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Having sever pain in knee and palm. Tried different treatment but not cured. Any suggestion?

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Orthopaedic Surgeon
Practicing since : 2000
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My Mom has a sever pain in knee & Palm. Its more than 10yrs and still the pain is not reducing. Her age is 48.
We have tried all sort of treatment and procedures but still the pain is same.
Kindly suggest me what is the Next step for proceed.
Posted Wed, 15 Aug 2012 in Bones, Muscles and Joints
Answered by Dr. Atul Wankhede 2 hours later
Thanks for posting your query.

One needs to treat both the areas differently, unless its a proved long standing arthritis like rheumatoid or gouty arthritis. I'm sure by now tests to rule out these special types of arthritis has been done and proved negative. So lets treat the pain in palm and knee as osteoarthritis and proceed respectively.

The knee, if very painful and deformed, should be evaluated with an MRI and treated accordingly. If medicines have stopped working, maybe she requires a slightly higher dose of analgesics or steroids, or even joint replacement.

The palm too needs an x XXXXXXX screening to ascertain the degree of degeneration/ deformity. It can be managed with local steroids or splints and activity modification.

Pain beyond doubt can be managed with the aforesaid ways, but I suppose we needs to diagnose her exact condition for accurate treatment. Even though you have already tried all sorts of treatment/procedures, you still have not been able to reach a diagnosis. That's why medicines are failing. Also there must be daily activities that needs restriction which your mother might be ignoring, which further aggravate the problem.

In my opinion, the next best option is to undergo test (even if previously done) like x ray/MRI/serology(RA factor,serum uric acid,ESR,CRP,serum calcium besides others) and conclude the condition. Then limit the condition with medications(higher if necessary), exercises & physiotherapy, lifestyle modification and use of splints/braces/supports.

This should work just fine and pain will go gradually. I hope this answer was informative. For any further help I'm available for follow up.
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Follow-up: Having sever pain in knee and palm. Tried different treatment but not cured. Any suggestion? 14 minutes later

Thanks a ton for your revert.

We have done all test and no test is left out to be done. All Lab reports are Negative and none of the report states some error.

Kindly Suggest
Answered by Dr. Atul Wankhede 3 hours later
Thanks for replying back.

Glad to hear as expected that all necessary tests have been done by your physician, and all are within normal limits or negative. That means the pain is nothing but age related wear and tear, especially in the knee. The pain in palm needs thorough clinical examination to comment upon.

As previously stated, your mother certainly needs stronger acting analgesics(pain killers- opiod or non-opiod) and calcium supplement if necessary. That along with physiotherapy (exercises,local ultrasonics) and use of proper brace should suffice. Local steroid injection too helps but should be kept as a last resort. Also keep in mind the benefits of joint replacement.

Feel free to ask more queries. I'm available for follow up.
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