Informing patients 5: Knee Pain – Benefits and Risks and Treatment Alternatives

ARCHIVED POST N.B. This post is based on the 2012 Osteopathic Practice Standards and therefore may not reflect current legislation or current Mint procedures.

An information resource for practitioners

The law on consent require health practitioners to inform patients of the benefits and risks of treatment and alternative treatments.  This article is part of a series to equip practitioners to inform their patients.  It is to be noted that it is difficult to find information on benefits and risks of treatments so please feel free to provide feedback so we can develop this resource.

This list is a generalised list to use a resource and needs to be applied using your osteopathic expertise, based on the patient’s condition, presentation, preferences and understanding.

N.B. this information is written for practitioners with medical knowledge, if you are suffering with shoulder pain please seek advice from a health practitioner.

Knee Pain

Education and activity modification

Weight loss, keeping active.  Reassurance about pain, underlying pathology and fact that improvements can be made.  Barefoot running may reduce stress on joint.  Crutches may be needed with ligament damage.

Benefits: low-cost option, possibility of improvement in pain, empowers patient

Risks:  Yellow flags may be barriers to improvement

Orthotics

May offer some benefit in patella-femoral pain syndrome.  Knee braces – controversial

Manual Therapy and exercise

Electrical stimulation, hydrotherapy, mobilisation, exercise. Strengthen postero-lateral hip muscles, eccentric training.

Meniscal tears – outcomes following physical therapy or sham surgery compared with partial meniscectomy not significantly different. MRI false positives – 16% have evidence of meniscal tears – 36% people over 45 years of age.

Benefits: Helps improve range of motion and reduce muscle tension, may help reduce likelihood of recurrence of symptoms.  Reduction in pain.  Pre-operative preparation.  Empower patient.

Risks: May have increased tenderness after hands-on treatment for 24-48 hours, improvement may take a few sessions (1 in 2).  Small risk of nerve compression causing temporary tingling and numbness (1 in 100).  Very low risk of long-term nerve damage.

Corticosteroid injection

Useful for short-term relief of pain but unlikely to affect long-term outcome.

Benefits: Pain reduction

Risks: infection, tendon rupture, hyperglycaemia in people with diabetes, local tissue atrophy, flushing, menstrual disorders in women

Analgesia

Aim: to control pain and help the person keep active

Medication Benefits Risks Additional Information
Paracetamol No gastrointestinal toxicity, well-tolerated   More effective taken regularly, rather than as required
NSAIDs – Ibuprofen

(naproxen, diclofenac)

Anti-inflammatory.  Limited evidence of effectiveness for short-term pain reduction. Dyspepsia

Gastrointestinal bleeding

Cardiovascular and renal adverse effects

Exacerbate asthma

Not effective for neuropathic pain

Gastroprotection may be required

 

Topical NSAID May be of benefit, especially in acute conditions.  Diclofenac cream may help with knee OA. Large amounts can cause systemic effects including hypersensitivity and asthma.  Photosensitivity is also a risk so care is needed in sun.  

 

Surgery

Total Knee replacement – 5-10% have lingering symptoms or are unhappy with outcome.

Benefits: Increased mobility, decreased pain

Risks: Thrombosis, infection (2 in 100), nerve or blood vessel damage, complex regional pain syndrome, strokes, heart failure, wear/loosening (average 10 years), knee stiffness

Arthroscopy, Meniscal transplantation, partial replacement with biodegradable scaffold, Ligament repair or autograft

Benefits: decreased symptoms, increased range of motion

Risks: Bruising and swelling, infection, no change or recurrence of symptoms, stiffness in knee, reaction to anaesthetic, numbness, thrombosis, increased cartilage destruction, OA knee

 

References

NICE Clinical Knowledge Summaries, available at: http://cks.nice.org.uk/

www.patient.info

Hull and East Yorkshire Hospitals patient leaflets https://www.hey.nhs.uk/patients-and-visitors/patient-leaflets/

NCOR – osteopathic management of knee pain  http://www.ncor.org.uk/research/evidence-for-osteopathy/

Evidently Cochrane website http://www.evidentlycochrane.net

Leave a Reply

Your email address will not be published. Required fields are marked *