What is the recommended treatment for a patient with left knee pain and slight swelling?

From the Guidelines

The recommended treatment for a patient with left knee pain and slight swelling typically begins with the RICE protocol and consideration of over-the-counter pain medications such as acetaminophen or ibuprofen, as well as topical NSAIDs like diclofenac gel, with the most recent and highest quality evidence supporting these interventions for initial management 1.

Initial Assessment and Management

The patient's complaint of left knee pain and slight swelling suggests the need for a comprehensive approach to manage symptoms and potentially address underlying causes.

• Rest the knee by avoiding activities that cause pain
• Apply Ice for 15-20 minutes every 2-3 hours
• Use Compression with an elastic bandage
• Elevate the knee when sitting or lying down Over-the-counter pain medications such as ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) can help manage pain and reduce inflammation, with ibuprofen potentially offering superior efficacy in patients with moderate-to-severe OA pain 1.

Pharmacological Interventions

Topical NSAIDs like diclofenac gel applied 3-4 times daily may also provide relief with fewer systemic side effects, making them a viable option for patients who cannot tolerate oral NSAIDs or prefer a localized treatment approach.

Further Evaluation and Treatment

If symptoms persist beyond 1-2 weeks or worsen, medical evaluation is recommended as physical therapy, knee braces, or further diagnostic tests may be needed. These interventions work by reducing inflammation, decreasing fluid accumulation in the joint, and alleviating pressure on pain receptors. Proper treatment is important as it prevents further injury and promotes healing of the affected tissues in the knee joint, with sustained weight loss and exercise also being beneficial for patients with knee osteoarthritis, particularly those who are overweight or obese 1.

From the FDA Drug Label

NSAIDs can cause serious side effects, including: Increased risk of a heart attack or stroke that can lead to death NSAIDs should only be used: exactly as prescribed at the lowest dose possible for your treatment for the shortest time needed

The patient is complaining of left knee pain and slight swelling. Ibuprofen 2 2 may be used to treat pain and inflammation. However, the patient should be carefully evaluated for any potential risks, such as gastrointestinal side effects or increased risk of heart attack or stroke.

• The patient's medical history and current medications should be reviewed to ensure safe use of ibuprofen.
• The patient should be instructed to take the lowest effective dose for the shortest duration necessary to minimize potential side effects.
• The patient should be monitored for any signs of adverse reactions, such as gastrointestinal bleeding or cardiovascular events.

From the Research

Left Knee Assessment

The patient is complaining of left knee pain, and upon assessment, the left knee appears slightly swollen. To determine the cause of the pain and swelling, a thorough evaluation is necessary.

Possible Causes of Knee Pain

• Osteoarthritis (OA) 3
• Patellofemoral pain 3
• Meniscal tears 3

Evaluation and Diagnosis

The evaluation should include:

• Patient history: age, location, onset, duration, and quality of pain, associated mechanical or systemic symptoms, history of swelling, description of precipitating trauma, and pertinent medical or surgical history 4
• Physical examination: inspection, palpation, evaluation of range of motion and strength, neurovascular testing, and special (provocative) tests 4, 5
• Radiographic imaging: reserved for chronic knee pain (more than six weeks) or acute traumatic pain in patients who meet specific evidence-based criteria 4, 5

Treatment Options

• Conservative management: exercise therapy, weight loss (if overweight), education, and self-management programs 3
• Pharmacological management: ibuprofen, paracetamol, or a combination tablet of ibuprofen/paracetamol 6
• Knee sleeves: can reduce knee adduction moments and alleviate pain in patients with early unilateral knee osteoarthritis 7

Recommendations for the Patient

• A thorough evaluation, including patient history and physical examination, should be conducted to determine the cause of the left knee pain and swelling.
• Conservative management, such as exercise therapy and education, should be considered as a first-line treatment option.
• Pharmacological management, such as ibuprofen or paracetamol, may be considered for pain relief.
• A knee sleeve may be recommended to alleviate pain and reduce knee adduction moments.