Possible Patellofemoral Syndrome with Osteoarthritis

Patient

Q: I twisted my knee golfing (Aug.) Then both knees (sept) started feeling stiff. Now they ache all the time and the more I am on them the worse the pain. This makes my thigh feel tight? and also ache. And the pain behind my knees can be very painful at times. My friends say it is arthritus. I am not so sure. It came on so fast and hard. I am taking the stairs, one step at a time (both feet). It is painful to get down on my knees. Doesn't hurt to be on them but I can even think of a way to get back up. I have to find something that I can hang on to to force myself up. In August I was walking, running, golfing and playing with my grandchildren like I was 20. Does old age (I am 61) come on this fast. Or is there a possible medical problem that is causing this. I can't believe it is arthritis. We lost our health insurance awhile ago so I would like to know if I should try to indure this situation or find help. Thanks.

Doctor

A:    There is a possibility that your symptoms may be due to degenerative changes in your knees, meaning Arthritis. On the other hand, the way you describe the situations when the pain worsens may suggest a common presentation of a Patellofemoral Syndrome. The pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (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." The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint. The suggested strategy for conservative treatment, in your case, for both: possible Arthritis and Patellofemoral Syndrome 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”), education about which activities avoid because those can aggravate the patellofemoral syndrome. You should practice consistently a home exercise program. Some lifestyle changes may delay or limit osteoarthritis symptoms: weight loss and exercise: Regular exercise may help you to strengthen the muscles and also potentially stimulate cartilage growth. Please, allow time for these conservative measures (exercise program, medication) to have an effect, usually 4-6 weeks is adequate for some resolution of symptoms.

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