knee arthritis vs knee tendonitis?

[dblaisde]

I've been having knee pain for quite some time (a year), and it comes and goes but has lately gotten disabling (I had to buy a cane at one point). The pain is located on the right side of my left leg just south of the patella and to the immediate left of the patella tendon. There's a small natural pocket there, and the pain is pretty much in that small space.

I thought from reading that this was patella tendinitis, but went to Bumrungrad yesterday to see Dr Wichan who says its patella arthritis, more precisely Patello-Femoral Arthritis. I've noticed that the treatment for the latter problem is almost the opposite of the treatment for the former. If I treat a tendinitis problem with an arthritis treatment, the 'net says it'll get much worse.

Dr Wichan seemed to base his diagnosis on the fact that patella tendinitis is much rarer than patella arthritis, particularly at my age (69), plus a few questions on the nature of the pain and a brief manipulation of my knee cap. There were no lab tests done.

1) Is it as easy to differentiate between the two problems as he seemed to be saying?

2) Are there tests I can do myself to confirm or refute his opinion?

3) Is there another Doc I can get a reliable second opinion from?

I don't want to screw up my knee because of a faulty diagnosis.

Thanks in advance for any help.

Edited June 30, 2016 by dblaisde

[Sheryl]

Arthritis is diagnosed with an Xray, which will show degenerative changes (wearing away of the cartilege). Did he not do one?

Both conditions respond well to NSAIDs (provided you have to contraindications to taking them). Both also respond well to PT/exercises with special attention to quad exercises.

[NickJ]

Kinda my whellhouse....plain film, x ray can reveal alot. Inflamation can be an issue. so the correct medication can help. body habitus as well. are u fat?...also past traumatic injury is a factor. If you are in a condition to PROPERLY strethen the quads is also important. If you were my patient and in good enough condition I would start a regime of anti inflam meds and staric strenthing of the muscles....back against the wall and in a semi seated posistion in 30 sec intervals degree of said posistions not to cause pain but muscle burn. 30 sec three times . three times at each time...then start walking with good footwear.....and advance from there....simple srupid easy. but consistency the key. Rehab is a slow gradual process

[NickJ]

This humid weather is hell on joints as well

[dblaisde]

Arthritis is diagnosed with an Xray, which will show degenerative changes (wearing away of the cartilege). Did he not do one?

Both conditions respond well to NSAIDs (provided you have to contraindications to taking them). Both also respond well to PT/exercises with special attention to quad exercises.

No, no Xray. Nothing except a few questions and palpitation of the knee. He was half asleep (yawning constantly) when I got there and his mind seemed somewhere else. I think maybe he just wanted to get me out the door and not wait around for xray results. It was right at the end of his shift.

Any suggestions about another Doc, or just find any that deals with knees and will give me an xray?

Edited July 1, 2016 by dblaisde

[mcfish]

1st thing to do is get the pain under control. What meds you taking?

[dblaisde]

1st thing to do is get the pain under control. What meds you taking?

Tramadol and Paracetamol.

But I think the first question is "what the hell have I got".

[Sheryl]

No, no Xray. Nothing except a few questions and palpitation of the knee. He was half asleep (yawning constantly) when I got there and his mind seemed somewhere else. I think maybe he just wanted to get me out the door and not wait around for xray results. It was right at the end of his shift.

Any suggestions about another Doc, or just find any that deals with knees and will give me an xray?

Yes. Dr. Panya at Bumrungrad is the top knee specialist and very good and thorough

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

[mcfish]

1st thing to do is get the pain under control. What meds you taking?

Tramadol and Paracetamol.

But I think the first question is "what the hell have I got".

Im on Tramadol as well for nerve pain. I always put pain control 1st because you cant function properly with pain and you can then take your time to research what you have.

However tramadol does absolutely nothing for my knee pain. I use Diclofenic for that which is very effective

[dblaisde]

No, no Xray. Nothing except a few questions and palpitation of the knee. He was half asleep (yawning constantly) when I got there and his mind seemed somewhere else. I think maybe he just wanted to get me out the door and not wait around for xray results. It was right at the end of his shift.

Any suggestions about another Doc, or just find any that deals with knees and will give me an xray?

Yes. Dr. Panya at Bumrungrad is the top knee specialist and very good and thorough

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

That's JUST what I wanted to know. A new face for me there. I thought I knew the entire Orthopedic staff...but no! "Thorough" (as in conscientious) is a very good adjective for a doctor.

Thanks again!

[dblaisde]

1st thing to do is get the pain under control. What meds you taking?

Tramadol and Paracetamol.

But I think the first question is "what the hell have I got".

Im on Tramadol as well for nerve pain. I always put pain control 1st because you cant function properly with pain and you can then take your time to research what you have.

However tramadol does absolutely nothing for my knee pain. I use Diclofenic for that which is very effective

Unfortunately I have gastroparesis, which is basically an irritated inflamed stomach, so the Diclofenic is probably a no-no for me. My pain is only after walking for awhile, but as I say, I'm not even yet positive what the problem is. Tendon, cartilage, meniscus? And the treatment for one problem will make the other problem worse, and vice versa. What I need are xrays and maybe an MRI.

[chubby]

an xray which is very basic, will just show how much joint space there is, since cartilage doesn't show up on xray a narrow joint space implies that the cartilage is worn -> "arthritis" .

tendonitis differential, might just be done, best, empiracally, by injection of some steroids into the ligament, if the symptoms go away soon after, then that may be what you got, 'course, you may have both.

long term use of NSAIDs in the older folks, is not a good idea, as you can end up with stomach ulcers,

you can try isometric straight leg lifts every day, protecting the joint, by not having move while strengthening, as the quads are shocks absorbers for the knee, though I think not so much for a patella problem.

funny taking tramadol already, but never had an xray

[GAJ]

1st thing to do is get the pain under control. What meds you taking?

Tramadol and Paracetamol.

But I think the first question is "what the hell have I got".

Im on Tramadol as well for nerve pain. I always put pain control 1st because you cant function properly with pain and you can then take your time to research what you have.

However tramadol does absolutely nothing for my knee pain. I use Diclofenic for that which is very effective

It makes you feel better about it if you take a couple of 50mg capsules now and then

Agree about the Diclofenac, worked quite well for me

[mcfish]

1st thing to do is get the pain under control. What meds you taking?

Tramadol and Paracetamol.

But I think the first question is "what the hell have I got".

Im on Tramadol as well for nerve pain. I always put pain control 1st because you cant function properly with pain and you can then take your time to research what you have.

However tramadol does absolutely nothing for my knee pain. I use Diclofenic for that which is very effective

It makes you feel better about it if you take a couple of 50mg capsules now and then

Agree about the Diclofenac, worked quite well for me

400 mg a day of Trama for the last 10 years . Its a life saver and apart from a low level buzz i can barely feel it but its a wonder drug and a bit of a hassle now that Thailand has listed it as a controlled substance...thank goodness for Pattaya pharmacies

[Sheryl]

Tramadol is not listed as a controlled drug. It is still legal OTC. However, they are now enforcing the requirement that the pharmacy have a grade one pharmacist present at all times and that sales be recorded. These are actually requirements for most OTC drugs but seldom enforced and did not used to be enforced for tramadol but now is.

Many pharmacies (in fact most) don't have a grade one pharmacist around all the time, and many also do not want the record keeping hassle. Hence the difficulty finding it.

[dblaisde]

Tramadol is not listed as a controlled drug. It is still legal OTC. However, they are now enforcing the requirement that the pharmacy have a grade one pharmacist present at all times and that sales be recorded. These are actually requirements for most OTC drugs but seldom enforced and did not used to be enforced for tramadol but now is.

Many pharmacies (in fact most) don't have a grade one pharmacist around all the time, and many also do not want the record keeping hassle. Hence the difficulty finding it.

Thanks for clearing up the confusion because my pharmacist in Bang Saphan has no scruples about giving me two months supply at one go. I thought this was due simply to disregarding the law but maybe he's a "grade 1", since he's the owner and sole employee of the shop. I also did some, um, "preemptive buying" before it went off the shelves (or under them). I find it a useful drug and much kinder on the stomach than the NSAID alternatives.

[NickJ]

When you see a cutter or his pal. They always wanna cut or replace....but hell yeah if insurance pays......no reason to get to a reasonble weight or eat correctly....and yeah....these are my favorite shoes. been wearing em years...yee ha.

[mcfish]

Tramadol is not listed as a controlled drug. It is still legal OTC. However, they are now enforcing the requirement that the pharmacy have a grade one pharmacist present at all times and that sales be recorded. These are actually requirements for most OTC drugs but seldom enforced and did not used to be enforced for tramadol but now is.

Many pharmacies (in fact most) don't have a grade one pharmacist around all the time, and many also do not want the record keeping hassle. Hence the difficulty finding it.

Thanks thats an eye opener. And I feel a bit better now knowing if I get busted leaving my Pattaya chemist with a 1000 pack that I wont be going to prison for 10 years

[dblaisde]

No, no Xray. Nothing except a few questions and palpitation of the knee. He was half asleep (yawning constantly) when I got there and his mind seemed somewhere else. I think maybe he just wanted to get me out the door and not wait around for xray results. It was right at the end of his shift.

Any suggestions about another Doc, or just find any that deals with knees and will give me an xray?

Yes. Dr. Panya at Bumrungrad is the top knee specialist and very good and thorough

https://www.bumrungrad.com/doctors/Panya-Wongpatimachai

I went to see him yesterday. The upshot: Dr Wichan was wrong, dead wrong in his diagnosis of arthritis. I've got mild patella tendonitis and almost no arthritis (exellent for my age he said). He said that if I did have patella arthritis it would hurt to move the patella up an down in its groove under pressure, and I'd hear it grinding. So he was mostly listening to my patella. There's a telltale clicking also. Why Wichan coulding figure this out, I don't know, but it solidifies my opinion about him based on other experiences I've have with him at Lerdson Hospital. Dr Panya is very much on-the-job. Thorough and knowledgeable. Thanks again.

There *is* pain where the patella tendon meets the patella, which I pointed out to him as I did for Wichan. For him, this meant tendonities without hesitation. For Wichan is don't know *what* it meant. He didn't even comment on it, except to say "tendonitis" because "arthritis in your age is very common and tenonitis is very rare. "Thanks Doc. Now can I have my money back?"

[Sheryl]

Glad it worked out. This reinforces the importance of selecting the right doctor (and also getting a second opinion if in doubt about what another doctor has said/done).

Dr. Panya is the very best IMO for knee issues.

[dblaisde]

I'm curious: how did you find out about Dr. Panya?

PS: Dr Wichan's credentials look good enough when I looked him up:

NAME: Dr. Wichan Kanchanatawan

SPECIALTY: Orthopaedics (Bone) - Orthopaedics (Bone), Sports Injuries Orthopaedics (Bone) Orthopaedics (Bone) - Orthopaedics (Bone), Foot & Ankle Surgery Language Spoken: Spoken: English, Qualifications: Medical School: - M.D., Faculty of Medicine, Chulalongkorn University, Thailand, 1989 Board Certifications: Diploma of The Thai Board of Orthopaedic Surgery, 1995

FELLOWSHIPS: - Sport Medicine & Harvard Shoulder Service, Massachusetts General Hospital, USA, 2000 Special Clinical Trainings: - Sport Medicine - Shoulder Surgery Special Clinical Interests: - Arthroscopy - Knee and Shoulder Surgery

---

Can't do any better than Mass. General Hospital. (I'm from Boston so I know, and have been there a few times). Top notch on all the national ratings.

Edited July 6, 2016 by dblaisde

[Sheryl]

I don't recall where I first heard of him, he is very well known in Thailand as the "go to" doc for knee issues and many TV members have used him.

[dblaisde]

I don't recall where I first heard of him, he is very well known in Thailand as the "go to" doc for knee issues and many TV members have used him.

Thanks.

My only fault with his service is that I left there without any exercises for stretching or strengthening that might help this from happening again. This was in part my fault because I forgot to ask, but I would think he'd have mentioned it unless he thinks it won't help. The only advice I got was "just walk through the pain and avoid stairs". Walking through the pain sounds like an invitation to even worse pain but what do I know.

In any case I found somethings online which seem to be helping a lot. The point being that the stress on the tendon can be lessened by stretching the tendon itself and loosening the quadriceps muscle which uses it.

These two internet goofballs showed me how it's done. For what ever reason, 2 days of these stretches have made me symptom free.