Dr. Amod Manocha

March 25, 2018

March 25, 2018

Knee pain can be a source of significant disability in all age groups as it limits mobility. It can be classified into traumatic or non traumatic and based on the site of pain into anterior, medial, lateral and posterior. The common reasons for knee pain vary with age group and pain site .Pain from other sites such as hip and lumbar spine can also present knee pain. In the above 50 years age group raised BMI is an important risk factor for developing symptomatic osteoarthritis.

Common minimally invasive non surgical interventions I offer in pain clinic for knee pain include

Genicular nerve blocks & radiofrequency ablation

This procedure is performed for chronic knee pain which may be secondary to various reasons such as osteoarthritis, degenerative joint disease and persisting pain after knee replacement. It offers a safe, effective non surgical alternative to knee replacement for patients who are either not keen or are unfit or have persisting pain after knee replacement. Genicular nerve radiofrequency is performed as a day case under local anaesthesia with no requirement for hospital stay or prolonged rehabilitation.

Knee joint is supplied by branches from many nerves and these are collectively addressed as genicular nerves. The initial diagnostic procedure involves local anaesthetic injections close to the nerves supplying the knee joint. If the diagnostic procedure produces effective pain relief then special type of radio waves are applied to these nerves, which can produce prolonged pain relief (radiofrequency ablation). The procedure alleviates pain by creating a heat lesion around the nerves which interrupts the transmission of pain signals to the brain. These nerves are approached percutaneously under x-ray and ultrasound guidance with no requirement for any surgical incisions.

Cooled Radiofrequency Treatment

Cooled Radiofrequency treatment is an option for those suffering from chronic knee pain and not keen on surgery or those left with persisting pain after knee replacement surgery. It is a minimally invasive treatment done on day care basis under local anaesthesia. The treatment aims to deactivate the nerves responsible for transmitting pain signals from the painful knee. It involves placing needles close to these nerves under x ray or ultrasound guidance followed by heating of nerves to reduce the pain signals being transmitted. It differs from conventional Radiofrequency as it has water circulating through the device and can create a larger treatment area increasing the chances of success. Normal activities can generally be resumed soon after the procedure. Less pain can lead to improved functionality and reduced medication requirements.

Saphenous nerve block & pulsed radiofrequency

Saphenous nerve is a sensory nerve which supplies the medial (inner side) of knee joint and leg. This nerve can get entrapped or injured high up in the thigh leading to groin and inner thigh pain or lower down causing knee and calf pain. Trauma and surgery are common reasons for injury especially of the infrapatellar branch of the nerve.

Most patients present with pain, increased sensitivity along the inferomedial aspect of knee although it is not uncommon to see pain involving most of the anterior knee. A nerve block can be easily performed under ultrasound guidance as a diagnostic test followed by radiofrequency treatment to produce long term pain relief.

Ultrasound guided knee joint, bursa injection

An ultrasound scan of the knee can help in identifying knee pathology and help guide the injection into the desired location. The injected drugs vary depending on the pathology being treated. The options include local anaesthetics, steroids, Hyaluronic acid or Platelet Rich Plasma (PRP). Injections around the knee joint can be either

Directly into the joint

Into the tissues surrounding the joints - such as bursa

Into the muscle or localized tender points

Hyaluronic acid occurs naturally in the cartilage and the synovial fluid that lubricate the joints. In people with osteoarthritis, injections of artificial hyaluronic acid into the joint can help in reducing pain and improving mobility.

Platelet Rich Plasma (PRP) injections

Platelets are one of the blood components. They help in clotting and contain growth factors which promote the healing process. PRP is blood plasma with concentrated platelets. PRP therapy is an attempt to utilise body’s natural ability to heal itself. Growth factors released from the platelets influence and accelerate the repair of tendon or ligaments. The procedure involves collecting a blood sample from the patient which is then placed in a spinning machine to separate different blood components. The component containing high platelets is separated and then injected under ultrasound guidance. Most people require 1-3 injections at 4 weekly intervals.

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