Understanding Knee Pain
There are many important aspects to understanding knee pain that the patient should understand in order to achieve maximum benefit from a consultation with a knee pain specialist. They include the causes of knee pain, the symptoms of knee pain, the diagnosing of knee pain, and the treatment of knee pain. The causes of knee pain can be injury resulting from sport or a sudden movement, or from the wear and tear experienced over a period of time. The causes can be disease or a mechanical problem such as a dislocated knee cap. The pain may be sudden and acute, or it may be a chronic long-term pain. The initial symptoms of an injury can be the swelling of the knee, warmth and redness in the joint, and a feeling of weakness in the knee. Symptoms may come and go, or the pain can be continual. In later life too, a knee pain specialist understands that knee pain is common and not just experienced by athletes. The pain can manifest from an injury that occurred earlier in life. Before assessing the symptoms of knee pain, an understanding of the mechanics of the knee is required in order to try and establish the different causes of pain. Given that the knee is formed by the joining of the thigh bone to the shin bone, the ability to move the joint relies on the support of ligaments joining bone to bone and holding the two bones together. Stability is achieved by the four ligaments within the knee itself. The most common of these joint pains is anterior knee pain resulting from problems surrounding the knee cap. This can be assessed by the location of pain under the knee cap and a feeling of giving way in the knee, and a knee pain specialist will understand this is due to the tracking of the knee cap against the thigh bone. Sudden pain or swelling can be a symptom of a torn ligament, and pain in a specific location can be an indication of a possible stress fracture.
Causes of Knee Pain
Dupuytren’s contracture. Treatment is not usually available for this condition, diagnosis is made by the characteristic appearance of the patient’s small finger. Flexion deformity of the fingers can also be caused by damage to the ulnar nerve at the elbow. High pressure injection of steroid with local anesthetic around the nerve can sometimes return the finger to the normal position but the effects are not usually lasting and the treatment can be difficult and painful to perform.
Meniscal tear. The menisci are crescent-shaped cartilage pads which act as shock absorbers in the knee. They can be torn during activities which cause a person to forcefully twist or rotate the upper leg while the foot stays still. Very severe pain and inability to continue activity with some swelling and joint locking are common symptoms of a torn meniscus.
The knee joint is a common site for acute injury. A few of the common problems which cause acute knee pain are: torn ligament, severe pain with rapid swelling. This will often involve joint instability and feeling the knee giving way. A common injury is seen in people who play football and rugby but can occur with a trivial slip on the floor. A torn ligament can be associated with a pop or snap at the time of the injury.
The knee joint is particularly susceptible to damage and pain because it takes the full weight of your body and any extra force when you run or jump. The knee joint pain, sometimes very severe, should not be confused with the pain from the patella-femoral joint, which is the pain under the kneecap. Very severe pain from minor injury or broken blood vessels around the joint is always a sign that there is something significantly wrong with the joint.
Symptoms of Knee Pain
You will feel different sensations or identify abnormalities when experiencing knee pain. The nature of the pain will depend on the underlying problem. Symptoms of knee injury can include pain, swelling, and instability. Pain can be the result of a ligament sprain or a meniscus tear. Swelling is a common response to an injury. The degree of swelling can indicate the severity of the injury. Severe swelling often indicates a more serious injury. If the swelling occurs rapidly and is intense, it is recommended that you see a specialist soon. Stiffness often is associated with pain and swelling. The stiff feeling can be the result of accumulation of scar tissue, formation of a cyst, or the body’s response to pain to protect the affected area. High-grade articular cartilage injuries often cause symptoms of catching, locking, or giving way. This can inhibit your ability to fully extend or flex your leg. If limited to your knee, catching is often an indication of a meniscus injury. Locking and giving way can be due to ligament injuries, meniscus tears, or a loose body in the knee. Instability is usually associated with ligament injuries and can be an indication of joint laxity. This occurs when your knee buckles or gives way with activity. A feeling that the knee is going to give way, particularly on uneven surfaces, is a common symptom of chronic ACL deficiency. Pain on the back of the knee/leg, particularly at night, can be a symptom of a hamstring insertion injury or popliteus strain. These symptoms can be related to a variety of injuries and should be discussed with a physician for proper diagnosis.
Diagnosing Knee Pain
X-rays can be an important step in diagnosing the cause of your knee pain. They provide detailed images of dense structures, like bone. This test is particularly useful to evaluate the alignment of the bones and to look for fractures. X-rays can also help determine if there is any degeneration of the joint caused by arthritis. After examining your knee and ordering X-rays, your physician may immobilize your knee in a brace to take pressure off the joint, and schedule another follow-up visit to re-evaluate your symptoms. This trial can be helpful in determining if the location of the pain is arising from the joint, or from a muscle or ligament that crosses the joint. For more detailed information to further define the problem, MRI is an excellent tool. This test provides 2-D and 3-D images of various densities and is useful in determining abnormalities of ligaments and cartilage. With a combination of a detailed history, physical examination, and the above tests, an accurate diagnosis can almost always be made. This is essential to give you a meaningful understanding of your problem, a prognosis, and a plan as to how it can be fixed.
After collecting subjective and objective information, a physician can learn a lot about the cause or causes of your pain. It’s at this point that specific tests may be recommended to further define the problem.
Treatment Options for Knee Pain
It is essential to ensure that the injured knee has fully recovered before returning to the previous activities. This can be judged on the basis that the knee is not painful, swollen, or giving way and that there is no significant difference in strength or endurance between the injured and uninjured legs.
In the case of severe pain, muscle inhibition, and delayed recovery, it is wise to seek professional opinion from a physiotherapist. A physiotherapist is a health professional who can assess and treat the mechanical problems that affect the knee and its muscles. Treatment with electrotherapy modalities such as ultrasound or interferential may help to reduce pain and swelling. In more severe or persistent cases, a comprehensive exercise therapy program will be required. A physiotherapist will be able to outline a suitable rehabilitation program that is tailored to the individual’s needs and goals.
Regular training of the thigh muscles (quadriceps) is important for rehabilitation. Strong quadriceps muscles are important for absorbing the shock from activities such as walking, running, and jumping. Failure to retrain the quadriceps is a common reason why people re-injure their knee. There are many ways to train the quadriceps. Initially, the aim should be to attain some degree of muscle activation or contraction without aggravating the knee pain. This can be achieved by using a simple ‘static quadriceps setting’ exercise.
One of the most important aspects of helping the injured knee to recover is to find physical activities that do not aggravate the problem. In the long run, one should be aiming to return to running and jumping activities. In the short term, it is beneficial to take up an alternative activity such as swimming or cycling. Swimming and cycling place minimal stress on the knee joint and are excellent for maintaining general fitness.
Surgical Procedures
The main success of a PKR is to relieve the pain of arthritis in one of the three compartments of the knee. In PKR only the affected compartment is replaced with metal and plastic components. This is usually recommended for older people who are less active and who have advanced arthritis. Younger people with arthritis in one compartment of the knee and a history of anterior cruciate ligament (ACL) deficiency may also benefit from this operation. The recovery is quicker compared to a TKR due to the fact that it is a less invasive operation and there is less blood loss. On average people will stay in hospital for 3-4 days and they can return to driving at around 4 weeks post-op. Full recovery may take 3-6 months.
Arthroscopy is a useful procedure for the removal of loose debris in the knee and to repair torn cartilage. It can be performed under local anaesthetic as a day case. The surgeon makes small incisions around the knee and inserts a small camera and a lighted scope to view inside the knee. Then the surgeon can remove the torn cartilage or loose bone fragments. The advantages of arthroscopy are the minimal hospital stay and quicker recovery with a return to work within a few days. This is not an option for every person with knee pain.
There are three main types of surgery for knee pain. These are arthroscopy, a procedure to repair damaged cartilage; a partial knee replacement and a total knee replacement. Your surgeon will discuss with you what the best option is for you. Factors such as the state of the knee problem, whether arthritis is present and your age and level of activity all have to be taken into consideration.
Rehabilitation and Recovery
Rehabilitation programs that incorporate physical therapy and exercise can be very effective in treating chronic knee problems. These programs, designed in conjunction with a physician and a physical therapist, usually begin with a protective weight bearing range-of-motion program that is used for about 4 weeks. The individual will work on fully extending the knee and regaining straight line movement. Once straight line movement has been achieved, he or she can begin to work on strengthening the muscles and ligaments around the knee. These exercises are very important in preventing future injuries. After 8 weeks of musculoskeletal strengthening, the individual can begin sport-specific exercises. This can be a very trying time for the individual, as progress may seem slow. But it is important that patience is exercised to prevent re-injury. A variety of equipment may be used during exercise. For example, an electrical stimulation machine may be used to reduce muscle atrophy and maintain quadriceps strength. Closed kinetic chain exercises using the leg press have been shown to cause less stress on the ACL graft than open chain exercises. Moderate and heavy resistance exercise has been shown to be safe and effective for the progression of strength and athletic ability. The time frame for return to activity can range from 5 months to a year, depending on the type of injury and the surgical procedure that was performed. Easing back into sports and other activities can help prevent re-injury. An individual who runs out and plays a game of basketball after 8 months of knee rehabilitation is at a much higher risk for re-injury than an individual who slowly works back into these activities over a period of time. A slow and steady progression after rehabilitation can help the individual avoid future knee problems, which often times are more severe than the first.
Finding a Knee Pain Specialist in Singapore
There are an increasing number of general practitioners and orthopedic surgeons in knee pain Singapore that say they can manage knee pain due to arthritis with viscosupplementation and have a special interest in this area. This is in part due to the increasing number of joint injections that they are doing as viscosupplements become more popular. While many of these doctors are able to effectively provide symptomatic relief for arthritis of the knee, they are not all necessarily knee pain specialists. The reason for this is that while viscosupplementation can help to provide symptomatic relief for arthritis of the knee, it is not always suitable for all types of knee arthritis and knee pain, and it is generally not a long-term solution for the underlying problem. An example would be a younger patient with an injury to the meniscus or articular cartilage of the knee causing pain and swelling. This patient may not benefit from an injection and will require a doctor with a sound understanding of arthroscopic surgical technique and the right indications for surgical management.
Once you have made the decision to see a knee pain specialist, you must understand that there is an abundance of choice when it comes to picking one in Singapore. There are many different types of doctors that can help alleviate knee pain, which can make it a daunting task to find the right doctor. The musculoskeletal system (bones, muscles, and connective tissues) is complex and intricate, and therefore managing and diagnosing the problems that can occur can be quite specialized. Therefore, selecting the right knee pain specialist can be the difference between obtaining an accurate diagnosis and the right treatment plan or continuing to suffer from knee pain.
Importance of a Knee Pain Specialist
It is often alarming and frustrating for most individuals who suffer from knee pain. For serious knee injuries, an early knee specialist consultation is crucial to understand the problem and avoid further aggravation. In addition, knee pain can emanate from different anatomical locations, therefore the accurate diagnosis is paramount to direct the appropriate treatment. The knee joint is a common location for arthritis. This is characterized by pain, swelling, and stiffness within the joint. The importance of early knee specialist consultation is again highlighted to halt the progression of arthritis and to minimize pain and maximize function of the knee joint. A recent review for the management of people with rheumatoid arthritis supported the benefit of seeing a therapist to delay the onset or progression of disability. This can be achieved through a combination of joint protection/orthotic devices, pain-relieving modalities, specific strengthening exercise for the muscles around the knee joint, and advice on activity modification to offload the affected part of the joint. With an increasing aged population in Singapore, knee pain from degenerative changes such as meniscus tears and osteoarthritis will become a significant healthcare issue. A knee pain specialist is able to offer non-invasive and invasive management options to provide pain relief and improve knee function. An example of non-invasive management would be a series of knee joint injections with hyaluronic acid, and for invasive treatment, a total knee joint replacement. With the myriad of knee injuries and pathologies, seeing a knee pain specialist would ensure an accurate diagnosis and the most effective treatment.
Factors to Consider when Choosing a Specialist
You need to find out whether your potential specialist has dealt with many cases similar to yours. This could include your specific diagnosis (e.g. tendon injuries, arthritis, ligament injuries), your age group, or your activity level. For example, a young athlete with an anterior cruciate ligament tear might be keen to find a specialist who has experience in arthroscopic ACL reconstructions and has a good track record with patients returning to sports. This could be different from an older, less active individual with the same diagnosis, who may be more inclined to find a specialist who has good methods of managing the condition conservatively without surgery. An easier way to find relevant specialists is to ask your potential specialist to see any relevant studies that they may have published or any involvement in teaching on courses related to your condition.
It helps to know the background of your potential specialist. Orthopaedic surgeons have completed medical school and then five years of postgraduate surgical training. After obtaining their basic medical qualifications, they have to pass basic surgical training exams to ensure that they have a good general knowledge of surgery before they can move onto higher specialist training in orthopaedics. During higher specialist training, they will sit for the final fellowship exams in orthopaedics. This whole process will typically take ten years. General practitioners and physiatrists also share the same basic medical qualifications. All three specialists will be able to assess your condition and prescribe medications. However, only orthopaedic surgeons will have the ability to perform keyhole surgical procedures and arthroplasty if the condition of your knee warrants it. This could be an important factor if you are in need of these procedures.
The number of orthopaedics, physiatrists, and general practitioners who profess an interest in managing knee pain might be surprisingly few. There are a number of factors to consider when trying to decide who is best qualified to help you.
Top Knee Pain Specialists in Singapore
For such a specialized search, there are some illustrious knee pain specialists in Singapore. The following knee pain specialists come highly recommended and are familiar with treating soccer-related injuries: Dr. Kevin Lee, founder of the Singapore Sports and Orthopaedic Clinic, Dr. Leslie Leong, Dr. Lim Yi-Jia, and Dr. Teo Yee Sze. Dr. Kevin Lee is an orthopaedic surgeon who has a special interest in knee and shoulder arthroscopic surgery and has also specialized in the treatment of muscle and ligament injuries. He also has a very extensive record with treating national athletes. National University Hospital (NUH) orthopaedic surgeons, Dr. Leslie Leong, Dr. Lim Yi-Jia, and Dr. Teo Yee Sze are also specialists that are very familiar with treating soccer-related injuries. They are all trained in general orthopaedics and have gone on to do fellowships in the US and sub-specialize in various areas of orthopaedics. NUH is a public hospital and treatment costs are usually quite affordable compared to a similar treatment in a private hospital. Also specializing in sports orthopaedics, Dr. Leong is the current head of the division and has been a team physician for various national sports teams. Dr. Lim specializes in the treatment of cartilage injuries to the knee and has been actively involved in research in cartilage regeneration. Dr. Teo has a special interest in ACL injuries and has vast experience in arthroplasty of the knee. With so many accomplishments and coupled with a solid track record treating athletes, any one of these specialists would be a wise choice for a soccer player with a knee injury.
