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Teenager suffering from severe knee joint pain - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Average Posted in: Bones, Muscles and Joints
Answered by

General & Family Physician
Practicing since : 2009
Answered : 680 Questions
User :   Hello,
I know it is hard to give advice over email but i really need some advice for my daughter. She has been complaining of knee pain and she walks pigeon toed. We were given custom-made orthotics 2 years ago and she currently sees a physiotherpist who has been taping her knees and giving her exercises. I believe that this is not helping her. She still complains of knee pain and still walks pigeon toed. According to her physio, her knees, pelvis and hips all turn in. If you saw a patient like this, what advice would you give them
User :   hello
Doctor :   Hi,
Doctor :   Let me read your query for few minutes to be able to have a good discussion here.
User :   he doc
Doctor :   I would ask for an Xray of all the major and minor joints
Doctor :   to look into cause\
User :   She did have an xray which showed nothing
User :   Should i ask for an MRI?
Doctor :   When the joints turn in then there will be a space created in the joint
Doctor :   if not have to look for it to make sure that there are no diphysial problems
Doctor :   which can be seen in malnourishment or many of the syndromes which affect the bone growth
Doctor :   yes, MRI , would be more help ful
User :   What could be done in the meantime?
Doctor :   but considering the cost , i would like to get a Digital xray of all the joints and focus the finding then order for an MRI
Doctor :   i would consider the crepe bandage will serve the purpose til then
Doctor :   may not cure , but will prevent worsening
User :   ok. is there anything that can help her with the pain?
Doctor :   May i know what have you tried til now for pain ?
User :   when it first started she was using panadol but she since then has been prescribed pain killers but they dont seem to be helping
User :   sometimes i see her crying herself to sleep because of the pain
Doctor :   have to tried topical analgesics ?
User :   yes
Doctor :   Ok , May i know her age ?
User :   16
Doctor :   ok then you can try other opiod analgesics
User :   for example?
Doctor :   Tramadol
User :   how is that administered? do you need a prescription for it?
Doctor :   Yes, you need prescription
Doctor :   its available in injectables and tablets
User :   so she would inject herself? she hates swallowing tablets
Doctor :   no , i has to be injected by a nurse
User :   how often?
Doctor :   twice a week
User :   and where do the inject this? straight to the source of pain?
Doctor :   it a muscular injection giving in the gluteal region
User :   ok.
User :   should physiotherapy be continued?
Doctor :   yes, its a must
User :   ok...but she doesnt seem to think it is helping
Doctor :   it will help preventing worsening
Doctor :   yes , it happens , as its effect is not immediate , will take long time to see a difference
User :   she has been seeing the physio for just over a long does it take
Doctor :   yes, may more than 2 to 3 years
Doctor :   its a less invasive process
Doctor :   but never harm
User :   ok
User :   what should the physio be doing with my daughter?
Doctor :   train exercises to adapt to the deformity , exercises to reduce the deformity and strengthen the muscles need for it
User :   and what if we believe that the exercises are not working?
Doctor :   they will help , you have to give it time
User :   yeah ok
Doctor :   anyway you are getting the MRI , the cause nd the exact treatment will be soon determined
User :   didnt you suggest a digital x-ray? i have never heard of that
Doctor :   ya , digital xray is one where the images are fed into the computer hence the resolution and the opacities are well made
User :   so it is basically like a normal x-ray but you do not have to wait for the images
Doctor :   yes,
User :   how long should my daughter receive Tramadol?
Doctor :   it depends on her response to the drug
User :   if it is postive?
Doctor :   may i know positive for what ?
User :   if the drug helps the pain, how long will she receive it?
Doctor :   not more than a month and a gap of a month again
User : it possible to overdose?
Doctor :   yes, it can cause addiction and withdrawal effects too
User :   will she get an addiction or have withdrawal effects?
Doctor :   hence i would advice ask a GP or a orthopedician to plan the pain management with tramadol or any drug of his choice
Doctor :   either are possible
User : there any other sorts of pain relief that she could use which dont cause addiction or withdrawal effects?
Doctor :   Its the NSAIDS , long term use of which will have undesired effects on kidney and cause gastritis
Doctor :   i would advice you either visit the orthopedicain or an anesthsiologist ( pain management specialist) who will plan the requirement without problems
User :   what would you recommend?
Doctor :   best would be integrated approach by both orthopedician and anaesthesilogist
User :   ok
User :   should she still tape her knees?"
Doctor :   yes,
User :   how should she tape them?
Doctor :   I am sorry , it can be demonstrated but not told
Doctor :   it needs skill
Doctor :   physiotherapist can help you with this
Doctor :   Are you there ?
User :   yes i am here
Doctor :   Please proceed
User :   the physio told us basic mcConnells taping should help, however it doesnt? Should we still tape the way we were shown
Doctor :   since how many days are you taping ?
User :   since 7th January
User :   2011
Doctor :   i think you have to continue with it ,
User :   but it has been a couple of weeks
Doctor :   i do not think 2 or 3 weeks will show an effect
User :   how long then?
Doctor :   and i think the physiotherapist will be able to tel how long the taping is needed as he would have examined the joints
User :   is there anything that can be done at home to help her knees, pelvis and hips align?
Doctor :   the exercises the physiotherapist has suggested along with the taping will suffice and would be a better home management
User :   i do not thing you have helped much
User :   got anything to say to that doc?
Doctor :   I Am sorry ., until the case diagnosis has made i could not be able to tell about the management completely
User :   i no those scam websites were correct
Doctor :   hence at first i mentioned i would start with a xray
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