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Sports Medicine

Shooting nerve pain in knee

12/21/2006

Question:

For close to a year now I have had pain in my left knee. It started out just feeling like it was bruised, then went on to shooting pain when I touched the outside knee area. It went on to cause too much pain to kneel down or bend my knee tight. My doctor sent me to physical therapy and the shooting pain was better and since then the skin feels numb. Now in the last few weeks the pain is coming back and it`s in both knees now. My calf and thigh hurt also. I also have bursitis in my hips and am feeling a great deal of pain in my hips, back, and knees. I was diagnosed with rheumatoid arthritis 8 years ago and am wondering if this is all related. What can be done to get some relief from the pain? I am currently taking prednisone to help with the swelling. I see a rheumatologist regularly but would like your opinion.

Answer:

Although it doesn't sound like you have a sports-related problem, perhaps the following information may help.

Shooting pain when touching a tender area is is usually not due to a "nerve" problem. If there is tenderness of the knee cap (patella) - and particularly if there is also fullness or swelling there - there may be "prepatellar bursitis" or inflammation between the patella and the overlying skin. On the other hand, if the tenderness is next to the outer (lateral) side of the patella, the pain could instead be due to friction from rubbing of the iliotibial band over a bony prominence (this would be unlikely unless you are involved in running sports - which would usually not be advisable for someone with rheumatoid arthritis...).

Rheumatoid arthritis (RA) typically affects the hip joints... hip joint pain can "refer" to the knees (usually the inner/medial side), as well as to the thighs... hip "bursitis" pain may "refer" to the outer/lateral side of the knee(s). RA typically also affects the knee joints... knee joint pain can refer down into the calves. The extent to which your symptoms are related to rheumatoid arthritis should be able to be determined by your rheumatologist.

Your skin numbness may or may not be due to nerve irritation in your lower back (lumbar spine); findings on physical examination should clarify the basis for this symptom, although such diagnostic testing as electrodiagnostic studies (to evaluate nerve function) and/or an MRI scan of your lumbar spine (to evaluate for any nerve compression) could be considered later.

The best treatment for your pain depends on its cause. Prednisone helps inflammation... check with your Rheumatologist to see if your dose needs to be increased temporarily. Selective injections of steroid (cortisone) - into the knee joints, hip bursae, hip joints, or your lumbar spine, among other areas - may help clarify the components to your pain symptoms. A number of different types of medications may be usefully combined with Prednisone for better pain control, including nonsteroidal anti-inflammatory drugs (NSAID's), opioid (narcotic) pain killers, "antidepressants" (which often help pain and/or sleep disturbance in people who may not be depressed), and "anti-seizure" medicines (to treat pain in people who don't necessarily have seizures). Nonmedication treatment options include heat, cold, electrical stimulation, therapeutic exercise, and therapeutic massage, among others. You should discuss the above with your rheumatologist.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University