Sunday 18 March 2018

Discovering the cause of knee pain and sore throats

Ask the GP

Knee pain
Knee pain

Nina Byrnes

GP Dr Nina Byrnes answers your queries on knee pain and tonsillitis.

Question: I have had a lots of knee pain in the past few weeks. I've just had an MRI and I've been told I have a torn meniscus.  What does this mean and what treatment will I need?

Dr Nina replies: The menisci are two C-shaped wedges of cartilage that sit between the thigh bone and the shin bone. These act as shock absorbers, helping to cushion it and keep it stable.

When people talk about cartilage injuries to the knee, they are normally talking about a torn meniscus.

Any movement that causes forceful twisting or rotating of the knee joint can cause a meniscal tear. Those who play tennis and basketball or those involved in contact sports are particularly at risk.

Those with a tear in a meniscus often describe a popping sensation in the knee. There is pain and stiffness. The pain is often worse on twisting or rotating the knee. It may be difficult to straighten the leg fully.

A medical examination of the knee may suggest a meniscal tear. Your doctor may arrange an X-ray of the knee to rule out any damage to the bones.

An MRI will show the cartilage and other structures of the knee. These are normally arranged if an obvious trauma has occurred or, in lesser injures, if the knee is not improving with simple treatment.

The treatment of meniscal tears depends on the severity of the tear. The outer aspect of the menisci have a decent blood supply and so may heal themselves. The blood supply is not as good to the thinner inner edge and so injury her is more likely to require surgery.

If you injure your knee the first thing to do is to follow the RICE technique. This advises: Resting the leg, applying Ice (for 20 minutes at a time and not directly to the skin), using a Compression bandage and Elevating the leg (above the heart).

Taking some anti-inflammatory medication may also help.

Physiotherapy is helpful in most muscle and joint injuries and this is a good place to start. They may prescribe strengthening exercise which can aid recovery. If pain is severe or if MRI shows a problematic tear, then it is likely you will need referral to an orthopaedic surgeon.

Arthroscopy (key hole surgery) of the knee may be required. The meniscus may be repaired trimmed or removed. Newer techniques involve implanting artificial replacement cartilage.

Rehabilitation exercises will be required in the post operative period.

Full recovery is expected in the majority of cases.

Question: I have had tonsillitis for the last three months and on been on several antibiotics. This morning, I woke up again feel in a sore throat again. I am getting very worried about this and just need some advice on what to do.

Dr Nina replies: It can be very frustrating if a simple antibiotic doesn't solve a problem and quite worrying when it reoccurs. There are several causes of a sore throat, not all of which require antibiotic treatment.

An infective sore throat may be associated with fevers, chills, and muscle aches and pains. You may notice white spots on your tonsils and swollen tender glands in your neck. The majority of infective sore throat are viral and don't require antibiotic therapy.

Bacterial infection is usually quite obvious.There can be swollen tonsils with large collections of pus and a very distinctive smell off the breath. This kind of sore throat requires antibiotic treatment.

Penicillin in its basic form is very effective but treatment may be required for 10 days to fully eradicate the bacteria.

The pain of a sore throat may be eased by simple pain killers, gargling with salt and water and by drinking warm drinks or eating cooling foods such as yogurt and ice pops.

If recurrent infectious sore throats occur, it is worth having blood tests and a throat swab taken. Glandular fever is a viral cause of recurrent sore throat that is most common in children and teenagers but can occur at any age. A throat swab can help identify a bacterial cause.

Allergies and hay fever may lead to a dry irritated throat. Tobacco alcohol and spicy food act as local irritants.Those that use their voice for work such as teachers, and singers are at risk of recurrent sore throat.

Acid reflux is another often overlooked cause.

Rarely, a sore throat may the sign of an underlying serious disease such as HIV or a tumour. It is worth attending your GP for some blood tests a full exam and a throat swab.

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