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Knee Pain Clinic

Are you frustrated with your knee pain that is not getting better? Are you experiencing Knee discomfort after prolong walking, squatting or running? You are in the right place! We certainly able to help with our innovative and non-invasive (non-surgical) form of treatment. Get your knee check today. Call us at (65) 64712744 or SMS to (65) 92357641 to schedule for an appointment

Knee Pain

Knee pain refers to pain that occurs in and around your knee joint. Knee pain can be caused by problems with the knee joint itself, or it can be caused by conditions affecting the soft tissues, ligaments, tendons, or bursae that surround the knee.

The severity of knee pain can vary widely. Some people may feel only a slight twinge, while others may experience debilitating knee pain that interferes with their day-to-day activities. In most cases, self-care measures can help you cope with knee pain.

The knee consists of two long leg-bones held together by muscles, ligaments, and tendons. Many knee problems are a result of the aging process and continual wear and stress on the knee joint. Other knee problems result from injury or a sudden movement that stiffens the knee.

Some common conditions of Knee Problem include:

  • ARTHRITIS – Knee pain is a common problem in Asia, especially in individuals above the age of 40. The most common cause of knee pain is degenerative osteoarthritis. Women are more prone to the disease. It is characterized by mild to debilitating pain.

  • LIGAMENT INJURIES – Ligament injuries in the knee; such as an anterior cruciate ligament (ACL) are dreaded by professional and amateur athletes alike. They can be painful and debilitating. They can even permanently change your lifestyle.

  • MENISCAL TEAR – The meniscus is a small “c” shaped cartilage that acts as a cushion in the knee joint. They sit between the femur and the tibia bone, one on the outside and one on the inside of the knee.

  • PATELLAR TENDONITIS – Patellar tendinitis is a common overuse injury. It occurs when repeated stress is placed on the patellar tendon. The stress results in tiny tears in the tendon, which the body attempts to repair.

  • CHONDROMALACIA PATELLA – Chondromalacia patella is a common cause of kneecap pain or anterior knee pain. Often called “Runner’s Knee,” this condition often affects young, otherwise healthy athletes.

  • DISLOCATING KNEECAPS – Kneecap dislocation occurs when the triangle-shaped bone covering the knee (patella) moves or slides out of place. The problem usually occurs toward the outside of the leg.

  • BAKER’S CYST – A Baker cyst is swelling caused by fluid from the knee joint protruding to the back of the knee. The back of the knee is also referred to as the popliteal area of the knee

  • BURSITIS – A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.

  • PLICA SYNDROME – Often called “synovial plica syndrome,” this is a condition that is the result of a remnant of fetal tissue in the knee. The synovial plica are membranes that separate the knee into compartments during fetal development.

  • OSGOOD-SCHALLATER DISEASE – Osgood-Schlatter disease is a disorder of the lower front of the knee where the large tendon under the kneecap (patellar tendon) attaches to the bone of the leg below.

  • OSTEOCHONDRITIS DISSECANS – Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone.

  • GOUT – Gout is a rheumatoid form of arthritis that causes the inflammation, joint pain and swelling especially in the toe, knee and ankle, also reducing their mobility.

  • SHIN SPLINT – Shin splints are a member of a group of injuries called “overuse injuries.” Shin splints occur most commonly in runners or aggressive walkers

When do you need to call us about your knee pain?

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of knee pain must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

  • Inability to walk comfortably on the affected side

  • Injury that causes deformity around the joint

  • Knee pain that occurs at night or while resting

  • Knee pain that persists beyond a few days

  • Locking (inability to bend) the knee

  • Swelling of the joint or the calf area

  • Signs of an infection, including fever, redness, warmth

  • Any other unusual symptoms

Treatments for Knee Pain

Treatment of knee pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.

Read more about patient guide to knee pain

Read more about knee pain while running

Read more about knee pain causing by heavy weight

Read more about 9 tips to avoid knee pain and injuries

Read more about Meniscus Cartilage Tear

Who is Knee Specialist?

Knee specialist is an orthopaedic surgeon specialise in disorders of the knee. They deal with conditions such as knee arthritis, and damage to the knee ligaments. The operations and treatments that knee specialists offer include total and partial knee replacement, arthroscopic knee surgery, and knee ligament reconstruction (including anterior cruciate ligament reconstruction).

CURE YOUR KNEE PAIN TODAY. GET A KNEE SPECIALIST TO RULE OUT THE CAUSES AND CURE OF YOUR KNEE PAIN. CALL US +65 64712744 OR EMAIL INFO@BONECLINIC.COM.SG TO SCHEDULE FOR AN APPOINTMENT

Patient Education about Knee Pain

The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee:

  • The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
  • The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
  • The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.
Numerous bursae, or fluid-filled sacs, help the knee move smoothly.

Your knee joints serve a vital role holding up your bodyweight and are put through even more pressure when you walk, run or jump. Knee pain is very common, both from sport injuries and the wear and tear of day-to-day life.

Knee pain can come from injuries including sprains, swollen or torn ligaments (anterior cruciate ligament or ACL), meniscus or cartilage tears and runner’s knee.

Sports injuries tend to affect one knee at a time. Pain in both knees is more common with arthritis, osteoarthritis, gout or pseudogout, usually later in life.

Conditions that cause knee pain

  • Tendonitis. This is an overuse injury causing swelling of the tendons, the bands of tissue that connect your bones and muscles. This is sometimes called ‘jumper’s knee’ as it is common in sports involving jumping, such as basketball.
  • Bone chips. Sometimes, a knee injury can break off fragments from the bone or cartilage. These pieces can get stuck in the joint, causing it to freeze up. You may also have pain and swelling.
  • Housemaid’s knee or bursitis is caused by kneeling for long periods of time or repetitive knee movements. Fluid builds up in the bursa, the sac of fluid that cushions the knee joints. Swelling behind the knee is called a ‘Baker’s cyst’ and may be caused by injuries or arthritis.
  • Bleeding in the knee joint. This injury is also called haemarthrosis and affectsblood vessels around the knee ligaments causing the knee to feel warm, stiff, bruised and swollen. This may require hospital treatment in serious cases.
  • Iliotibial band syndrome. This is an overuse injury to the iliotibial band of tissue that runs from the hip to the shin past the knee.
  • Medial plica syndrome. This overuse injury affects the plica, a fold of tissue in the knee joint.
  • Osgood- Schlatter Disease. This overuse condition is common in teenagers playing sport and causes swelling and tenderness over the bony bump just below the knee.
  • Partially dislocated kneecap (or patellar subluxation). This is usually due to a physical condition with the legs rather than a sports injury. The kneecap slides out of position and causes pain and swelling.

Treatment for knee pain

Treatment will depend on the type and severity of the injury. Many knee injuries will get better on their own, or can be treated at home. Avoid putting weight on the injured knee as much as possible. Raise the leg with cushions and use an ice pack or bag of frozen veg wrapped in a towel held to the knee. Painkillers such asibuprofen can help with pain and swelling.

You may need to see your GP or seek medical advice if:

  • No weight can be put on the injured knee
  • There’s severe pain when no weight is put on the knee
  • The knee locks, clicks painfully or gives way
  • The knee looks deformed
  • There’s fever, redness or a feeling of heat around the knee, or there’s extensive swelling
  • The calf beneath the injured knee is painful, swollen, numb or tingling
  • Pain is still there after three days of home care treatment

A doctor will carry out a physical examination of the injured knee and may arrange some extra tests, including blood tests, an X-ray or MRI scan.

Treatment may involve physiotherapy, painkillers and sometimes an arthroscopy – a form of keyhole surgery that is used to look inside a joint and repair any damage that has occurred.

When will my knee pain feel better?

Recovery from knee pain will depend on the type and severity of the injury.

If recovery prevents you doing high impact sport such as running, try a low impact one like swimming.

Preventing knee pain

Knee pain cannot always be avoided, but good precautions include stretching, warming up and cooling down around a workout or playing sport. Having the right equipment, such as trainers designed for running and kneepads for jobs involving kneeling can help.

Stop exercising if you feel pain in your knee.

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Patella Injuries

The patella, or kneecap, is one of three bones, along with the tibia (shin bone) and femur (thigh bone), that make up the knee joint. All of these bones are covered with a layer of cartilage at points where their surfaces come into contact. Furthermore, the patella is wrapped within a tendon. This tendon connects the quadriceps muscle of the thigh to the shin bone (tibia) below the knee joint.

Condromalacia Patella

Condromalacia Patella

The patella is important functionally because it increases the leverage of the knee joint. From a mechanical perspective, the patella allows for an increase of about 30% in strength of extension (kicking) of the leg at the knee joint.

Symptoms of Kneecap Problems

Problems with the kneecap typically cause pain felt directly around the kneecap. Often these symptoms are noticed doing specific activities:

  • Walking stairs (particularly down)
  • Prolonged sitting
  • Kneeling

There are several common problems associated with the kneecap that can cause problems and pain in the knee

Chondromalacia Patellae (Runner’s Knee)
The most common disorder is known as chondromalacia, often called Runner’s Knee. Chondromalacia occurs because of irritation of the cartilage on the undersurface of the kneecap.

Prepatellar Bursitis (Housemaid’s Knee)
Prepatellar bursitis, or Housemaid’s Knee Syndrome, is a condition of swelling and inflammation over the front of the knee. This is commonly seen in patients who kneel for extended periods, such as carpet layers and gardeners.

Patellar Subluxation
Also called an unstable kneecap, patients who experience this painful knee condition have a patella that does not track evenly within its groove on the femur.

Kneecap Dislocation
When the kneecap comes completely out of its groove, the condition is called a patella dislocation. When the kneecap dislocates, it must be put back into its groove.

Treatment of Kneecap Problems

Treatment of these various kneecap conditions depends on the diagnosis, however there are some general guidelines that can be followed. For more information, and for a diagnosis of your knee pain, it is important to see your doctor.

  • Rest
    Resting the injured knee to allow time for inflammation to subside is very important. Cross-training will allow you to keep in shape. When you do return to activity, do so gradually.
  • Physical Therapy
    Physical therapy is very important to balance the strength of the muscles around the knee joint. Most importantly, the quad and hamstring muscle groups should be flexible and balanced.
  • Ice the Injury
    Apply ice to the knee to cool down inflammation in stimulate blood flow to the area. Be careful not to ice too much!
  • Anti-Inflammatory Medications
    Anti-inflammatory medications may help with inflammation and will also help alleviate some of the pain associated with patella conditions.
  • Arthroscopic Surgery
    While surgery is seldom needed because of a kneecap problem, arthroscopy is a treatment option if the problem is not getting any better with conservative treatment.

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Preventing ACL Injuries

ACL (anterior cruciate ligament) knee injuries can cause many problems for kids who play sports. Besides the chance of having to sit out an entire season, they might face loss of scholarship funding, lowered academic performance,1 and long-term disability from osteoarthritis (a painful joint condition). More than 50,000 debilitating ACL injuries occur in female athletes at the high school and intercollegiate varsity levels in an average year.

Knee Bursitis

Knee Bursitis

Why do ACL Injuries occur in kids?

Most ACL tears do not occur from player-to-player contact. The most common causes of noncontact ACL injury include: change of direction or cutting maneuvers combined with sudden stopping, landing awkwardly from a jump, or pivoting with the knee nearly fully extended when the foot is planted on the ground.

Who is at Risk for An ACL Injury?

There is no definitive link between age and gender, and the rising rates of ACL injuries. However, landing, cutting, and pivoting maneuvers have been shown to differ between male and female athletes. For example, some female soccer players may perform playing actions with more of a knock-kneed position, or a reduced hip and knee joint range of motion, or decreased hamstring strength, any of which may underlie their increased risk for an ACL injury.

How can an ACL Injury be prevented?

It is difficult to assess how athletes can best modify their movements to prevent noncontact ACL injuries. Speaking with an athletic trainer, physical therapist, or sports medicine specialist is a good place to start. Recent research has allowed therapists and clinicians to easily identify and target weak muscle areas (e.g., weak hips, which leads to knock-kneed landing positions) and identify ways to improve strength and thus help prevent injury. In addition, other risk factors such as reduced hamstring strength and increased joint range of motion can be further assessed by a physical therapist or athletic trainer to improve performance—or rehabilitation efforts after an injury has occurred.

Current studies also demonstrate that specific types of training, such as jump routines and learning to pivot properly, help athletes prevent ACL injuries. These types of exercises and training programs are more beneficial if athletes start when they are young. It may be optimal to integrate prevention programs during early adolescence, prior to when young athletes develop certain habits that increase the risk of an ACL injury.

Summary

There are several factors that determine whether or not a young athlete will get an ACL injury. Preseason screening programs that monitor important risk factors and identify young “high-risk” athletes who would benefit from targeted neuromuscular training interventions may be the most beneficial way to reduce the risk of ACL injuries in young athletes.

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Pain Behind Knee

Pain Behind knee is a major problem for a lot of people and many of them have been suffering from it for years now. In most cases, the patients that get pain behind the knee are older in age. Usually, the case of the pain is either an older knee injury, or a problem of an orthopedic nature. One of the possible causes for pain behind the knee is the excess weight. The problem can either be the fact that you carry heavy objects around, or it can be excessive body weight. The possibility that an injury will appear increases considerably in this case and the bone degeneration is much faster as well. The result is the appearance of pain behind knee.

Causes of Pain Behind the Knee

Back of Knee pain causes can be many, so it’s not always easy to figure out which one is the problem in your case. This type of pain can be caused by arthritis, cartilage injury, baker’s cyst, ligament injury, patellar tendonitis or a meniscal tear. This type of problem can appear in patients of all ages.

 

  • Arthritis is one of the possible explanations for knee pain, a condition which appears when the joint gets inflamed. You will find that there is medication available which can be used to treat it, medication which can be obtained by visiting a doctor, which can confirm the problem.
  • Injuries in the ligament area can appear because of a few different problems, including injuries to the MCL (medical collateral ligament),PCL (Posterior Cruciate Ligament) and ACL (Anterior Cruciate Ligament). Treating this type of injury is sometimes a matter of a surgical procedure, but that’s a call that the doctor has to make, based on what he finds and on the symptoms. This type of injury is usually experienced by athletes.
  • Meniscal tear is another type of cause for knee pain and it’s a type of cartilage injury. It doesn’t matter if you’re old or young, you can still get this type of injury. The cause is sometimes traumatic injury, which is something that athletes experience. In other cases, when the patient is older, the cause is usually a degenerative process, caused by brittle bones. The tests which tell doctors if a meniscal tear is the cause of the pain include MRIs and x-rays.
  • Another potential cause for pain behind knee is the condition known as Patellar Tendonitis, which appears because of the knee’s extreme usage. The knee is surrounded by tissue and tendon, which can become irritated and swollen. Another name that is used for this condition is Jumper’s knee, since it often appears during jumping, when the knee is used excessively. Athletes which practice sports which require lots of jumping will often have this problem, especially if they’re not reducing the amount of physical activity they do.
  • The baker’s cyst is another major knee pain cause.It is also known as popliteal cyst.In this type of condition, fluid accumulates in the area behind the joint of the knee.This is not something that can spread behind the area where it appears though, so it is not considered a tumor. This condition is something that older people get and young individuals don’t usually have a problem with it.

Back of Knee Pain Symptoms

Feeling pain in back of knee usually happens because of an inflammation of the knee joints, making it difficult to move it backward or forward, either when climbing or walking stairs. If you’re having this type of problem, it’s a good idea to talk with a physiotherapist, so he can give you advice on the right posture to keep when you’re carrying or lifting heavy objects. One other possible reason why you would feel pain in that area is because of a weaker hamstring. These muscles are important when you want to bend the knee, together with the quadriceps muscles.

Treatment options for Pain Behind the Knee

If you want to reduce the chance that you will get an injury to the knee and if you want to keep them as supple as possible, you should try to make sure that the joints remain flexible and strong. When you do feel pain behind your knee, you should try resting it, while applying a cold compress on it. At the same time, try to make sure that the symptoms don’t get any worse.

When it’s a chronic case, you should discuss the problem with a doctor, in order to get a course of treatments which will improve your situation. Once the doctor examines you and figures out what causes the knee pain, he will be able to give you some recommendations. One example would be to wear some knee braces, which would help the ligaments act naturally, while easing your knee soreness feeling. There are a number of different types of equipments available for gyms which can help with the pain you feel behind your knee. They work by making weak muscles stronger, muscles which give support to the joint of the knee. It is advisable that you discuss it with a physiotherapist though, as he knows best what you need and he can give you advice on the sets of exercises which will not force the joints.

These days, there are improved surgical procedures and better drugs that are anti inflammatory, so if you have damaged tissue area and knee joints chances are better than ever that the doctors will be able to fix the problem. The patients that suffer from these problems today are much more likely to recover faster and to get back a good function level of the joint, while getting rid of pain at the same time.

Know your limits

People don’t know the limits of what their body can do, or they don’t realize that as they grow older, they can’t do as much as before. Repeated stress put on the knees can result in injuries and pain. The best course of treatment for pain behind  knee is preventing it in the first place, something that is true for many medical issues.

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ACL Injury: Does it require surgery?

What is an ACL tear?

An ACL tear is a relatively common sporting injury affecting the knee and is characterized by tearing of the Anterior Cruciate Ligament of the knee (ACL).

A ligament is a strong band of connective tissue which attaches bone to bone. The ACL is situated within the knee joint and is responsible for joining the back of the femur (thigh bone) to the front of the tibia (shin bone).

The ACL is one of the most important ligaments of the knee, giving it stability. The ACL achieves this role by preventing excessive twisting, straightening of the knee (hyperextension) and forward movement of the tibia on the femur. When these movements are excessive and beyond what the ACL can withstand, tearing to the ACL occurs. This condition is known as an ACL tear and may range from a small partial tear resulting in minimal pain, to a complete rupture of the ACL resulting in significant pain and disability, and, potentially requiring surgery. An ACL tear can be graded as follows:

  • Grade 1 tear: a small number of fibres are torn resulting in some pain but allowing full function
  • Grade 2 tear: a significant number of fibres are torn with moderate loss of function.
  • Grade 3 tear: all fibres are ruptured resulting in knee instability and major loss of function. Often other structures are also injured such as the menisci or collateral ligaments. Surgery is often required.
Iliotibial Band Syndrome

Iliotibial Band Syndrome

Causes of an ACL tear

ACL tears typically occur during activities placing excessive strain on the ACL. This generally occurs suddenly due to a specific incident, however, occasionally may occur due to repetitive strain. There are three main movements that place stress on the ACL, these include:

  • twisting of the knee
  • hyperextension of the knee
  • forward movement of the tibia on the femur

When any of these movements (or combinations of these movements) are excessive and beyond what the ACL can withstand, tearing of the ACL may occur. Of these movements, twisting is the most common cause of an ACL tear.

ACL tears are frequently seen in contact sports or sports requiring rapid changes in direction. These may include: football, netball, basketball and downhill skiing. The usual mechanism of injury for an ACL tear is a twisting movement when weight-bearing (especially when landing from a jump) or due to a collision forcing the knee to bend in the wrong direction (such as another player falling across the outside of the knee). Occasionally an ACL injury may occur during a sudden deceleration when running.

Signs and Symptoms of an ACL tear

Patients with an ACL tear may notice an audible snap or tearing sound at the time of injury. In minor cases of an ACL tear, patients may be able to continue activity only to experience an increase in pain, swelling and stiffness in the knee after activity with rest (particularly first thing in the morning). Often the pain associated with this condition is felt deep within the knee and is poorly localized.

In cases of a complete rupture of the ACL, pain is usually severe at the time of injury, however, may sometimes quickly subside. Patients may also experience a feeling of the knee going out and then going back in as well as a rapid onset of considerable swelling (within the first few hours following injury). Patients with a complete rupture of the ACL generally can not continue activity as the knee may feel unstable, or may collapse during certain movements (particularly twisting). Occasionally, the patient may be unable to weight bear at the time of injury due to pain and may develop bruising and knee stiffness over the coming days (especially an inability to fully straighten the knee). Patients with a complete rupture of the ACL may also experience recurrent episodes of the knee giving way following the injury.

Diagnosis of an ACL tear

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an ACL tear. Investigations such as an X-ray, MRI scan or CT scan may be required to confirm diagnosis and determine the extent of damage or involvement of other structures within the knee.

Treatment for an ACL tear

Most patients with a minor to moderate ACL tear  heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. A vital aspect of treatment is that the patient rests sufficiently from any activity that increases their pain. Activities placing large amounts of stress on the ACL should also be minimized, particularly twisting and hyperextension of the knee. Resting from aggravating activities ensures the body can begin the healing process in the absence of further damage. Once the patient can perform these activities pain free a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the problem becoming chronic. Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence or ACL surgery.

Patients with an ACL tear should follow the R.I.C.E. Regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime involves resting from aggravating activities (this may include the use of crutches), regular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also significantly hasten the healing process in patients with an ACL tear by reducing the pain and swelling associated with inflammation.

Patients with an ACL tear should also perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. One of the key components of ACL rehabilitation is pain-free strengthening of the quadriceps, hamstring and gluteal muscles to improve the control of the knee joint with weight-bearing activities. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Surgery for an ACL tear

Surgical reconstruction of the ACL is often required in patients who have a complete rupture of the ACL and are seeking the highest level of function. The procedure is known as an ACL reconstruction and generally comprises of arthroscopic surgery to reconstruct or repair the ACL with other tissue from your body. The hamstring tendon or patella tendon are most frequently used in this process.

Following ACL reconstruction surgery a lengthy period of rehabilitation of 6 – 12 months or longer is required to gain an optimal outcome and return the patient to full activity or sport. Surgery for an ACL tear should be particularly considered in patients who have a complete rupture and:

  • are < 40 years of age
  • need a high level of knee function for recreational, work or sporting activity
  • have associated damage to their menisci or collateral ligaments of the knee
  • are able to comply and commit to intensive rehabilitation
  • have ongoing knee pain, swelling or recurrent episodes of the knee giving way despite appropriate rehabilitation

Following a complete ACL tear, patients who choose not to have surgery may suffer from ongoing knee instability and recurrent episodes of the knee collapsing or giving way with certain movements (particularly twisting). Patients with a complete ACL tear may also have an increased likelihood of developing knee osteoarthritis due to excessive movement and subsequent wear and tear of the knee.

In those patients who undergo surgical intervention, rehabilitation should commence from the time of injury, not from the time of surgery. This is essential to minimize swelling, improve range of movement and strength and ensure an optimal outcome following surgery.

Prognosis of an ACL tear

With appropriate management, most patients with a minor to moderate ACL tear (grades 1 and 2) can return to sport or normal activity within 2 – 8 weeks. Patients with a complete rupture of the ACL will frequently require surgical reconstruction followed by a lengthy rehabilitation period of 6 – 12 months or longer to gain optimum function. Patients who also have damage to other structures of the knee such as the meniscus or collateral ligaments are likely to have an extended rehabilitation period.

Physiotherapy for an ACL tear

Physiotherapy for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of future recurrence. Treatment may comprise:

  • soft tissue massage
  • joint mobilization
  • taping
  • bracing
  • ice or heat treatment
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • exercises to improve flexibility, strength and balance
  • hydrotherapy
  • education
  • activity modification advice
  • crutches prescription
  • biomechanical correction
  • a gradual return to activity program

Other intervention for an ACL tear

Despite appropriate physiotherapy management, a small percentage of patients with a minor to moderate ACL tear and most patients with a complete ACL tear do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. Surgical reconstruction of the ACL is frequently required in cases of a complete ACL rupture particularly when conservative measures fail.

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Osteoarthritis (Knee Pain Clinic)

Are you looking for effective way to manage and cure Osteoarthritis? You are at the right place. Stop your Knee Pain today! Call us at +65 6471 2744 or SMS to +65 92357641 to schedule for an appointment.

The most common form of arthritis, Osteoarthritis (OA) affects an estimated 40% of the adult population. Of these, only 10% seek medical advice and only 1% are severely disabled.

Knee Osteoarthritis

Knee Osteoarthritis

Causes

Osteoarthritis (OA) means inflammation of the joints although it is better known as a degenerative disease due to the inflammation of the joints with thinning of the articular cartilage. The cartilage in our joints allows for the smooth movement of joints. When it becomes damaged due to injury, infection or gradual effects of ageing, joints movement is hindered. As a result, the tissues within the joint become irritated causing pain and swelling within the joint.

Symptoms

In OA, you will have no problem in the morning on arising but as the day progresses your discomfort will increase.

In the evening, there will be a dull ache in the area of the affected joint.

Other symptoms include:

  • Pain
  • Swelling of the affected joints
  • Changes in surrounding joints
  • Warmth – The arthritic joint may feel warm to the touch
  • Crepitation – A sensation of grating or grinding in the affected joint caused by the rubbing of damaged cartilage surfaces
  • Cysts – In OA of the hand, small cysts may develop, which may cause the ridging or dents in the nail plate of the affected finger

The changes associated with degenerative arthritis tend to involve similar joints. Whereas in post-traumatic degenerative arthritis where there is a history of acute or chronic trauma, the changes tend to be isolated to the specific joints injured.

Risk Factors

Old age
As a person grows older, it becomes more likely that the cartilage may be worn away. OA is uncommon in people below 40 years of age.

Gender
Women are more likely to suffer from OA, especially after menopause.

Previous joint injury
Someone with a previous injury to the cartilage within the joint, e.g. after a fracture involving the joint or after a sporting injury to the joint will have a higher risk of developing OA later in life.

Weight
A greater than normal body weight puts more stress on the weight-bearing joints such as the hip and knee, increasing the likelihood of developing OA in these joints.

Bone deformities
People born with deformed joints or abnormal cartilage have an increased risk of OA.

Other diseases that affect the joints
Bone and joint diseases that increase the risk of OA include other arthritic conditions such as rheumatoid arthritis and gout.

Genetics
Genetic factors may predispose to the development of OA.

Diagnosis

The specialist will begin by taking a detailed history of your problem and past medical problems, followed by a physical examination. He may then proceed to other tests, such as:

X-rays
This is the most commonly performed test to evaluate the status of the affected joint and the alignment of the joint. Normal x-rays are safe, simple and pain-free.

Blood tests
Depending on the clinical findings, blood may be drawn for special testing, to rule out other causes of joint pain, e.g. due to rheumatoid arthritis, gout or infection.

Joint aspiration
Occasionally, especially when the joint is very swollen, the doctor may choose to suck some fluid out of the swollen joint for special testing. Removal of joint fluid also sometimes relieves pain.

Treatment Options

The goals for treatment for osteoarthritis are:

i. Pain relief
ii. Maintenance of function
iii. Prevention of associated deformities
iv. Patient education

The treatment for OA depends on the severity of the disease and the patient’s own lifestyle expectations.

Early cases of OA can generally be treated with:

  • Rest and lifestyle modification, such as weight loss and cessation of smoking
  • Use of aid (e.g. a walking stick). Use of good shoes is also helpful for relieving symptoms in some
    cases of OA
  • Exercise and physiotherapy to strengthen muscles and improve joint flexibility
  • Medication

In OA of the hand, rest can be accomplished by selectively immobilising the joint in a splint. Splinting is initially done for a period of 3 – 4 weeks, during which the splint is worn continuously.

This is usually combined with non-steroidal anti-inflammatory medication (NSAIDs) taken at the same time. If there is improvement in symptoms, use of the splint during the day is progressively diminished over the course of the coming month/s.

Use of NSAIDS
Gastrointestinal intolerance remains one of the major factors limiting the prolonged use of NSAIDs and may require temporary or permanent discontinuation of the anti-inflammatory agent. Concomitant use of H2 blockers, omeprazole, or misoprostol, a prostaglandin analogue that counteracts the mucosal effects of NSAIDs, may mitigate some of the gastrointestinal effects. Nephrotoxicity is a well-known complication of NSAIDs, and patients with pre-existing renal insufficiency should not take NSAIDs for extended periods.

Types of medication
There is presently no medication that can cure OA or regrow the cartilage in osteoarthritic joints.

The most commonly prescribed medications are painkillers. The type of painkiller prescribed depends on
the severity of the pain. For early disease with mild and occasional pain, simple painkillers, although more severe pain may require the use of non-steroidal anti-inflammatory drugs (NSAID’s) for relief. Analgesic (painkillers) creams and adhesive patches can also be used.

Glucosamine, with or without chondroitin, has also become a popular drug treatment in recent
years. It can be purchased without a doctor’s prescription.

However, it is ineffective in many patients, especially those with severe OA. The duration of its symptomatic relief also tends to be temporary. There is no evidence that glucosamine or chondroitin is able to result in cartilage repair.

Injections
For the treatment of OA, your doctor may sometimes recommend a lubricant injection to coat the cartilage and stimulate the healing process.

Surgery
Surgery is usually only offered for severe disease that has not responded to conservative treatments mentioned. Both the type of surgery and the decision for surgery are made following careful discussions between you and your doctor.

For many joints in the hands, arthodesis or fusion of the joint is the method of choice. In joint fusion, the arthritic surface is removed and bones on either side of the joint are fused to eliminate movement from the problem joint.

There may be some loss of movement but the pain ablation and stability may functionally improve the joint that is severely affected by the degenerative joint disease.

STOP YOUR KNEE PAIN TODAY. CALL US AT +65 6471 2744 Or SMS TO +65 92357641 FOR APPOINTMENT

Patient Guide to Knee Pain

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.

Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.

Symptoms

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully straighten the knee

When to see a doctor
Call your doctor if you:

  • Can’t bear weight on your knee
  • Have marked knee swelling
  • Are unable to fully extend or flex your knee
  • See an obvious deformity in your leg or knee
  • Have a fever, in addition to redness, pain and swelling in your knee
  • Feel as if your knee is unstable or your knee “gives out”

Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

  • ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball, soccer or other sports that require sudden changes in direction.
  • Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
  • Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
  • Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Runners, skiers, cyclists, and those involved in jumping sports and activities are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems
Some examples of mechanical problems that can cause knee pain include:

  • Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.
  • Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.
  • Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you’ll be able to see the dislocation.
  • Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis
More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:

  • Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
  • Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
  • Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
  • Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
  • Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Other problems
Chondromalacia patellae (patellofemoral pain syndrome) is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in athletes; in young adults, especially those who have a slight misalignment of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

Risk factors

A number of factors can increase your risk of having knee problems, including:

  • Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
  • Biomechanical problems. Certain structural abnormalities — such as having one leg shorter than the other, misaligned knees and even flat feet — can make you more prone to knee problems.
  • Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don’t absorb enough of the stress exerted on the joint.
  • Certain sports. Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball’s jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.
  • Previous injury. Having a previous knee injury makes it more likely that you’ll injure your knee again.

Complications

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.

Preparing for your appointment

You’re likely to start by seeing your family doctor. Depending upon the cause of your problem, he or she may refer you to a doctor specializing in joint diseases (rheumatologist), joint surgery (orthopedic surgeon) or sports medicine.

What you can do
Before your appointment, you may want to write a list of answers to the following questions:

  • When did you begin experiencing symptoms?
  • Did a specific injury make your knee start to hurt?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What medications and supplements do you take regularly?

What to expect from your doctor
Your doctor may ask some of the following questions:

  • Do you exercise or play sports?
  • Do you experience any swelling, instability or locking of the knee?
  • Are you experiencing symptoms in other areas, or just in your knee?
  • Have you ever had knee pain before? If so, do you know what the cause was?

Tests and diagnosis

During the physical exam, your doctor is likely to:

  • Inspect your knee for swelling, pain, tenderness, warmth and visible bruising
  • Check to see how far you can move your lower leg in different directions
  • Push on or pull the joint to evaluate the integrity of the structures in your knee

Imaging tests
In some cases, your doctor might suggest tests such as:

  • X-ray. Your doctor may first recommend having an X-ray, which can help detect bone fractures and degenerative joint disease.
  • Computerized tomography (CT) scan. CT scanners combine X-rays taken from many different angles, to create cross-sectional images of the inside of your body. CT scans can help diagnose bone problems and detect loose bodies.
  • Ultrasound. This technology uses sound waves to produce real-time images of the soft tissue structures within and around your knee, and how they are working. Your doctor may want to maneuver your knee into different positions during the ultrasound, to check for specific problems.
  • Magnetic resonance imaging. MRI uses radio waves and a powerful magnet to create 3-D images of the inside of your knee. This test is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.

Lab tests
If your doctor suspects an infection, gout or pseudogout, you’re likely to have blood tests and sometimes arthrocentesis, a procedure in which a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis.

Treatments and drugs

Treatments will vary, depending upon what exactly is causing your knee pain.

Medications
Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout.

Therapy
Strengthening the muscles around your knee will make it more stable. Training is likely to focus on the muscles on the front of your thigh (quadriceps) and the muscles in the back of your thigh (hamstrings). Exercises to improve your balance are also important.

Arch supports, sometimes with wedges on one side of the heel, can help to shift pressure away from the side of the knee most affected by osteoarthritis. In certain conditions, different types of braces may be used to help protect and support the knee joint.

Injections
In some cases, your doctor may suggest injecting medications directly into your joint. Examples include:

  • Corticosteroids. Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.
  • Supplemental lubrication. A thick fluid, similar to the fluid that naturally lubricates joints, can be injected into your knee to improve mobility and ease pain. Relief from one or a series of shots may last as long as six months to a year.

Surgery
If you have an injury that may require surgery, it’s usually not necessary to have the operation immediately. Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what’s most important to you. If you choose to have surgery, your options may include:

  • Arthroscopic surgery. Depending on your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage, and reconstruct torn ligaments.
  • Partial knee replacement surgery. In this procedure (unicompartmental arthroplasty), your surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed with a small incision, and your hospital stay is typically just one night. You’re also likely to heal more quickly than you are with surgery to replace your entire knee.
  • Total knee replacement. In this procedure, your surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Lifestyle and home remedies

Over-the-counter medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others) — may help ease knee pain. Some people find relief by rubbing their knees with creams containing a numbing agent, such as lidocaine or capsaicin, the substance that makes chili peppers hot.

Self-care measures for an injured knee include:

  • Rest. Take a break from your normal activities to reduce repetitive strain on your knee, give the injury time to heal and help prevent further damage. A day or two of rest may be all you need for a minor injury. More severe damage is likely to need a longer recovery time.
  • Ice. Ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You can also use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don’t use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin.
  • Compression. This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that’s lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation.
  • Elevation. To help reduce swelling, try propping your injured leg on pillows or sitting in a recliner.

Alternative medicine

  • Glucosamine and chondroitin. Study results have been mixed about the effectiveness of these supplements for relieving osteoarthritis pain. People who have moderate to severe arthritis pain appear to get the most benefit from these supplements.
  • Acupuncture. Research suggests that acupuncture may help relieve knee pain caused by osteoarthritis. Acupuncture involves the placement of hair-thin needles into your skin at specific places on your body.

Prevention

Although it’s not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration:

  • Keep extra pounds off. Maintain a healthy weight; it’s one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
  • Be in shape to play your sport. To prepare your muscles for the demands of sports participation, take time for conditioning. Work with a coach or trainer to ensure that your technique and movement are the best they can be.
  • Get strong, stay limber. Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can contribute to injury, stretching is important. Try to include flexibility exercises in your workouts.
  • Be smart about exercise. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.

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Patient Guide to Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

Symptoms of Osteoarthritis:

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Tenderness. Your joint may feel tender when you apply light pressure to it.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor
If you have joint pain or stiffness that lasts for more than a few weeks, make an appointment with your doctor.

Causes of Osteoarthritis

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

Risk Factors of Osteoarthritis:

Factors that increase your risk of osteoarthritis include:

  • Older age. The risk of osteoarthritis increases with age.
  • Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.
  • Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  • Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  • Obesity. Carrying more body weight puts added stress on your weight-bearing joints, such as your knees.
  • Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
  • Other diseases. Having diabetes, underactive thyroid, gout or Paget’s disease of bone can increase your risk of developing osteoarthritis.

The complication of Osteoarthritis:

Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become severe enough to make daily tasks difficult. Some people are no longer able to work. When joint pain is this severe, doctors may suggest joint replacement surgery.

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Knee Pain Clinic

Most athletes will experience some knee pain from time to time. Overuse, long training days or bumps and bruises from contact sports often result in minor knee pain that heals within a day or two with some rest and ice. But there are some clues that indicate more serious knee pain and injuries that may need to be seen by a doctor for a complete evaluation and treatment plan.

When to See a Doctor for Knee Pains

You should see a doctor for your knee pain if you have any of the following warning signs:

  • Pain that lasts more than 48 hours
    If you have knee deep within the knee joint for more than a day or two your should get checked by a doctor. The knee joint isn’t covered by muscle so pain here is rarely of muscular origin.
  • Swelling that lasts more than 48 hours
    The first thing that happens after an acute injury is swelling around the site of the injury. When soft tissue is damaged, it swells or possibly bleeds internally. This swelling causes pain and loss of motion, which limits use of the muscles or joints. Swelling is usually obvious and can be seen, but occasionally you may just feel as though something is swollen even though it look normal. Swelling within a joint often causes pain, stiffness, and may produce a clicking sound as the tendons snap over one another after having been pushed into a new position from the swelling.
  • Loss of range-of-motion in the joint
    Reduced range-of-motion can indicate significant internal swelling, as well as other joint injuries. If you have limited range-of-motion for more than a day, you should contact your doctor.
  • Instability: feeling that the knee will give out
    Any instability in the knee joint or any sensation that the knee may give out or collapse may indicate a ligament injury to the knee. The knee ligaments provide support and stability to the joint and instability; if they are stretched or torn due to an injury, instability is one of the most obvious warning signs.
  • Inability to put your full weight on the leg
    A difference in your ability to support your full body weight on one leg,compared to the other, is another tip-off to an injury that requires attention.
  • Deformity of the knee joint
    If the knee joint looks deformed compared to the pain-free side, you should see a doctor. A fracture, patella tracking injury or a dislocating kneecap might sound obvious, but there are varying degrees of injury.
  • Knee joint pain in an active child
    If a child has knee pain it should be checked out be a doctor to rule out Osgood-Schlatter Disease.

Find the Right Doctor for Knee Pain

If you have any of these signs, you may want to see a specialist for a complete evaluation and treatment plan.

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