Question
I have had an increasingly difficult time walking due to knee pain. It went from bothersome, to stiff, to extreme pain. I went to the orthopedic MD, and I'm seeing his PA. He gave me the cortisone, lidocane, movacaine injection 12/19/06. It helped some, but now my leg is locking, and the medial side of my knee has sharp shooting pains so bad now, that I can truthfully say, I can not walk. I'm unable to squat, or even bend my leg to get into bed. I'm on the verge of tears now. Night before last I had a MRI, and the tech said he saw nothing obvious. I actually cried. What could be causing this severe pain, and what kind of help do I need? I'm willing for surgery at this point. I'm only 44 and I feel disabled. Help!

Answer
Hello,
A knee hurts for a reason, and if that pain keeps returning or not going away, the reason may still be there. The injections may relieve pain for a while but do not stop the wearing out of the joints and may sometimes actually increase it by removing the protection that pain provides. The MRI is a picture that does not show the knee moving or carrying weight, so it is hard to tell what you should avoid doing by pictures alone. Surgery is a last resort to stop pain. Joint replacements are a type of surgery that is becoming more common.

From what you say happened to date, the issue becomes more of long-term damage control rather than just short-term pain relief. So the question remains, what keeps the knee hurting? Your lifestyle and daily activities come into play. The knee should be very carefully analyzed whether it is running smoothly and quietly, after all, it is a mechanical thing. Have there been injuries, are you overweight, have there been aggravating exercises, are there a lot of stairs to climb daily, have medications been used in the past to hide the first stages of damage, and most important is to determine precisely which movements should be modified, limited or avoided. Hiding pain and continuing doing what may have caused it can lead to more damage, so it is not really about the pain.

Ask your doctor, or seek out someone in your area, who deals with trying to preserve joints and who asks the questions mentioned above. The real issue again is, why does the irritation of the knee persist and what can you as the patient do to stop it. It is this type of vital information that protects joints. It is not only the short time spent in offices for treatment that matters, it is educating the person exactly how to care for their own knee based on a detailed mechanical analysis. Your MRI apparently told you there was not obvious damage already visible to date, so perhaps there is still hope.

Thank you again for your question, and if you have any further ones, please feel free to contact me again.