From the Guidelines
The patient should continue with physical therapy for his left knee pain while awaiting orthopedic evaluation, and consider over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) for pain management, as recommended by the American Academy of Orthopaedic Surgeons 1. The patient's knee pain likely stems from a combination of the Baker's cyst, compensatory gait changes following his stroke, and possibly underlying osteoarthritis given his age and 15-year pain history. Some key points to consider in the patient's treatment plan include:
- Completing the previously ordered knee X-ray to rule out structural issues
- Avoiding activities that exacerbate the knee pain while continuing stroke rehabilitation exercises
- Applying ice for 15-20 minutes several times daily and using compression wraps to reduce inflammation
- Maintaining communication with his primary care provider about pain levels and any new symptoms while working on insurance coverage for orthopedic care The multidisciplinary approach with cardiology, neurology, gastroenterology, and physical therapy should continue as planned to address his post-stroke care comprehensively, taking into account the patient's complex medical history and current symptoms, as outlined in the American College of Rheumatology 2012 recommendations 1.
From the Research
Patient's Current Condition
- The patient is a 62-year-old male with a history of hypertension and a left-sided hemorrhagic stroke in 2024, resulting in right-sided deficits.
- He is experiencing left knee pain that has persisted for over 15 years, characterized by cramping, which worsens with activity.
- The patient's current pain level is rated at 5/10, with a maximum intensity of 10/10 at its worst.
- He suspects that this pain may be a result of increased activity from participating in physical therapy or compensating for the right side following a stroke.
Treatment and Referrals
- The patient has a pending ortho referral for a Baker's cyst, but this referral is currently cost-prohibited.
- He has been attending physical therapy three times a day and reports that his condition has improved.
- The patient has pending appointments with cardiology, neurology, and ortho, as well as a scheduled appointment with gastroenterology.
- He and his aunt are working on obtaining new insurance to cover these referrals.
Relevant Studies
- A study published in 2013 2 compared the effectiveness of ibuprofen, acetaminophen, and their combination in relieving musculoskeletal pain in emergency department patients.
- The study found that there was no significant difference in pain reduction among the three treatment groups, and the need for rescue analgesics was similar across groups.
- However, this study may not be directly relevant to the patient's current condition, as it focused on acute musculoskeletal pain rather than chronic pain.