1 / 5

Knee Pain Treatment in India by the Pain Specialist Dr.Amod Manocha

Dr. Amod Manocha offer minimally invasive non surgical interventions for knee pain treatment in Delhi, India. Knee pain can be a source of significant disability in all age groups as it limits mobility.

bestpainspecialist
Download Presentation

Knee Pain Treatment in India by the Pain Specialist Dr.Amod Manocha

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. KneePainTreatmentinIndiaBythe PainSpecialistDr.AmodManocha Kneepaincanbeasourceofsignificantdisabilityin all agegroups asitlimits mobility.Itcanbeclassifiedintotraumaticor non traumaticand basedonthesiteof painintoanterior,medial,lateralandposterior.Thecommonreasonsforkneepain varywithagegroupandpain site. Painfromothersitessuchashipandlumbar spinecanalsopresent knee pain.Intheabove50 yearsagegroupraisedBMI isan importantrisk factorfor developingsymptomaticosteoarthritis. CommonminimallyinvasivenonsurgicalinterventionsIofferin painclinicfor kneepaininclude Iliotibialband Syndrome May17,2021 WhatisIliotibialband syndrome? Iliotibialband(ITB)isathickenedbandoftissuethatrunsalongthe outersideof thigh fromthepelvistotheshinbone(justbelowthekneejoint). It helpsto transmit

  2. forcesfromthehiptotheknee and acts astabiliseroftheoutersideofknee,playing animportantrolein posturalcontrol. • Withbendingandstraighteningofthekneethisbandmovesoverthelowerouter endofthighboneandsometimesrepeatedmotioncancausetheITBtoirritatethe surroundingtissues. Thisisaddressedasiliotibialbandsyndrome(ITBS)or IT syndrome. It manifestsaspainalongthe outersideofkneeafterrepetitivemotion. Althoughanyonecandevelopthiscondition,itoccursmore frequentlyinathletes and those participatinginactivitiesinvolvingfrequentkneebendingandstraightening. • Keypointsaboutiliotibialband syndrome • Iliotibialbandsyndromecausespainontheouterside ofthe knee • Thisconditioncanaffectanyone,althoughis morecommoninathletesespecially runners • Mostpeoplerecoverwithrest,simplepainkillersandphysicaltherapy • Earlyultrasoundguidedinjectionscanbehelpfulinrelivingsymptomsandpromoting earlyreturntoroutineactivities • Identifyingoftheunderlyingcauseisimportant forpreventingreoccurrences Whatarethe symptomsofITBS? • Commonpresentingfeatures include: • Sharp,stinging,achingorneedle-likepainon theoutersideoftheknee • Thisoccursatthesamedistance,lateinorsometimesevenaftercompletinga sportingactivity.Astheconditionprogressespainbeginsearlierinthecourseofthe activityor caneven affecttheabilitytowalkor sit withkneesbent. • Paintends tobeworseevery timetheheelstrikestheground.Activitiessuchas running downhill,cyclingor stairscan makeitworse • Snappingorpoppingsoundfromtheknee,sometimesassociatedwithswelling • Pain may radiateupwardtowardsthe outersideofthethigh/hip ordownwards towards theleg • ITBSisuncommonintheinactivepopulation.Itisseen morefrequentlyin • Long distancerunners- incidencerangesfrom1.6%–12% • Cyclists–accounting for15–24% ofoveruseinjuriesincyclists • Athletesparticipatinginhiking,hockey,basketball,tennis,weightlifting,soccer, jumpingactivities,rowingandskiing • Militaryrecruits–incidencebetween1%to5.3% • Thosewhosquatrepeatedly

  3. WhatcausesITBS? • Theexactcauseofiliotibialbandsyndromeis notclearandthere may bemultiple factorscontributingtoitsdevelopment.Mostpopularbeliefisthatthisisanoveruse injuryresulting fromfrictionfromthemovementoftheiliotibialbandoverthelower outeredgeofthethighbone,asduring repeatedbendingandstraighteningofthe leg.Mostcontactbetween the ITBand lowerendofthighboneoccurswhenthe kneeis bent(flexed) at 30degrees,whichistheangleatwhichthe footstrikes the groundand hencethe maximalpainatthistime. Othertheoriesattributethe conditionto theabnormalcompressionofthetissuesbeneathITB or tothe inflammationinthesmallfluid-filledsac (bursa)boneandtendonsin the area. • Acombinationofissuesmay contributetoitsdevelopmentincluding • Poortrainingfactorslikerunningonunevenofhilly terrain,abruptchangesintraining intensity,running withwornoutshoes • Poorstrengthandflexibility ofmusclessuch ashavingweakhipmuscles,tightIT band.Thehipmusclesplay animportantroleinthe gaitandtheirweakness places increasedstrainonITB • Other mechanical imbalances such as unequal leg length, arthritis of the inner side of knee or bowed legs. Imbalances may also involve low back and pelvis (abnormal pelvis tilt). These situations can cause the iliotibial band to become excessively tight thusenhancingfriction. • ITBSoccursmorecommonly inassociationwithcertainotherconditionssuchas • outer hip pain (greater trochanteric pain syndrome/ trochanteric bursitis) and pain alongthe kneecap(patellofemoralsyndrome). Howisthisconditiondiagnosed? Iliotibialbandsyndromecanbediagnosedonthe basisofhistory andexamination findings. Thereisoftenhistoryofrecentchangeinlevelofactivitieswiththetypical symptoms as explainedpreviously.Tendernessontheoutersideofkneejustabove thejointandotherspecialclinicaltestscanhelpinthediagnosis.Investigationssuch astheMRIorultrasoundscanscanhelpconfirmthe diagnosis andruleoutother conditionswithsimilarpresentation. Ultrasound scan hastheadvantageofbeingarapid,low cost,widely available,in clinicinvestigationwhichcandemonstrateswelling,fluidcollection,bursitisand thickening oftheITB.It hastheadvantageofbeingable tocomparewiththeother

  4. sideandcarryingoutadynamicassessment(assessmentwithlegmovement).MRI mayshowthickening,tearing ofITB or swellingabove/belowtheITB. Whatare thetreatment options forITBS? • Optimalmanagementofthesepatientsrequiresamultidisciplinary teamapproach withthepain specialistsand physiotherapistsplaying thekeyrole. • Acutephasetreatment • During thisphasetheaimistorelievepainandlimit the inflammatoryresponse. This requiresactivitylimitationormodificationandrefrainingfromprovokingactivities suchas running.Generalprinciplesofmanagementduring thisphaseare • Refrainfromtheincitingactivity forup to6weeksoruntilthepainhasresolved. Activitiessuchasyoga,swimming,walkingwhichdonotprovokepaincanbe continued. • Rest,ice,compressionand elevation(RICE) • Simplepainkillersandanti-inflammatorymedications • Ultrasound guided Injections • Physiotherapy • Ultrasound guidedsteroidInjections • Localinjections areconsideredinseverecaseswherephysicaltherapyandoral medicationsfailtoprovideadequaterelief.Localinjectioncanhelpinconfirmingthe diagnosis,providingprolongedpainreliefandfacilitatingearly returntoroutine physicalactivities,especiallywhenusedearlyinthedisease.Ultrasoundguidance throughouttheprocedureisvaluableinimprovingaccuracy andreducing complications.Anyfluidcollection,ifpresent,canberemovedatthesametime.Post injectionactivitiescanbeincreasedinagradedfashiononcethepatienthasbeen painfree for twoweeks. • Subacutephase-GradualStretching • Onceinflammationis undercontrolexercisesfocussingonstretchingandimproving flexibility canbestarted.Thislaysthefoundationforsubsequentstrengthtraining. • Anycontributoryfactorssuchasfootwear,posture,sportsspecifictechniquetraining etc should be addressed. • Restartingactivities • Mostpatientsareable toreturnto activitywithin6to8weeks. ITBS howevercan haveafluctuatingcourseandmay relapseduring thetreatmentorreturnto activity phase.Stretchingoftheiliotibialband,gluteusmuscles andstrengtheningofthelow back, hips,knees, andleg musclesisfrequently recommendedas partofthe

  5. treatmentplantopreventreoccurrences.Improvingstrengtharoundthehiphelps to reducetheforceson theITband. Identifyingandaddressingtheunderlyingcausesoftheproblemis important.It may involveanalysisofgait,leglength,pelvictilt,andthatofmusclestrength,balance andflexibility. Surgical interventionisreservedforrefractorycasesnotrespondingtotheabove- mentioned measuresformore than6months.OptionsincludeITBrelease,ITB lengthening,removalofbursa(ITBbursectomy),andarthroscopicITBdebridement.

More Related