Than to treat a pain in a lap and to what doctor to address
Pains in the field of knee joints - the widespread complaint of people of all age groups. This symptom always causes a legitimate interest in the causes of the onset. Even more urgent is the question of how to deal with it and what to do in order not only to get rid of the pain, but also to prevent its re-emergence. Useful answers to these questions are described in this article.
General description of the treatment of pain in the knee joints
Before dealing with the treatment of conditions in which the knees hurt, it is necessary to learn information about what can be generally helped with such problems. The general plan for the event of undifferentiated medical care is as follows:
- Creation of a physiological dormancy for immature knees( immobilization).
- Cold procedures.
- Thermal procedures.
- Topical application of anti-inflammatory gels and ointments.
- Taking painkillers and anti-inflammatory drugs.
- Medical medicamentous blockades and intraarticular manipulations.
- Physiotherapy treatment.
- Complex exercise therapy and therapeutic gymnastics.
- Taking medications that strengthen the articular cartilage.
- Methods and recipes of traditional medicine.
- Arthroscopy and surgical treatment.
- Balanced power.
- Correction of the load regime on the lower limbs.
It's important to remember! The longer the knees ache, the more serious the cause of their onset. Such patients need a full-fledged examination and differentiated treatment!
How to choose the best treatment for
It is impossible to fully cope with pain in the knees, without establishing the cause of their occurrence. Proper treatment should be based on a correctly established diagnosis. Otherwise, do not expect positive results from the treatment activities. Moreover, improper medical care can worsen the condition not only of the anatomical structures of the knee area, but of the body as a whole.
Maximum unloading of the affected knee is a key intervention for any cause of knee pain
Often it happens that the pain in the knees arises suddenly or worries a person periodically for a short time. In this case, consult a specialist or not, or the patient temporarily does not see the need for it. Such people need undifferentiated care. Undifferentiated treatment will be correct regardless of the reasons for which the knees ache. Such activities include:
- Creating a sick limb of resting state. In any case, if the knees ache, immobilizing the knee joint and giving the limb a semi-bent and slightly elevated position, you can achieve a reduction in pain. In general, the leg should be given the position in which the pain decreases.
- Moderately dense or easy bandaging of the painful area with a simple or elastic bandage. Fixed and slightly compressed tissues are less painful. If compression causes pain or any discomfort, there is no need for it.
- Compresses from a half-alcohol( vodka) solution to the area of the painful knee. They can be represented by wet-drying lotions, but can be performed by the classical method using a sealed polyethylene layer.
- Easy massage of the entire knee joint, in particular pain points. Massaging movements should not cause increased pain. The patient's knee can not be squeezed strongly by the palms, wrapped around with both hands, stroking and gently rubbing the skin, producing acupressure of reflexogenic and painful zones.
- Local application to the skin of the knee area of the ointment, which has analgesic effect, containing anti-inflammatory drugs( diklak gel, imide gel, fastum gel, dip-lift, remisid, dolobeni).Such local treatment has no contraindications, except for individual intolerance and allergic reactions to certain medications. The main thing is, before rubbing a knee with ointment, get acquainted with its composition and active substances.
- Taking painkillers. It can be dexalgin, ketans, tempalgin, analgin, aspirin, paracetamol, fanigan. Their reception should not be long and uncontrolled, limited mainly to those cases where the knees hurt very much.
It's important to remember! Pain in the knees is just a symptom. It is inadmissible to restrict treatment to anesthetics alone. It must necessarily be comprehensive, aimed at arresting the mechanism of triggering the disease and the pain caused by it!
To which anti-inflammatory drugs
are shown. Tablets and injections non-steroidal anti-inflammatory drugs are the main group of medicines for symptomatic and pathogenetic therapy for pain in the knees. This means that with their help inflammatory changes in tissues decrease. Thus, the pathological process can be stopped, and its symptoms are stopped.
Treatment of NSAIDs refers to differentiated methods of medical care. Given that knee pain is always caused by the pathology of the knee, tendon, meniscus, bags, cartilage, etc., their treatment can not do without anti-inflammatory drugs. Therefore, every case of joint pain is the reason for their appointment. But you need to do this competently, taking into account the potential risks and benefits. The drug should have the appropriate characteristics of the situation, have the desired dosage form of administration, do not have contraindications for use in a particular case. All these subtleties can only be known by a specialist.
There is a mass of non-steroidal anti-inflammatory drugs in the pharmacological arsenal. The widest distribution and trust in pain in the joints were:
- Diclofenac( diclac, orthophen);
- Ibuprofen( ibuprom, nurofen);
- Nimesulide( imide, nimesil);
- To rheumoxicam.
Some of these drugs are available in the form of tablets and capsules, and some also in injectable solutions. Picking up the drug of the desired dosage form, you can achieve maximum therapeutic effect with minimal side effects on the body. The main drawback of this group of drugs is their ability to cause the formation of ulcers in the stomach and duodenum. Before treating them, it should be borne in mind, especially for patients with a history of a history of the problem, and people taking long-term NSAIDs.
It's important to remember! Nonsteroidal anti-inflammatory drugs can be taken in most cases of knee pain. The drug for a systematic intake should be appointed by a specialist. For immediate relief of severe pain, you can take anti-inflammatory pills or an injection, even if you can not consult a doctor!
In what cases are the chondroprotectors
Treatment of pain in the knees is not only a relief of the pain syndrome. The effect on the substrate of its occurrence will relieve not only the pain sensations, but also the more severe consequences of the causative disease. The administration of drugs restoring articular cartilage( chondroprotectors) is indicated for those patients who have knee pains in osteoarthrosis 1-2-3 stage. In all other cases, there is no need to use them.
The most popular products of this group are:
- Chondroitin complex,
All these drugs do not have direct analgesic effect. They are designed for pathogenetic therapy through long-term course. Therefore, at the first stage of treatment, they are almost always combined with analgesic and anti-inflammatory drugs.
Intra-articular administration of anti-inflammatory and chondroprotective drugs is a good method of specialized care for many diseases accompanied by pain in the knee joints.
Than physiotherapeutic procedures will help
Almost any knee joint disease can be treated with physiotherapy methods. But even such effects on the pathological focus require a differentiated approach. They should not be used in an acute period after getting injured. Neglect of this rule will lead to aggravation of the existing symptoms( increased edema and pain).The only useful exercise in such a situation, which can conventionally be called physiotherapy, is the application of cold to the injured knee. Only a few days later, thermal physiotherapy techniques can be included in the treatment.
Among the effective methods:
- shock wave therapy;
- LFK and therapeutic gymnastics.
Correctly chosen physiotherapeutic complex is absolutely harmless for the organism, able to shortly reduce pain and cure the causative disease.
Treatment of diseases of the knee joint requires a complex individual approach
Methods and recipes of traditional medicine are very often the first and only remedy for pain in the knees. To treat sick joints in this way is not entirely correct, since it is necessary to work on the disease in a complex way. The people's means are assigned an auxiliary role in this complex. In practice, such recipes proved to be quite good:We also recommend reading: Treatment of knee joint diseases
- Compresses made of honey and camphor oil. Ingredients: honey - 1 tbsp.l. camphor oil - 2 tbsp.l. Stir thoroughly and lay on a soft, cut off from hard ribs a leaf of cabbage. Evenly smear the prepared mixture on its surface and arrange it on the patients joints. Wrap and hold for about 3-4 hours. The procedure can be carried out once a day for several days.
- Rubbing the diseased knee with a cut onion.
- Compresses made of natural yellow clay. Dry clay is macerated in hot water until a thick, greasy consistency is obtained. It is applied to the diseased knee joint and wrapped in a food film, bandaged with a simple or elastic bandage. The duration of the compress is 10-12 hours. Procedures can be carried out within a week.
- Healing ointment: honey - 100 gr., Equal parts of salt, soda and mustard powder - half a teaspoon. Mix the ingredients thoroughly until smooth. Apply to a sick joint once a day 6-7 times.
When and to which specialist to handle
When the knees are aching for the first time and the pain is associated with prolonged stays in a certain position, muscle overstrain or minor trauma, you can handle it yourself. But if there is a pronounced edema of the knee, the impossibility of movements, or the pain is chronic, one can not do without a visit to a specialist. To address it is necessary, first of all, to the orthopedist-traumatologist. Useful advice can be a surgeon and therapist, rheumatologist. The first thing to be clarified is the cause of the pain, which we described in detail in this article.
There are a lot of methods in the arsenal of specialists that allow to get rid of pain in the knees. Do not yourself struggle with insurmountable problems.
Arthritis of the knee joint - symptoms and treatment, to which doctor should be treated with arthritis
Pain in the knee joint can carry a "natural"( it is also called functional) character, and, which is much more common, it can be the manifestation of somedisease. The so-called functional pain by origin is akin to the one that arises in muscles after being overloaded by physical work at the dacha or in the gym, passes quickly enough. However, if there are signs of inflammation, or arthritis, the knee joint is a signal for urgent consultation with a doctor.
What is knee arthritis?
The knee joint consists of bones, intraarticular structures( for example, a meniscus, articular cartilage), a ligamentous device holding this structure in a certain position, and an internal lining of the joint( synovial membrane).Inside the joint, there is normally a small amount of fluid that plays the role of lubricant and "nutrient solution."
Classic signs of inflammation are blunt, burgeoning pains, joint enlargement in the volume and smoothing of its contours( swelling), redness of the skin above the joint surface( optional), increased temperature in the knee area, inability to fully support the leg, or increase pain when trying to bendor unbend the leg in the knee.
What causes arthritis?
Specialists in the treatment of diseases of the musculoskeletal system have to deal with such causes of arthritis:
- "inflammatory", or autoimmune, rheumatological disease ( rheumatoid arthritis, spondylitis, psoriatic arthritis, gout, systemic lupus erythematosus and some others).In these cases, the inflammation inside the joint is caused by a "breakage" in the immune system, in which the body's own defense cells begin to attack their own cells of the joint internal lining.
- osteoarthritis in case of exacerbation of .Osteoarthritis is a disease of the musculoskeletal system, which is not very well called "degenerative".It arises in people of physical labor, in those who often and often walk, especially on the stairs, as well as among athletes( often regardless of the sport - weightlifter-weightlifters suffer as often as athletes, runners)."Victims" of osteoarthritis become with equal frequency of men and women. Even the development of this disease is facilitated by the unplanned flat feet, wearing uncomfortable shoes, including high heels, in a word - any inadequate load on the legs in general and the knee joint in particular."Natural" load - the body weight of a person exceeding the norm, in itself is a rather serious risk factor for the development of osteoarthritis, the first sign of which can be inflammation of the knee joint.
- post-traumatic phenomena ( if there was a blunt joint injury, stretching or rupture of ligaments or intra-articular structures, which is often the case, for example, when falling from mountain skis).- stands alone Baker's cyst - intra-articular fluid formation, periodically filled with synovial( joint) fluid. Such a "bag" can bring a lot of trouble if it grows to large sizes( sometimes up to several tens of centimeters), or to get bogged down.
- infection .Several dozen microorganisms and viruses capable of causing inflammation of the knee joint have been described. This chlamydia, and ureaplasma, and streptococci, and the herpes virus, and the hepatitis virus. .. If you can identify the pathogen and choose the appropriate drug, arthritis disappears completely.inflammation against a common disease. Unfortunately, such severe conditions for the body as cancer, HIV infection, tuberculosis, sarcoidosis and some others can occur with the phenomena of arthritis. There are such diseases are not so often, and are usually accompanied by weight loss, loss of appetite, weakness, shortness of breath with physical exertion, pallor, torrential sweat. Experienced therapist, summarizing all the data obtained, without any difficulties, will reveal the true "culprit" of arthritis, and, with successful treatment, pain in the joints disappear just as they did.
Why does the joint swell, increase in volume and hurt?
The main reason is the accumulation of a large amount of fluid inside the knee joint."Sticking", "stupid", "pressing" nature of pain is explained in this case by purely mechanical causes. The liquid presses from inside the joint walls, and, without finding an outlet, causes painful sensations. In addition, the fluid that forms in the knee joint during inflammation contains a large number of irritating intraarticular structures of substances. These substances additionally cause the production of a liquid - and a vicious circle is obtained. The third cause of inflammation and pain is the settling of the crystals of uric acid( in the so-called "sand" people) in the joint. These crystals represent the tiniest needles that cause microdamages to the intra-articular structures, the synovial( articular) membrane, contributing to the development of arthritis.
Symptoms of arthritis of the knee joint
What disturbs the patient when it comes to the knee joint? As a rule - dull raspiruyuschaya pain, the inability to bend or unbend the leg, less often - "wedging" the joint. Often disturbed by crunching or snapping when flexing or unbending the leg in one knee joint or both. It is very important to clearly articulate - when it hurts, at what time of day, and at what load.
What is heard? Talk with the patient.
The very history of the appearance of pain in the knee joints can already push a doctor to the idea of a diagnosis.
- First, the doctor will exclude the post-traumatic nature of the inflammation.
- Secondly, ask questions about the presence of "inflammatory" diseases in relatives. It is known that diseases such as rheumatoid arthritis, spondyloarthritis( simultaneous damage to the joints of the limbs and the skeleton of the spine), and some others can be inherited.
- Thirdly, clarify the condition of other joints. It often happens that the leading complaint of the patient at the reception is a pain in the knees, and when questioning it will be found out that in the mornings it is difficult to bend or unbend fingers, or at night worried pains in the lower back, or it became difficult to wear out due to the swelling of the ankle joints. The so-called "multiple" joint damage is a hallmark of some inflammatory rheumatological diseases, as well as polyarthritis in certain "common" diseases, for example, oncological diseases.
- Fourth - it is very important to clarify the general condition, the patient's well-being. It usually does not suffer from post-traumatic arthritis and osteoarthritis.
What is visible in the survey?
When examined, the presence of skin defects - bruises, scratches, pricks - will strengthen the doctor's opinion that before him is a patient with post-traumatic arthritis. It happens that the trauma only "starts" the autoimmune process, but it happens much less often. The doctor records the presence of signs of inflammation( we dwelled in detail at the beginning of the article), signs of arthrosis. The latter are determined by the presence or absence of soreness by pressing certain "painful" points and probes with "passive" movements.
Surveys. To what specialist to apply?
- Orthopedic Surgeon .Most often, with diseases of the musculoskeletal system, patients turn to surgeons or traumatologists. Or to traumatologists-orthopedists, if they are available in a polyclinic. This is where the first diagnostic search takes place, and the first diagnostic errors. Orthopedists are rarely well-trained in the field of rheumatology, their task is to diagnose and treat post-traumatic joint changes.
- Therapist .This is the doctor to whom the patient addresses, if in addition to pain in the knee joint there are so-called "general" complaints: fever, weakness, weight loss, morning stiffness in the body or individual joints. The therapist is that person who can( and should) suspect the presence of an "inflammatory" rheumatological disease and prescribe at least a blood test. Further along the chain, the patient is usually sent to the rheumatologist.
- Rheumatologist .The best option for the patient. Narrow profile specialization allows rheumatologists, at the stage of examination and questioning, to get as close as possible to the cause of the problem, to prescribe the necessary additional examination and to choose the right treatment as early as possible. Often it is precisely the time prescribed medications determine the patient's prognosis for work capacity, physical activity, and sometimes for life.
- Infectionist .Solves a fairly narrow range of problems, but is necessary when it comes to arthritis associated with infection. To be sure that the causative agent is removed from the body forever and arthritis does not recur, regular monitoring is needed, which is performed by the infectious disease specialist.
Diagnosis of knee arthritis
To clarify the diagnosis, in addition to laboratory methods, so-called instrumental instruments are widely used. Well, when we have at our disposal a whole arsenal of diagnostic procedures, you can choose the most informative, most appropriate to the clinical situation.
- Radiography .The cheapest, but not enough informative method. Will allow to evaluate the structure of the bone: there is no gross destruction of bone, excessive growth of bone( this is called "proliferation" and it looks like the formation of build-ups or thorns).In some cases, the gap between the large bones will be narrowed, in other cases - widened. All these are indirect indications by which an experienced radiologist can presume, for example, the presence of osteoarthritis.
- ultrasound( ultrasound) .This method of research is highly respected by surgeons, because, unlike radiography, ultrasound can understand what happens to soft joint structures - ligaments, tendons, menisci - suffering, especially in trauma. Using this method, it is possible to identify articular "bags" filled with fluid( Baker's cyst), because of which the joint can "jam".On many devices now it is possible to see deposits of crystals of uric acid, which in most cases confirms the diagnosis of gout.
- MRI( magnetic resonance imaging) .An expensive, informative method that serves to identify a small amount of fluid, initial signs of bone tissue destruction, meniscus tears, in general, those changes that neither X-ray nor ultrasound are visible.
- Arthroscopy .The only method that allows "live" to see the joint from the inside. Through special punctures, a video camera is inserted into the joint on a flexible conductor, allowing the doctor to estimate the situation as accurately as possible. Cons of this procedure - the need for anesthesia, rehabilitation period of several days, possible complications( including joint suppuration).
- Laboratory methods .With the help of a blood test, you can determine whether the occurrence of arthritis is a sign of an autoimmune disease, or is it a manifestation of inflammation especially in the joint area that does not extend to the entire body. The second situation is much more comforting for both the doctor and the patient.
To signs of a common, or as rheumatologists say, systemic inflammation, include:
- increase in ESR( sedimentation rate of erythrocytes)
- inflammatory changes in the body "confirm" the increase in the level of leukocytes and lymphocytes( these figures will be increased with infectious( reactive) arthritis).
Biochemical blood test will be useful, first of all, for determining the level of uric acid in the blood( this is, first of all, a sign of gout), and also to determine possible contraindications to the prescription of medicines( increase of hepatic enzymes).
Immunological analyzes are the most expensive, but also the most informative studies. Without going into details, let's just say that one immunological analysis can be enough to make a diagnosis.
And what if all test results are negative, there is no inflammation, but the phenomenon of arthritis is pain, is there a swelling?
In this case, a complex treatment of osteoarthritis or post-traumatic events is prescribed( diagnosis is determined using instrumental methods of investigation).
Treatment of knee arthritis
The main thing that worries a patient with knee arthritis is how to relieve pain. For the first time faced with such a problem begin to take uncontrolled tableted non-steroidal anti-inflammatory drugs, or, worse, intramuscularly administer them. These drugs are randomly sold in the pharmacy chain, like vitamins or cosmetics! But after all each drug except indications( pain, inflammation), there are also their contraindications. The pharmacists usually do not know about this, or do not consider it necessary to remind.
For example, that non-steroidal anti-inflammatory drugs can not be taken with gastritis and ulcers of the stomach and intestines, as well as hemorrhoids and ischemic heart disease.
- Nonsteroidal anti-inflammatory drugs are the drugs that usually treat the arthritis of the knee joint.
- "Local" treatment - a variety of gels, creams and ointments containing the same non-steroidal agents - can be used fairly freely if there is no skin reaction to the drug( redness, itching, flaking).In case of intolerance to the gel or ointment, it should be discarded, and in the future, after normalizing the skin condition, to resume local treatment with another remedy.
Treatment of autoimmune diseases is performed only by a rheumatologist under strict control.
Special drugs are used that suppress "raging" immune cells exactly where it is needed.
- Drugs from the group of chondroprotectors require patient patience, perseverance in achieving the intended goal and a clear understanding of the meaning of treatment: slow( otherwise it will not work) and a gradual improvement in the structure, and hence the function of the articular cartilage.
- Physiotherapy treatment. Used for osteoarthritis, post-traumatic arthritis, gouty arthritis. These are procedures, so beloved by the "spawners", based on the influence of magnetic, ultrasonic waves, weak laser radiation, local cold application. In autoimmune diseases, it can cause an even greater exacerbation.
- Fixation, or joint orthosis. The purpose of this treatment is to give the sore joint a rest, to unload it. Bandages, orthoses, elastic bandaging are used.
- Intra-articular and periarticular steroids injection is a rapid achievement of anti-inflammatory effect. This method of treatment should not be confused with the favorite surgeon's "blockade" when a solution of novocaine for pain relief is injected into certain points around the joint( this procedure is performed, for example, during the match, when there is no opportunity to rest the injured leg).Steroid, or glucocorticosteroid drugs should not be administered more than once every 3 months, in addition, they can cause quite serious side effects.
- Hyaluronic acid preparations. They are prescribed for osteoarthritis and represent a "prosthesis" of the synovial fluid. In the classical course of osteoarthrosis, synovial fluid in the knee joints is small, it is viscous and does not fulfill its role of cushioning and feeding cartilage sufficiently. The introduction of these drugs directly into the joint with a syringe allows you to achieve a long anesthetic and, most importantly, improving the very structure of the joint, the effect.
Recommendations for patients with knee arthrosis
1. Food. In case of locomotor system, any special diet, except for gout, is not required. If gout is detected, this imposes certain restrictions on the patient: it is necessary to exclude red meat( beef, veal, mutton), tomatoes, smoked products, spices, fresh leaf greens, alcohol from the diet.
2. Treatment of the underlying disease, manifestation of which became arthritis of the knee joint. It is worth attune to a long enough, perhaps, for several months or even years, treatment with repeated courses. But an easy step is worth it, is not it?
3. Fighting overweight is the cornerstone for most patients with osteoarthritis. It must be remembered that the joints of a person are "calculated" by nature to a certain weight, and not to the one that we like.
4. Physical therapy, swimming, cycling. Sufficient physical activity is vital for those who are faced with the problem of osteoarthritis.
5. When walking, it is strongly advised not to make ascents and descents on the stairs, this strengthens the "wear" of the knee joints.
6. It is worth not to stint and buy a good quality, if possible orthopedic shoes or order orthopedic insoles for an individual cast. Like physical education, classes in the pool or taking prescribed medicines is a financial investment in one's own organism, which will reciprocate in response to care!
The knee hurts. To what doctor to address?
Everything depends on what is on the picture and in the conclusion of the radiologist. It would be nice to have a general blood test and a biochemical blood test for Revmoactor and C-reactive protein. X-rays only see the bones, the computer tomography is more informative.if the right knee hurts - it is necessary to look or see a cholic bubble( sometimes so stones or an inflammation of ducts of a cholic bubble are shown).The left knee is often a hidden pathology of the pancreas and the left lobe of the liver.
to the orthopedist. And he will send after the inspection where necessary
not to run. .. to a radiologist one way
to an orthopedist if not start with a local therapist
to an endocrinologist
It depends on what it hurts. If from hitting something, then to a traumatologist. If the pain with injuries is not related, then to the neurologist.
To a sex therapist. .. or change the pose.
To the traumatologist, and he, if necessary, will send for research and to other specialists.
If it hurts periodically the knee, then which doctor should I contact?
Depending on why the knee is hurting, you need different doctors.
Surgeon( he is also a traumatologist) will deal if there is some kind of injury.
Osteopath - if it's the nerves, or the joints.
Rheumatologist for a start.
orthopedist or surgeon
I went to the surgeon.
To an orthopedist, but it is better at first to the family( to the therapist), and then with the analysis and letter from him - to the orthopedist.
to the orthopedist, it is possible to traumatologist
First of all to the rheumatologist. And then he will send you himself to the right place. I'm not kidding.
* HoHa *
To the surgeon
. .. traumatologist, the direction will give to the pictures, good luck))))
Osteopath. The case may be not in the knee, but in the t.b.the joint, and the load is redistributed to the knee, it overloads and hurts.
Take a referral to the surgeon and do not tighten. My brother had a pain in his knee * pulled on the rink), and then he caught a cold and could not walk at all. The surgeon prescribed treatment.
surgeon Knees are aching to which doctor you need to go
To the therapist, he knows where to send further
To the traumatologist it is possible or to the neurologist
If you live in the Russian Federationto the neurologist you at once on reception will not get. For this, contact the surgeon first. He will examine you, give directions to x-rays and so on. If necessary, refer to other specialists, including and to a neurologist.
to the surgeon
Go to the orthopedist.
First to the surgeon, and then to where he will send. .. Maybe to a neurologist or a rheumatologist, or else. ..