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Neuros

Neuros

February 23 2016

Knee pain

How to manage knee pain in outpatient setting?

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Neuros
Neuros
February 23 2016 #

Knee pain is the 10th most common reason for outpatient visits. If patient presents with locking and catching (mechanical symptoms) ? Refer to orthopedics

PHYSICAL THERAPY WEIGHT LOSS

  • Physical therapy and weight loss are the Foundations of non-surgical treatment of OA related knee pain
  • Evidence shows that active management (stretching, strengthening, exercise) is more effective in decreasing knee pain than ultrasound therapy, electric stimulation, cryotherapy
  • Patellar taping is also a popular therapy
  • Ice massage, cold packs to help reduce swelling
  • Weight loss for BMI > 25 kg/m2 (Normal BMI 18.5 to 24.9)
  • Avoid twisting and high impact activities that cause pain

MEDICATION THERAPY

  • Extended-release tylenol (acetaminophen): 1300g x 3 times daily (most effective, according to studies)
  • NSAIDs - keep changing classes if not effective (not for long term)
  • Topical NSAIDs in those who cannot tolerate oral NSAIDs (gastritis, ulcer, renal etc)

SUPPORTIVE THERAPY

  • Medial unloader Valgus knee brace
  • Study shows, lateral wedge inserts may also help (added as new AAOS guideline)
  • Steroid injections for short term relief (only lasts for 1-2 weeks, give once in 3 months only)
  • Regeneration injections (refer to ortho) / no clear recommendations, suggested to use only if conservative treatment fails

If all conservative treatment above fails, refer to Orthopedics. If patient is not a surgical candidate, treat with:

OPIOIDS

  • Tramadol, only if above fails to help patient
  • Opioids if patient is non-surgical candidate, to improve function only (Use 90 days rule)

References:

  1. Jones, B et al. Nonsurgical Management of Knee Pain in Adults. AFP Journal 92 (2015): 875-78

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