When to worry about knee pain
Zandi Nkosi suffered a throbbing pain in her right knee for months. After being misdiagnosed and given medical advice that could potentially have led to a shattered kneecap, she sought a second opinion. Here we speak to an orthopaedic surgeon about common reasons for knee pain and when to worry.
Common causes of knee pain
Dr Quinton Accone, an orthopaedic surgeon at Mediclinic Morningside in Sandton, says there are two predominant causes of knee pain – it’s either caused by a mechanical problem, or it’s inflammatory.
‘Usually it’s trauma – someone has fallen or hurt themselves, maybe twisted their knee. That’s the most common cause. Other causes are inflammations such as gout, tuberculosis of the knee joint, or septic arthritis,’ says Dr Accone, adding that other, less common causes include cancer or growths.
Mechanical issues include:
- anterior cruciate ligament (ACL) injury
- torn meniscus
- knee bursitis
- loose bodies – bone or cartilage fragments in the knee joint
- dislocated kneecap.
- Overuse injury (jumpers knee)
- Osgood Schlatter Syndrome (characterised by a painful bump just below the knee and most often seen in young adolescents).
Inflammatory issues include:
- rheumatoid arthritis
- pseudo gout
- septic arthritis
- tuberculosis of the knee joint.
In 2005, Zandi Nkosi started to feel an ache down the side of her right knee. Hoping it would dissipate, she delayed seeking medical attention. But when the ache became a throbbing pain that affected her ability to walk, she sought a doctor’s opinion.
After an X-ray to rule out any mechanical issues, Zandi was advised that the discomfort could be caused by her weight, and was advised by her doctor to initiate physical exercise, which she did. But six months went by and the pain became so unbearable that she had to stop exercising. She then decided to get a second opinion.
Zandi underwent a magnetic resonance imaging (MRI) scan, which picked up a 5cm tumor in her knee. Initially the tumor was suspected to be an osteosarcoma – a potentially deadly cancer that occurs in the long bones of the body and is usually accompanied by a tumour. Fortunately, after the tumour was surgically removed and examined, it was declared non-malignant.
Zandi’s doctors told her that had she continued to exercise with the tumour, she could have shattered her kneecap.
When to seek medical attention for knee pain
Dr Accone advises that in all cases of knee pain, the patient needs to get a proper diagnosis first. He says that usually, by the time a patient reaches a specialist, they’ve been taking anti-inflammatory medication and have perhaps already been treated by a physiotherapist.
‘In all cases you need at least a basic investigation – an X-ray – to determine if there is any damage to the bone, or even a fracture. The most important thing is to get a diagnosis. Anti-inflammatory treatment just masks the symptoms,’ says Dr Accone. He adds that an MRI scan is necessary if it’s a soft-tissue problem that an X-ray wouldn’t detect.
Dr Accone stresses that the cause of knee pain should be diagnosed early. Recurring pain, noises in the knee, swelling or instability are all good reason to consult a medical professional.
‘If something has changed in your knee and it’s preventing you from doing what you normally do – either because of pain and swelling or instability – seek proper help sooner rather than later,’ he advises.