Every knee problem will not require interventional treatment by an orthopaedic specialist. Perhaps after a visit to the ER or Family Physician, pain and swelling from an acute incident can be managed using the old standby for injury treatment, PRICE (Protection, Rest, Ice, Compression and Elevation). Adding an over-the-counter anti-inflammatory medication, such as Ibuprofen or Aleve, can help most problems resolve without clinical intervention.
Many people, who have chronic knee pain from conditions like arthritis, are well-versed at managing the “ups-and-downs” of their pain and stiffness. Their treatment for knee pain includes over-the-counter anti-inflammatory medications, like Motrin or Aleve, heating pads, warm baths, muscle rubs – like Icy Hot or BioFreeze, and finding other ways to manage their discomfort, through exercise and paying attention to their bodies.
However, some patients will not respond to conservative home treatment or have a condition that has progressed to the point where more intensive intervention is needed. That is when they see an orthopaedic physician to ask for help with the problem.
When visiting OSC, patients will complete a history form that will tell us about any knee problems they have had and any other medical conditions about which we need to know. We will order x-ray studies (done in our office) of the patient’s knee to show whether or not any bone damage, arthritis or fracture exists. An OSC Orthopaedic Specialist will review those images with the patient while together in the examination room.
An examination of the patient’s knee includes the following:
1. Check the knee for swelling, discoloration, tenderness and pain
2. Assess the patient’s range-of-motion in the knee joint and if movement causes pain, ascertain which movement; test the knee for instability.
3. Ask the patient to point to the area of the knee that hurts
4. Ask questions about the pain, when it started, how did it start, when is it better or worse
5. Ask them what kind of home treatment they have tried
6. Evaluate whether physical therapy has been ordered and if so, how successful it was
Once the physical examination is complete, your physician will review your x-ray images with you. Your physician will point out any fractures or bone damage that may show up on the x-ray, and will share a diagnosis with you and what treatment that is recommended. If your doctor does not see a serious problem that needs immediate surgical intervention, he can recommend a variety of conservative treatment options in order to help with the pain, swelling and lack of strength and range of motion in the knee. These may include strong anti-inflammatory drugs, pain medications, physical therapy, bracing, taping. Occasionally, rest and time is the best treatment of all!
Sometimes, we will provide a brace to support and keep the knee immobile while it heals. We usually have patients try these conservative treatment modalities first for several weeks. We then have them come back to our office for a follow-up visit in 3-4 weeks. If, at that time, they have not improved, we may order an MRI (Magnetic Resonance Imaging) of the knee, to better understand if there is problem that did not show up on the x-ray images. MRI helps us to see what injury or condition may be affecting the soft tissues of the knee, such as those affecting ligaments, menisci and tendons.
After completing all of these steps, your physician may find that surgical intervention is necessary in order to fix the problem, restore function and to provide the best chance for a full recovery. For issues that do not respond well to ordinary, non-surgical treatments, most of these surgeries can be performed arthroscopically. Visit the Knee Arthroscopy section for more information.