available. By doing some initial research, you may be able to find a physician who is a good fit for you and your needs.
Researching and Evaluating Potential Doctors
Finding a knee doctor who is versed in orthopedic surgery and one that personally has had a knee arthroscopy experience is beneficial. Noting that there are many sub-specialties in orthopedics (sports medicine, joint replacement, spine, etc.), finding one that is tailored to your knee condition can be the most beneficial. An experienced knee care doctor should be able to evaluate and investigate the problem through the usage of diagnostic tools to provide a clearer understanding of the knee pain condition. Ask for specifics in your inquiry. High-resolution ultrasound and MRI are some of the tools available that can provide a non-invasive and detailed information about soft tissue structures in and around the knee. In some cases, it can be much clearer than findings off an arthroscopic procedure. A clear diagnosis is the first step to coaching the patient to understand the situation and what treatment options are available.
It is not always easy to find out information about a knee care doctor’s professional background or malpractice record. Making an informed choice can be essential when it comes to a patient’s health and medical treatment. Even though it is common and easy to get a second opinion of whether surgery is needed, it is an eye-opening experience to find out that none of the opinions were in agreement.
Most knee pain patients usually start off with their family physician or even an orthopedic surgeon who was referred by the family doctor. With an estimated 400 orthopedic surgeons in Singapore, finding a doctor can be an easy but yet arduous task. The question is… how good is your knee doctor?
Questions to Ask During a Consultation
A patient should come prepared to a doctor’s visit with the questions that are important to understanding their particular condition. General questions about a doctor’s background and experience are important. For the doctor’s part, he or she should be able to answer the questions asked in history and about the physical examination and will be anticipating questions about the patient’s diagnosis and prognosis. These processes will vary, depending on the patient’s underlying problem, as well as the specific treatments offered by the particular doctor. Usually the doctor will have brochures or other printed materials about the diagnosis and its treatment, and will be able to steer the patient to websites that are reputable sources of information. On a more specific note, patients may also want to take into account the following questions: Were my condition diagnosis and treatment plan explained to me to my satisfaction? Do I understand what I should and should not be doing? Has the doctor discussed how this will affect my job, recreational activities and other aspects of my life? Will I be able to continue working? What are my restrictions? When do you expect to change my functional status? Should I be expecting future surgery? What are the risks involved with surgery? What can I expect post-operatively and long term? How many of these procedures have you done? What are the results? This time off work is tough for me financially, when can I get back to work? It is the quality, duration and end results of treatment discussed during these visits, which ultimately prove the value of the care provided.
Post-Treatment Follow-up and Support
After receiving treatment from your knee pain doctor, it is important to maintain regular contact with the doctor and staff in order to maximize the outcome of what you have just undergone. During the treatment of knee pain and arthritis, it is imperative that you follow up with your physician on a regular basis. By doing so, the doctor can monitor your progress and response to the treatment. This can be done through a variety of methods, such as in-office follow-up appointments, telephone calls, or repeat visits to the knee pain clinic. All of these allow for effective communication between you and your doctor. Should your progress be deemed unsatisfactory, early detection of recurrent symptoms or worsening of the condition will allow for timely implementation of alternative and more aggressive treatment. Failure to follow up routinely can result in unnecessary prolonged pain and swelling, further progression of arthritis and meniscal damage, and an overall poor result of the treatment. If you find that there is no improvement or worsening of your condition despite the intended treatment, do not hesitate to seek an earlier follow-up with your doctor in order to address the current issues. Remember, your commitment to your doctor’s treatment plan is the key to a successful outcome.