Knee Joint Pain Management

Knee Joint is the largest joint in the body which can commonly be a site of pain. For those experiencing severe knee pain, treatment options range from conservative management to advanced interventional procedures.

Knee is the largest complex joint prone to osteoarthritis, sports injury. Relieved by an innovative techniques like PRF & USGDN. The hamstring muscles at the back of the knee serve to flex or bend the knee. There are many powerful ligaments which provide stability of the knee. There are many bursae or fluid filled sacs above below and back of the knee that help free movement.
Femur or thigh bone articulates with tibia or shinbone

Femur or thigh bone articulates with tibia or shinbone
Fibula is a smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint. Patella is a bone in the tendon of the quadriceps muscle which extends the knee, makes it straight.

Causes of Knee Pain:

Up to 40 percent of the population may have knee osteoarthritis, or “wear and tear” arthritis. This is the gradual breakdown of the cartilage in the knee. Also called degenerative joint disease, is caused by ageing, wear and tear of all the structures though only cartilage has been emphasized.

Chondromalacia patellae or patellofemoral syndrome or runner’s knee is a common cause of pain in front of the knee in young people. The cartilage on the underside of knee cap(patella) is irritated because of the patella going out of alignment because of unequal pull on the patella by the muscles forming the quadriceps. Rheumatoid arthritis affects women 3-5 times more than men and it usually starts at a young age in teens or in the twenties. In rheumatoid arthritis the body’s defences themselves attack the muscles tendons and the synovium of joints.

Bursitis is the inflammation of the fluid filled sacs around the knee meant for cushioning and protecting the knee. The most common sites are the suprapatellar bursitis in front above the patella and the Baker’s cyst behind the knee.

Tendonitis- tendons are the ends of the muscles that attach to the joints to move them. These tendons get inflamed due to overstrain, sports injuries.
There are several tendons around the knee which can get inflamed.

Knee pains due to injuries – Knee is a very vital weight bearing joint which can get injured due to falls, sports activities, trauma and degenerative changes of age that make the knee vulnerable to injury after trivial buckling slips or strains. The structures which get involved most often are the medial/ lateral meniscus, the supportive ligaments like cruciate ligaments (ACL).

Postsurgical pains after arthroplasty and knee replacement – Pain is a very major problem after any surgery particularly total knee replacement (TKR). According to a literature review published in 2020 post TKR pain occurs in 10–34% of TKRs, and 20% of TKR patients experience more pain post-operatively than pre-operatively. Specialized knee replacement surgery pain relief techniques have been developed to address this significant challenge, including targeted nerve blocks and comprehensive pain management protocols.

Sign and Symptoms:

The earliest change that occurs in an arthritic joint is joint inflammation with redness, warmth, swelling, tenderness and pain.
It can progress to deformity like bowing of the knees. Difficulty in walking, standing, getting up from sitting position.
In chrondromalacia patellae, the pain usually occurs just below the patella, causes a creaking sound with a grinding sensation particularly when climbing stairs and may occasionally cause buckling.
Rheumatoid arthritis affects joints on both sides of the body mainly the small joints of the hands and feet.
The bigger joints like the knee and hip are also affected. The soft tissues of the joint are majorly affected and later the articular surfaces and the cartilage of the joints are also affected.
It is characterized by inflammation, swelling and severe pain. Patients with post TKR pains come with moderate neuropathic pain to very severe incapacitating pain from a condition called CRPS.

Precaution:

Weight loss plays a major in preventing progression of knee osteoarthritis because knee is a weight bearing joint.
Regular exercise and prevention of fall in elderly is essential.
Maintenance of levels of Vit D3 and B12 plays an important role.

Treatment :

For patients suffering from severe knee pain, treatment approaches are customized based on the underlying cause and severity of symptoms.

Interventional treatments for knee pain – Commonly performed treatments for Knee pain are injections of viscosupplements (joint lubricants), anti-inflammatory agents, stem cell /platelet rich plasma. These advanced interventional procedures provide effective severe knee pain treatment options for patients who haven’t responded to conventional therapies.

Pulsed Radiofrequency
RF ablation of genicular nerves
USGDN

All of them have proven to be very effective.

In early cases of knee Osteoarthritis, USGDN of muscles of thigh, back of thigh, calf is all that is needed. But pain in patients with arthritic pains for more than a year, with attendant reduction in activity and deconditioning, would require treatment to address the nerves irritated by the constant synovial (joint lining) and muscle irritation. Hence, these nerves need to be treated. In patients where the joint involvement is mild to moderate (but the pain is severe) we do Pulsed radiofrequency (PRF) treatment for the entire nerve supply of the joint.

This is a treatment where a special radiofrequency generator converts electric current to radiofrequency waves which are then conveyed through a needle. This treatment reduces the pain transmission through the nerves so that it relieves pain. After this we do systematic USGDN of muscles to eliminate the muscle knots so that there are no residual pains. Since the USGDN targets muscle dysfunction patients regain the ability to be more active, like walking more, climbing and increase activities in general. In carefully chosen patients even moderate to severe arthritis responds to this combination therapy of RF, PRF and USGDN.

In certain patients, injections into the joint may be indicated. These injections include potent anti-inflammatory medications to reduce the pain and inflammation in the joint. Ozone injection into the joint can produce reduction of pain stiffness and inflammation. In patients with dry knees with significant friction and reduced movements, viscosupplementation to improve the knee lubrication, and a cushioning effect becomes very useful in mild to moderate osteoarthritis. In patients with tendon and ligament injury stem cells/ platelet rich plasma therapy is indicated. The platelet rich plasma is taken from the patient’s own blood and injected into the damaged ligament cartilage or tendon.

Summary:

These treatments are not just for providing pain relief but actually address the root cause of the problem of arthritis, that of restoration of easy friction free joint movement.

Whether you’re seeking knee replacement surgery pain relief or solutions for severe knee pain, treatment options are available to help restore function and improve quality of life.

Relaxation of muscle spasm reduces the inflammation at the tendons of muscles and hence it has a definite beneficial action in reducing the inflammation of rheumatoid arthritis. All these treatments are very useful in osteoarthritis rheumatoid arthritis, sports injuries, bursitis, tendonitis.

Knee Joint Pain Management

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Treatment :

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