Knee pain may signal a chronic joint disorder.
Q My mother is 51 years old and her left kneecap is swollen. When she walks for long distances, her left leg will start to hurt.
She cannot stand up for too long either. She went for acupuncture but it did not seem to help much. Is there a way for doctors to find out the root of the problems?
A: Knee pain is a common complaint with a fairly diverse number of causes. After the age of 40, degenerative conditions, such as osteoarthritis, are behind a majority of these cases.

Osteoarthritis is a chronic joint disorder in which the cartilage lining of the joint gradually breaks down, forming cracks and holes. This eventually exposes the underlying bone. It is a common disorder and is the leading cause of dysfunction and disability in the developed world, affecting up to 20 per cent of the population over 65.The symptoms of osteoarthritis, which appear to be consistent with your mother’s complaints, include pain during physical activity such as walking or climbing the stairs, swelling and stiffness. Osteoarthritis usually takes a protracted course, with a gradual increase in the severity of symptoms. Sometimes, the symptoms may suddenly get worse as well. In the advanced stages of the disease, deformity of the knee joints becomes apparent, with most people showing worsening signs of bow-leggedness.

Other possible causes of knee pain include traumatic events such as twists and falls; inflammatory conditions such as gout, in which there is a build-up of uric acid crystals in the joints; and rheumatoid arthritis, when a chronic swelling of the joint lining eventually damages the cartilage lining. If your mother chooses to consult a doctor, the general evaluation would begin with taking her medical history, where the doctor will ask questions specific to your mother’s condition and general health. The doctor will also take note of the duration and severity of your mother’s knee swelling and discomfort.

Swelling in the knee joint arises when there is a build-up of fluid within the joint. It could occasionally point to inflammation. The presence of pain in other joints of the body, such as the neck and spine, hip joints and small joints of the fingers and feet, will also be examined. This aids the doctor in determining whether the disease is localised or part of a more systemic process.

Limitations on activities of daily living and the impact on quality of life will also be assessed, as well as her expectations of the treatment outcome. This helps the doctor to tailor a management plan that is suitable for your mother. Next, a physical examination of your mother’s knee joint will be performed where any deformity, muscle wasting and fluid build-up in the knee joint will be assessed. Tenderness around the knee joint and its flexibility and stability will also be evaluated. Finally, an examination of the spine and hip joints (and any other involved joints) will usually be performed to exclude a more generalised disorder.

Generally, X-rays of the knee joint will be performed so that the doctor has an idea of how much cartilage and bone has been worn away, as well as the severity of any deformity of the knee joint. More detailed scanning tests, such as magnetic resonance imaging, is occasionally requested in early degenerative disease or for ligament or meniscal (shock absorber) tears. If an inflammatory joint disorder is suspected, then blood tests may have to be performed too.

Unfortunately, there is no cure for osteoarthritis and treatment is targeted at controlling the symptoms and restoring normal function. This is usually achieved through measures such as physiotherapy, medication (painkillers and anti-inflammatory medicine) and the occasional use of walking aids. Surgical intervention via keyhole surgery or knee joint replacement is advised only when conservative means fail to ease the symptoms.