Knee Pain

[twix38]

I have had knee pain for about 2 months now mainly in left knee. It started one morning when I awoke with it and it was worst then. Now it is variable. My knee internally clicks in full extension and back 90 degrees and the inner bone is often tender to feel. I know of no reason it started.

Brief history so far regarding treatment. 1st Hospital Doctor at Memorial suspected Gout and I took some tablets for 24 hours that I didn't like the sound of researching on internet (forgotten name for now). Only 5 tablets given and taken and no change. Subsequent Uric Acid result was normal and as I had expected this was a wrong guess and blood test result supported that, I did not continue.

2nd Hospital Doctor today at BKK/Pattaya. Checked knee and diagnosed Patellofemoral Arthritis.

Mentioned having an X-RAY and then later an MRI, but cost made me wait and so went down medication route only. Although I asked 3 times what medicine he was prescribing, I got no answer. I finally found out at the Hospital pharmacy. It was 20mg/day Omeprazole - I refused this as I already take it daily. Idarac 200mg x 1 tablet only. and Celebrex 400mg/day for 15 days and a return follow-up appointment.

These were both Orthopedic specialists.

I have rested my knee, cold compress, but the pain/discomfort refuses to go away completely for some 2 months now. I did doubt the Gout diagnosis from the start, but can accept that osteoarthritis or the Patellofemoral arthritis may well be right, but how does anyone yet know to be giving me tablets and what must I get done and what (like the Gout) is wrong/unnecessary?

My other questions are:

Is there any Hospital recommended in/around Pattaya or specific Orthopedic Doctor and I assume I should get an MRI? - where? I balked at the cost at BKK/Pattaya as told by nurse around 19,000 Baht plus all the add ons - doctors fee/nursing fee etc.

I am not sure I should be taking this Celebrex as first port of call and strength etc?

What is the way to deal with Patellofemoral Arthritis and am I going to get back to a normal pain free knee again - if so, How???

I am taking from my own research - Glucosamine Sulphate x 1500mg/day, Omega 3 x 2,000mg/day and plan to get some Chrondroitin Sulphate or mixed in with Glucosamine. Knee strengthening excersise.

I was expecting this problem to eventually disappear of its own accord and it does improve and then come back, but never as bad as the night it started. What tests/checks/remidies/medication or plain advice has anyone got please?

[Sheryl]

Do I understand correctly that you did not have even an X-ray??

And an Xray is absolutely necessary to confirm this diagnosis. WShereas an MRI is not needed unless the Xray fails to show a cause (in which case this is probably not the diagnosis).

If it is patellofemoerol arthritis, it is not likely to just go away although exercise and medication can help. Sometimes surgery is required.

See

http://orthoinfo.aao...fm?topic=A00590

And if this doctor truly did not order an Xray, see another doctor. Many top notch, US n=board certified orthopedic specialists at Burmungrad. in Bkk. Or, if you prefer closer to home and don't mind the longer waits/red tape of a government facility, there are good ones at Queen Sirikit Naval Hospital and costs there are quite low.

[ravip]

Hi,

I am a moderately active person who used to walk/jog 8 - 10 Km a day. Suddenly, I had almost the same problem with my left knee about one year ago. After many unsuccessful attempts to ease the pain with all types of medications finally a Specialist Rheumatologist diagnosed the problem as early stages of Osteoarthritis with an X-Ray of the affected knee.

Some medications I was prescribed along the way...

Neopyrozone

Neurobian

Celox R

Fastum Gel

Biclopan

Lomac

Paracetamol

Also I took

Carticare - Glucosamine Sulphate & Chrondroitin Sulphate Capsules

Reflex - Rosehip Powder Capsules - http://myreflex.info/index.html

Absolutely nothing worked and I was experiencing excruciating pain on my left knee. Even after continuing medication for more than 2 months, I came to a stage where I found it difficult to walk/climb steps. Sometimes I had to miss work too.

Knee/calf strengthening exercises were recommended. Was advised against squatting exercises – too much stress on the knee, I guess. But you must keep moving.

Finally in desperation, I consulted an Ayurveda Doctor (I had never experienced Ayurveda treatment before). After 5 weeks of continuous treatment, the pain vanished and today I am doing my 8 – 10 Km of walks/jog.

Never was a MRI recommended and the cost of Ayurveda treatment was very minimal.

Hope the above helps and would be glad to answer any questions you may have.

Hope you get well soon…

[twix38]

That is correct - no X-RAY and he didn't check what medication I was already taking and prescribed my only existing medication (Omeprazole - guess it's somehow relevant here too?) yet again and didn't answer me when I asked what he was prescribing.

As mentioned I was going to have an X-RAY and I asked how much (1,200) that was fine I said.

Then I asked a few other questions and he said to have an MRI. I actually said what about the x-ray?

He replied no, MRI better. As mentioned I was not willing there and then to have/pay for MRI and so he said go down medication route and return for follow-up.

Bumrungrad - That was where (you may remember) the specialist failed to diagnose my Barratt's Epithelium as I had an endoscopy and given anxiety tablets with no follow up recommended, whereas on return to UK a Gastroscopy was advised and condition of Barratts LGD found.

Frankly I despair with Thai doctors. Some appear not to have patients best interests at heart or are various degrees of incompetant and reach for either what's easiest, most likely correct guess or costly and the medicine rack, always with at least 2 different products prescribed. 3 seems typical. Anyway, I shouldn't tar all with the same brush, but it's my experience so far.

Anyway, I will try the Queen Sirikit and should I go for X-RAY or MRI? - if they have one

Cartilage cannot be seen on x-ray, but reduced gap can, I gather. Is x-ray sufficient for diagnosis of Patellofemeral Arthritis or whatever it's likely to be, going on my symptoms?

Should I be taking the Celebrex meanwhile or at all?

Ravip,

thanks for reply. I note it is an alternative treatment. My usual thinking is I avoid these and that may be to my cost, but I haven't found one that works for me. I know they are all different, but I tend to restrict myself to tried and tested main stream. If you can recommend a Pattaya proponent (locally) I may try it out, but I'm not likely to travel to try. Thanks

Edited February 19, 2012 by twix38

[ravip]

Yes, it is an alternative treatment. I too had never experienced it before. It was sheer desperation to rid myself of the excruciating pain I was suffering at that time and the lack of any other choice that actually drove me to this new treatment.

With the relief I experienced first hand, I never hesitate to ‘advertise’ the fact to anyone who may benefit from it – I still cringe at the thought of that pain!

Unfortunately, I have no knowledge to recommend anyone locally in Thailand or to give specific details of the medications I received – it was all plant & herbal material, I think.

[JSixpack]

You need an X-ray, as noted above.

Suggest you google and look on youtube for knee rehab exercises and stretches. I've used these w/ good success, avoiding medical interventions even though my knees are in rather poor shape from marathoning in younger days. I do these quite regularly, however; and they take time to show results.

Also an ice pack can be quite helpful. And you can try a heating pad or hot water bottle.

Edited February 20, 2012 by JSixpack

[FBN]

It may be a meniscus lesion as well with resultant osteoarthritis but a good clinical examination and a plain X-ray can go a long way to diagnose the problem. MRI is a second line investigation.

Alternate treatment options if you can't take anti-inflammatories (with the Barret's Esophagitis) may be an intra-articular injection of steroids but a very specific diagnosis needs to be made before this step..

Further treatment may include arthroscopy down the line.

The non-invasive measures some posters suggested above such as non-weight bearing exercise, knee mobilisation and muscle strengthening can be done in the mean time.

[Sheryl]

the omeprazole is to offset the gastric irritation that the NSAIDs will cause. likely you were already on it due to the Barrett's. Which if it worsens, will be because of these meds.

Xray as soon as possible and from your description I would indeed switch docs. Orthos at Queen Sirikit are reliable and will not try to sell you on unnecessary tests, but you'll want to have a Thai speaker along to navigate the red tape esp. on first visit.

[ravip]

Painkillers, NSAIDS, Injections, Knee Replacements... all these are temporary solutions, aren’t they? This was what I understood reading about knee problems like this and in my case Osteoarthritis.

[twix38]

Thank you all,

I will go to Queen Sirikit early next week when my Thai wife returns to assist and get an x-ray.

[JSixpack]

I dunno if you're overweight, but one the best things you can do for your knees is stay thin.

[ravip]

Hi txix, How did it go with your knee problem?

[tropo]

You mentioned: (Quote from OP) - "and the inner bone is often tender to feel".

This sounds like tibiofemoral arthritis to me - same as I have. The bone on the inside of the knee is tender to the touch - it's acutally the joint between the femur and tibia that feels tender.

Have you had it checked out yet? You didn't mention your age.

[glbv]

Ive had some serious knee pain in my life, 1 double knee orthoscopic surguries, 2 full, and 1 more to remove screws, all before i was 22. I had a powerlifting acident and inturn became overweight only makeing the problem worse. Droped 100lbs and now its fine 99% of the time.

Ive found the best thing for me is heat and heat compresses. The tigher the heat the better, if my knees get bad i will put on full knee braces and get into a steaming hot bath. This will help tremedously.

If its a arthiritis kind of pain, fish oils and glucosumine have been shown to help, a bit but its price vs effectiveness.

[23962323]

Knee pain is the pits,myself waited for months for the pain to go. Went to Queen Whateverthename, prescribed a ton of pills etc, I knew they were a waste of time,got estimate for operation to repair whatever the problem was at the other low cost hospital(compared to the high end ones in Patts)and that came to $8000 for openers,probably topping 12000 at the end.

Took the decision to quit Thailand for anything in the way of surgical intervention,for $300 flight return I had my knee MRI'd by state of the art imagining,operated on (torn lateral muscle,or something like),24 stay while recovery,and Bobs your uncle,few months after,all pain gone. cost $800