Episodic knee pain 4 times a year


Q: Hello. I have been dealing with knee pain for quite some time now (4 to 5 years). The pain only flares up maybe 3 to 4 times per year and last approximately 6 to 8 weeks, then subsides. The pain I experience comes after I sit for a short period of time then try to stand (straightening the knee), and also when I stand for a short period of time and attempt to sit (bending the knee). I wouldn't describe it as sharp pains. More of a throb if I had to describe. Also, I experience swelling and can't sleep a full night due to the pain being so severe. No matter the movement, if my knee has been in any one position for over 5 to 10 minutes, it is extremely painful to move it. Recently, I visited the Emergency Room because it was after hours and I couldn't even bare to walk. After I arrived, the doctor I saw came in and told me it appeared to be one of two things: either torn cartilage or torn ligaments. He didn't do Xray's because he saw no signs of recent trauma, such as bruising or lacerations. He referred me to an orthopedic doctor so that I could have an MRI done and arrange proper treatment. He sent me home from the ER with a prescription of hydrocodone 7.5 apap 500. He wanted me to see the doctor within two days, therefore, he only gave me a script for 15 pain pills. Currently, I am in between jobs and have no insurance or medicaid. I desperately need to have this problem treated so the pain will subside; this is the longest I've been in pain thus far, almost three months. Unfortunately at this time, I have to wait to get the MRI because of it's cost. I don't have an extra 1500 bucks laying around to pay for this. I did contact the ER to explain my situation and asked if the doctor could prescribe me just enough pain meds to get by until I can have the MRI done. I was told the only option I have is to visit the ER again. The typical cost for that in my area, with no XRays or anything else, is approximately 1500 bucks, which I know I cannot pay for at this time. What would you recommend I do to control my pain while I am waiting on a new job with insurance benefits?


A:    Knee pain is the most common presentation of patellofemoral syndrome in young and active people. The pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (e.g, during squats, ascending/descending stairs or pendants). Pain may be worsen by sitting with the knee flexed for a long period of time, such as while watching a movie, hence leading to the terms "theatre sign" and "movie-goer's knee." Also “grinding” and “clicking” may be present. The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint. The suggested strategy for conservative treatment should be as follows: Physical therapy program (exercises and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory medication (i.e.: “Aleve”, “Advil”), educate you about which activities avoid because those can aggravate patellofemoral syndrome. Also, and very important, remark the need for extended adherence to the exercise regimen. Your physical therapist should educate you about a home exercise program. Please, allow time for these conservative measures (e.g: exercise program) to have an effect, usually 4-6 weeks is adequate for some resolution of symptoms.

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