The movement of the patella in the trochlear groove is controlled by the contraction and relaxation of the quadriceps and its angle of pull on the patella. During movement, the kneecap shifts up and down in the femoral groove. Altered tracking or tilting of the patella in the femoral groove can cause increased pressure between the patella and the underlying femur. This pressure can cause damage to the articular surface and the back of the patella, resulting in pain and swelling.
The patellofemoral joint provides the leverage for the quadriceps muscles in our thigh to straighten the knee. The patella, or kneecap, is attached to the quadriceps muscles by the quadriceps tendon. The kneecap is also attached to the shin bone (tibia) by the patellar tendon. This complex lever system allows us to bend and straighten our knees with a minimum of effort, gliding the muscles over the bones.
Anterior knee pain is a common problem where pain is felt over the front of the knee, around the knee cap, and sometimes on the inner side of the knee. It can affect people of all ages and does not necessarily result from an injury. The pain can be due to a specific condition – patellofemoral pain syndrome – or it can be from more general causes like overuse during growth spurts. Overuse injuries can cause significant problems if ignored. In some cases, they may result in permanent damage and disability if not treated promptly.
Causes of Knee Pain
The bone structure of the knee joint is formed by the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the kneecap (patella). These are all held together by ligaments, which are tough bands of tissue that connect one bone to another. The knee joint has two types of ligaments. These are the collateral ligaments, which are found on the sides of the knee and control the sideways motion of the knee, and the cruciate ligaments, which are found inside the knee joint and control the back and forth motion of the knee. Any sudden movements, such as twisting the leg while the foot is planted, can cause the ligaments to over-stretch and in severe cases, tear. This can cause extreme pain and there may even be a popping or a snapping sound upon the injury occurring. Those with only a partial tear may still be able to walk with minimal pain. A complete tear can cause instability of the knee and it may feel as though the knee cannot support your body. This is usually followed by swelling and is almost always painful. A complete tear can make the knee feel as though it is giving way and certain activities may be impossible to perform. An especially severe or complete tear may require surgery. Any damage done to the ligaments can increase the risk of developing osteoarthritis in that particular joint.
Arthritis is a group of conditions in which the knee joint becomes inflamed. There are three different types of arthritis that can occur in your knee. The first type is osteoarthritis. This is the most common form of arthritis in the knee. It is a degenerative “wear-and-tear” type of arthritis that occurs most often in people age 50 and older, but may occur in younger people too. It can affect any joint, but it occurs most often in weight-bearing joints, such as the knee. Osteoarthritis affects the entire joint. It causes changes in the cartilage and can cause the bone under the cartilage to change. This, along with the other types of arthritis, can be very painful and is the most prevalent cause of knee replacement surgery. The second type is rheumatoid arthritis. This is a chronic disease that can affect many joints, including the knee. It is an autoimmune disease, which means the immune system attacks its own body. In the knee joint, the lining of the joint (synovial membrane) becomes inflamed and swollen. This disease process can destroy the cartilage and surrounding ligaments. The third type of arthritis is post-traumatic arthritis. This can develop after a serious knee injury. Fractures, ligament injuries, meniscus tears, and damage to the knee joint can increase the risk of developing this type of arthritis. This type of arthritis can develop years after the trauma to the knee occurs. Each of these types of arthritis can lead to pain and dysfunction in the knee joint.
Arthritis
The most important in management of knee arthritis is weight control and activity modification. Non-impact activities such as swimming and cycling would be less aggravating to the knee. Use of a walking stick can help to reduce the load on the affected knee. Exercise is vital to improve the strength of the knee muscles to help stabilize the knee. This would help to alleviate the stress on the knee joint. A good supportive pair of walking shoes or orthopedic shoes with insoles can help to cushion the load on the knee.
The common symptoms of knee arthritis are: – Pain with activity – Limited range of motion – Stiffness of the knee – Swelling of the joint – Tenderness around the joint
Rheumatoid arthritis is a systemic disease that can also cause harm to the body’s internal organs. Septic arthritis is caused by joint infection. Knee arthritis can be one of the more painful areas to be affected. There are three different types of arthritis that can occur in your knees. The most common type is osteoarthritis (wear and tear). Post-traumatic arthritis can develop after an injury to the knee. This type of arthritis is similar to osteoarthritis and can develop years after a fracture, ligament injury, or meniscus tear. The other kind of arthritis that can affect the knee is rheumatoid arthritis, which is a chronic systemic disease that affects the lining of the joints such as the knee. It can cause pain, stiffness, swelling, and limitation in the motion and function of the knee.
Ligament Injuries
Ligaments are tough bands of sinew that fasten bone to bone or fascia and act to stabilize a joint by forming a capsule and preventing excessive motion. The ligaments in the knee joint are sturdy, but are often stretched or torn in twisting or pivoting injuries. The severity of a ligament injury can be determined by the amount of pain and swelling and the extent of joint instability. Partial tears of ligaments can lead to joint instability that predisposes to further injury and eventually to complete tearing of the ligament. Complete tearing of the ligament is often accompanied by a “pop” in the joint and the feeling of the knee “giving way”. Complete tears of small ligaments can be stable while tears of large ligaments can be functionally disabling. For instance, a complete tear of the Anterior Cruciate Ligament (ACL) is often accompanied by swelling, a feeling of instability, the inability to continue activity, and significant pain. Complete ACL tears also have a high association with damage to the meniscus and articular cartilage. This can predispose to the early development of osteoarthritis in the knee joint.
Meniscus Tears
The meniscus is a piece of cartilage in your knee that acts as a cushion and stabilizer. There is one located on the inside of the knee and another on the outside. The most common way of injuring the meniscus is by twisting the knee with a planted foot. This can happen in activities like soccer, basketball, and volleyball. Meniscal tears are also fairly common in older adults because the cartilage weakens and wears thin over time. Whether you are young or old, the risk of a tear is higher if you have degenerative joint changes, which is just the fancy way of saying arthritis in that knee. This is because the cartilage is less pliable and more prone to being damaged. People with arthritis can often times sustain a meniscal tear from a movement as simple as getting up from a chair. Symptoms of a meniscal tear may include pain, stiffness, swelling, catching, or locking of the knee. Sometimes it will feel okay and the person will try and return to their sport and have it give way on them. If you think you have a meniscal tear, it is important to get it checked by a knee specialist. Leaving a torn meniscus unattended can elevate the risk of developing arthritis and increase the likelihood of needing total knee arthroplasty later in life. A knee specialist will be able to diagnose a meniscal tear based on your symptoms, mechanism of injury, and the results of a physical examination. Sometimes an MRI may be needed to confirm the diagnosis.
Treatment Options
Medications: Many different types of medications are used in treatment of knee pain. The most commonly used are a group of medications called non-steroidal anti-inflammatory drugs (NSAIDs). This is a large group that includes aspirin, ibuprofen, naproxen, and many others. These medications are helpful for conditions which cause inflammation in the knee. A specific type of NSAID called COX-2 inhibitors is also effective with less risk of causing stomach irritation. Another commonly used group of medications are simple analgesics, also known as pain killers. These are drugs like acetaminophen. Simple analgesics may be used in conditions which do not involve inflammation. The use of any medication must be weighed with the risks of possible side effects. This is a decision that needs to be made with the guidance of a physician.
Physical therapy: Exercise is considered the foundation of treatment for knee pain. The exercises prescribed will depend on the specific condition that is causing the knee pain. For example, quadriceps strengthening is helpful for many conditions. It might be done through straight leg raising exercises and short arc quadriceps exercises. These exercises are discussed in detail in the rehabilitation programs for specific conditions. Range of motion exercises are helpful for almost all conditions. It may consist of active or passive range of motion exercises. Additional physical therapy treatment may include use of modalities such as ice, heat, ultrasound, and electrical stimulation. The use of a support, such as taping of the knee or a brace may be helpful. Instruction in walking gait retraining is needed for patients with instability. Gait retraining may include the use of a different assistive device such as a cane or crutch. Taping and gait retraining techniques are discussed in more detail in the individual sections for specific conditions.
Physical Therapy
The health and function of articular cartilage is essential to preventing the occurrence of knee pain. Cartilage is a firm but elastic tissue that functions as a cushion between the bones of joints. It helps provide smooth and frictionless movement at the joint surfaces. Essentially, it increases the stability and mobility of movable joints. Articular cartilage can be damaged due to a variety of factors such as traumatic injuries, meniscal tears, and malalignment of the joint. Damaged cartilage has limited potential to revert back to its healthy state due to its complex structure and avascular nature. As joint pain is usually an indication of surface damage and/or irritation, articular cartilage could likely be a contributing factor. It often acts as a pain generator when it no longer functions in its normal fashion. Measures to treat knees with damaged cartilage have a strong emphasis on the restoration of smooth and painless mobility. Physiotherapists use many strategies to improve the knee health of those with articular cartilage problems. These may include stretching and flexibility exercises, aquatic therapy, and in more severe cases, specific exercises to offload the damaged area. Coordination with other health professionals such as surgeons is sometimes required.
Physical therapy is an appropriate initial treatment for patients suffering from chronic knee pain. Physical therapists are trained to treat musculoskeletal injuries. By design, the musculoskeletal system’s function is to move the body and each of its parts. The knee joint is crucial in movement. The degree of movement using the knee is largely dependent upon the elements of stability and mobility. Muscular stability is the key to maintaining the natural alignment and function of the knee. When there is an imbalance around the knee, whether it be due to an injury or poor development, the function of the knee will be altered and result in pain. Time is another factor which alters mobility. Simply with age, the strength and elasticity of the muscles diminish. When one’s activity level is relatively low, atrophy of the muscles surrounding the knee will be a detrimental factor. It has been shown that lack of muscular strength and balance is strongly related to the occurrence of chronic knee pain. Physical therapy can help re-establish the muscular strength and balance on which the knee greatly depends.
Medications
It must be noted that these drugs do not actually cure knee pain. They simply help to relieve the symptoms. It is important that you use these drugs as well as a form of treatment that will help to correct the problem. Anti-inflammatory drugs are known to be hard on the stomach and can cause problems when used for long periods of time. Be sure to consult your doctor if you experience any adverse effects. Other types of medications are available, especially those aimed at relief of arthritic knee pain. These drugs can be discussed with your doctor. Always consider your health and any possible drug interactions when taking new medications.
There are several types of medications that are known to be helpful in the treatment of knee pain. The types of drugs that are most commonly used to fight knee pain are anti-inflammatory medications. These are used to reduce the inflammation that occurs within the knee and is the main cause of pain for the patient. These medications do not actually correct the problem but are used to relieve the symptoms of knee pain. It is important to consult your doctor before taking any new medications. He will be able to tell you what drugs are best suited for you and he will also inform you of any side effects that may occur.
Injections
The use of viscosupplementation varies throughout the world. In the UK, it is not recommended as a form of treatment on the NHS but can be done on a private basis. The reason for this is that viscosupplementation has mixed results in clinical trials, with some showing no significant difference compared to corticosteroids for pain relief and functional improvement. Other studies have shown viscosupplementation to be effective for patients with more mild, moderate, and severe knee OA. Duration of pain relief varies from having no added benefit to providing pain relief for 6 months, a year, or longer. The use of viscosupplementation would be a decision made between the patient and physician. A factor that comes into play in decision making is that viscosupplementation is far more costly than corticosteroid injections.
Viscosupplementation injections involve the use of hyaluronic acid. Hyaluronic acid is a naturally occurring substance found in the synovial fluid of a joint. It works by acting as a lubricant and shock absorber in the joint. Increasing the concentration of hyaluronic acid in the joint can help to increase the joint’s resistance to compressive forces and also alleviate pain. The theory behind viscosupplementation as a treatment for knee OA is that adding hyaluronic acid to the affected joint may lessen pain and inflammation, and improve movement. Articular.
Corticosteroid injections are traditionally used to reduce inflammation. They are a potent anti-inflammatory agent which works by inhibiting the inflammatory response of the body when tissues are injured. By doing so, it effectively reduces pain. Corticosteroid injections are commonly given in the USA and can be done by any physician.
Surgical Procedures
A comparative surgery is a meniscus repair. This is performed in a circumstance where it is felt that the meniscus can be repaired, instead of totally evacuated. The recuperating procedure is any longer than a meniscectomy, with a more drawn out restoration period. The long haul advantage is that if fruitful, the meniscus will have been spared, lessening the danger of building up osteoarthritis at a later stage.
Another normal surgery is a meniscectomy. This is a surgery performed to expel a torn meniscus. The meniscus is ligament in the knee and aides pad the joint. There are two menisci in every knee. The removal of part or the majority of a harmed meniscus can incredibly help with knee torment alleviation. Be that as it may, the long haul impacts of this surgery can be an expanded danger of creating osteoarthritis.
A standout amongst the most well-known strategies is a knee arthroscopy. This is a strategy used to explore and possibly repair the harm inside the knee joint. The specialist will make a little entry point and utilize an arthroscope (a little camera) to research the knee joint. This method is perfect as the recuperating time is generally short.
Surgical procedures will be considered by your specialist only in the event that it is the main alternative left. There are numerous sorts of surgery which can be performed. The choice for the kind of surgery will rely upon the degree of the harm and the proposed action of the surgery.
Finding a Knee Pain Specialist in Singapore
For those living in Singapore or visiting from abroad, there are several viable options for finding a knee pain specialist. This could be done by searching the websites of public and private hospitals in Singapore for specialists in orthopedic surgery, rheumatology, or physical medicine. Many patients prefer to see a specialist in private practice as it is often more convenient and allows more time with the doctor for discussion and education. A simple and efficient way of finding a suitable knee pain specialist in the private sector is through the Singapore Medical Specialists website. This is a comprehensive online directory of specialist doctors in private practice, sorted by specialty and area of practice. Other than contact information, it provides a convenient way to gather information about the specialist’s qualifications and areas of expertise.
Your decision on a suitable doctor should be guided by the specific medical problem that you have. If you have a particular diagnosis, seek a specialist with expertise in that area. If you know which treatment you would like to have, find a specialist who can offer that treatment. If you are uncertain about the nature of your problem and its optimal treatment, seek a specialist who can guide you through options and offer an unbiased opinion. Finally, it is important that the specialist is able to give you the time and attention that you need.
It is vital in your quest for knee pain relief to consult with the right type of specialist. Your family doctor may be a good starting point and a source of primary advice. It is however advisable to see a specialist with a particular interest in knee problems and will have the expertise to guide you through the best course of treatment. These specialists may be orthopedic surgeons or doctors who have done additional training in rheumatology or physical medicine.
Researching Specialists
The most likely first approach to finding a specialist would be to “research beforehand” using the internet. Many of us are already familiar with the internet and its various resources. Whether the good information is free to access is another matter. This should be your first stop when you have finally decided to do something about your knee pain. Use a search engine to look for specialists in the field of knee pain Singapore and gather a list of names and clinics. There are various websites that allow you to search for specialists using criteria such as location, availability, and subspecialty. Try to make your criteria as general as possible, searching for specialist names that fit the highest number of criteria you are looking for. Gather a list of clinics and walk away from the computer. Take a moment to look through the specialist names and, using any resources available to you, try to gather some information on the specialists you have listed. This step is best approached by making the most of your social network. You may know someone in the health industry who has heard of a specialist name and can provide you with information. You may have family, neighbors, or coworkers with a similar history of knee pain who have visited a particular specialist and can provide feedback. This is also the time to secure referrals if you are confident of specific names. By the time you have finished this self-education process, you should have a pretty good idea of which specialist and clinic is best for you. This approach, while comprehensive, requires a fair amount of effort and autonomy on the patient’s part. It is probably best suited to those who are more at ease when provided with a great deal of information.
Recommendations and Referrals
As with finding any sort of healthcare professional, getting a recommendation from someone trustworthy is always a good start. As the majority of knee problems become more prevalent in the later years of life, it is likely that the individual will know someone, whether it be a friend or work colleague, who has gone through a similar process. With modern day demands, it is very common for individuals to keep physically active despite the ageing process. It is far more comforting and assuring to hear a personal testimony from a similar individual who has sought a knee specialist regarding their injury. A patient can also get in touch with their local GP for information regarding specialists. Most GPs will have a database of specialists with a brief rundown of their interests and specialties. This will allow the patient to source a specialist suited specifically to their problem. Step one, however, would be consulting the GP about the knee problem at hand. The GP may be able to provide a quick fix solution there and then, and it would save the patient money by avoiding fees from consultants. Should the GP recommend a specialist, it is feasible that the patient can then source further information about the suggested specialist from other people such as the methods listed above.
Once a patient has located a knee pain specialist, it would be wise to call the clinic to ask about the specialist’s availability to see the patient at a given time and also to ask about the charges before making an appointment to avoid disappointment. Be sure to have questions to ask the specialist about his qualifications, the exact problem with your knee, and the available treatments. Be observant about whether or not the specialist pays full attention to you and if he seems rushed or too hurried to explain your treatment. If you are not comfortable with the specialist, do not hesitate to get a second opinion from another specialist. A good knee specialist will take time to explain the problem and the required treatment.
Word of good service gets around in every line of work as someone, somewhere will have information on what you are seeking. Yet another easy and effective way to find a knee pain specialist in Singapore is to use Google to locate one in your area. Simply type “Knee pain specialist Singapore” in the Google search bar and you will be given the locations and names of various knee specialists in the area. A good knee specialist will be the one on the first page as that is usually prestigious to those who know about technology and is a reliable source to get good service. Only rely on this source if nothing has manifested from the previous methods mentioned before.
Patients suffering from knee pain are often unaware of how to effectively find a knee pain specialist in Singapore. Those with a family doctor who they can feel comfortable asking for a recommendation should start with that as they can be assured the doctor has their best interests at heart. Most of the time, family doctors are a reliable source to ask for a friendly recommendation for a knee specialist who is esteemed in his field. It is also beneficial to ask anyone in their workplace who has suffered from knee pain as word of mouth can be the best way to find a good service or product.
