- NEURORADIOLOGY & PAIN SOLUTIONS OF OKLAHOMA -

ANATOMY OF THE KNEE JOINT

The knee is one of the largest joints in the body, formed by the lower end of the femur, the upper end of the tibia, and the patella (kneecap). Several ligaments and muscles attach to the bones of the knee joint to maintain the normal motion of the joint. Special tissues known as menisci are located between the two articular ends of the joint. These act as a cushion between the articular surfaces and absorb shock during movement.

Diagnosis & Treatment

A detailed medical history and physical examination of the knee are crucial for diagnosis. Your doctor may also conduct diagnostic imaging studies such as X-rays, MRI scans, CT scans, and ultrasound. Blood tests may be performed to identify any infection, gout or pseudogout. Sometimes, arthrocentesis may also be performed, wherein the fluid from the knee joint is removed and sent for laboratory analysis.
Treatment options depend upon the underlying cause responsible for knee pain. Common treatments for knee pain include rest, ice and heat application, non-steroidal anti-inflammatory medications, stretching, physical therapy, and cortisone injections.
If surgery is not available or desired, we can offer:
● Nerve Ablative Therapy● Knee Injection ● Radiofrequency Ablation ● Peripheral Nerve Stimulation Treatment ● Spinal Cord Stimulator
If you have trouble or inability to walk, deformity around the joint, inability to bend the knee, knee pain persisting beyond a few days and more at night, or pain associated with swelling, warmth or redness, you should consult your doctor for immediate medical intervention.

Causes

Some of the common causes of knee pain include:
● Arthritis: a condition associated with inflammation of the joint● Knee ligament injuries.● Torn meniscus.● Patellar tendonitis: inflammation of the patellar tendon, which connects the kneecap to the shinbone.● Chondromalacia patellae: softening of the articular cartilage on the under surface of the kneecap, causing knee pain.● Dislocated kneecap.● Baker's cyst: a fluid-filled swelling in the back of the knee, which usually results from another injury such as a meniscus tear.● Knee bursitis: inflammation of the bursae, small fluid-filled sacs located around the joints, usually between a tendon and bone.● Plica syndrome: results from inflammation of the synovial tissue of the knee causing knee pain and swelling.● Osgood-Schlatter disease: caused by irritation of the growth plate at the front of the knee joint; more common in adolescents.● Osteochondritis dissecans: characterized by detachment of a cartilage fragment and a thin layer of the bone from the end of a bone due to inadequate blood supply. These fragments may either stay in place or slide around the joint, causing pain and joint instability.● Gout: characterized by sudden, severe attacks of joint pain, with swelling and redness around the joint, caused by the accumulation of uric acid crystals in the joints.

Causes

Nerve pain can be caused by injury to the central or peripheral nerves.
● Central nerve pain: This is caused due to damage to the nerves of the central nervous system by the presence of lesions or diseases such as stroke, spinal cord injury, or multiple sclerosis.
● Peripheral nerve pain: This arises due to dysfunction or injury to the peripheral nerves (nerves that carry senses and motor signals from the brain and spinal cord to the entire body). Diabetes, trauma, vitamin deficiency, kidney disease, certain medications, and alcoholism can cause peripheral nerve pain.

Diagnosis & Options Available

Nerve pain is diagnosed with a detailed review of your medical history and a thorough physical examination. A grading system is used to determine the cause of pain as neuropathic.
● Ablative therapy.● Spinal Cord, Dorsal Root Ganglion Stimulation, and Peripheral Nerve Stimulation.
Early treatment is important to manage nerve pain as nerve damage is progressive. Nerve damage cannot be cured completely. Treatment is centered around relieving symptoms.
The first line of treatment is to manage your underlying condition such as diabetes and changing medication that may be causing nerve damage. Surgery may be indicated to remove tumours.
Your doctor may prescribe anti-epileptic analgesic drugs, antidepressants, opioids, opioid-like drugs, topical anesthetic, and analgesic medications to relieve symptoms. 
Electrical nerve stimulation such as TENS may be performed to relieve pain. Alternate treatments such as meditation, acupuncture, hypnosis, and biofeedback may be ordered to help you cope with pain.

SYMPTOMS

Nerve pain can be differentiated from normal pain symptoms as follows:

● The normal symptoms of pain are altered and present as prickling or tingling sensations to a stabbing, shooting, or burning pain, similar to an electric shock.
● Allodynia or pain that occurs from a stimulus that does not normally cause pain sensations.
● Hyperalgesia or increased pain caused by a stimulus that usually causes pain.
● Anaesthesia Dolorosa or pain that is felt in a numb region.

NEUROPATHIC PAIN CONDITIONS

THERE ARE SEVERAL CONDITIONS THAT CAN LEAD TO NERVE PAIN. SOME OF THE MOST COMMON INCLUDE:
● Diabetic peripheral neuropathy: This is a common condition if you have diabetes. It is characterized by a stabbing or burning pain and numbness in the legs and feet.
● Trigeminal neuralgia: This is a frequently occurring condition that arises due to multiple sclerosis or from a tumour compressing the trigeminal nerve, which carries signals of sensation to the face and motor functions such as chewing and biting. Typical symptoms include sudden facial pain lasting for several seconds to minutes and intense burning pain, usually accompanied by involuntary spasms or facial twitches.
● Chemotherapy-induced peripheral neuropathy: As the name indicates, this type of nerve pain is commonly seen while undergoing chemotherapy, due to sensory nerve damage in the dorsal root of the spinal nerves. Common symptoms include pain and numbness, which may aggravate as the therapy continues.
● HIV-associated sensory peripheral neuropathy (HIV-SN): This condition affects HIV patients either due to the attack of the HIV virus on the peripheral nerves or the effect of the medicine, which is neurotoxic. Advancing age, malnutrition, genetics, and associated diseases such as diabetes further increase the risk of HIV-SN.
● Post-herpetic neuralgia: This condition occurs if you have previously suffered from herpes zoster infection. Reactivation of the herpes zoster virus where it resides in the dorsal root ganglion can lead to pain typically along the spine and around the eyes.

treatments

At Neuroradiology and Pain Solutions of Oklahoma, we offer a variety of treatments for this condition, including:
● Epidural Injection ● Selective Nerve Root Block ● Peripheral Nerve Stimulation Treatment ● Spinal Cord Stimulator ● Intrathecal Pump Placement