Knee pain 101 and the PRICE of treatment

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by Dr. Art Mollen, Special to azfamily.com

azfamily.com

Posted on June 5, 2012 at 8:48 AM

Updated Wednesday, Oct 30 at 9:15 AM

PHOENIX -- Knee pain is the most common musculoskeletal complaint that brings people to their doctor.  With today’s increasingly active society, the number of knee problems is increasing, as well.

The knee relies on a number of structures including bones, ligaments, tendons and cartilage.

The knee joint involves four bones. The thigh bone or femur comprises the top portion of the joint. The tibia provides the bottom weight-bearing portion of the join. The knee cap or patella rides along the front of the femur.  The remaining bone in the calf, the fibula, is not involved in the weight-bearing portion of the knee joint.

Inflammation is the body’s physiologic response to an injury.  In treating many types of knee pain, a common goal is to break the inflammatory cycle, which starts with an injury. 

After an injury, substances that cause inflammation invade the knee, which causes further injury, which leads to further inflammation, and so on. This cycle of inflammation leads to continued or progressive knee pain.  he cycle can be broken by controlling the substances that cause inflammation, and by limiting further injury to tissue.

Some common home-care techniques for knee pain that control inflammation and help to break the inflammatory cycle are protection, rest, ice, compression and elevation. This regimen is summarized by the memory device PRICE.

  • Protect the knee from further trauma.
  • Rest the knee.
  • Ice the knee.
  • Compress the knee with a knee brace or wrap. 
  • Elevate the knee.

Over-the-counter pain medication:  Commonly used pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a role in the treatment of knee pain.

These drugs directly control pain and, at higher does, act as anti-inflammatory agents, helping to break the inflammatory cycle.  Like all medications, these drugs have side effects.

Acetaminophen (Tylenol) can also be used to control knee pain but does not have the anti-inflammatory properties of NSAIDs.  Still, this treatment is remarkably useful in many types of knee pain such as osteoarthritis.

X-ray+of+a+right+knee+showing+lateral+view+of+the+femur%2C+patella+and+tibiaPhysical Exam: Depending on your particular history and exam, the doctor may suggest X-rays of the knee.  X-rays show fractures (broken bones) and dislocations of bones in the knee, as well as arthritis and abnormally large or small joint spaces. 

Rarely, the doctor may order a CT.  Box X-rays and CT scans are excellent for diagnosing fractures.  They both are also poor, however, at evaluating soft tissue structures of the knee such as ligaments, tendons and the menisci.

Magnetic resonance imaging (MRI) uses large magnets to create a three-dimensional image of the knee.  In contrast to CT scans, MRIs do not image bones and fractures as well.  MRIs are excellent for evaluating ligaments and tendons for injuries.

The orthopedic surgeon may elect to perform arthroscopy if you have chronic knee pain.  This is a surgical procedure where the doctor will insert a fiber-optic telescope into the knee joint.  The arthroscope is attached to a camera that relays real-time images to a video monitor.

By doing so, the surgeon may be able to see small particles in the knee or to look more closely at the damaged menisci or cartilage.

The doctor may also be able to repair damage by shaving down torn cartilage or removing particles from the knee while looking at the inside of your knee on a video monitor.

 


Dr. Art Mollen's practice is located at 16100 N. 71st St., Scottsdale. For more information call 480-656-0016 or visit www.drartmollen.com.


 

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