What is the treatment for left knee swelling and pain?

Treatment for Left Knee Swelling and Pain

The recommended first-line treatment for knee swelling and pain includes acetaminophen (up to 4g daily), topical NSAIDs, or oral NSAIDs with appropriate gastroprotective measures, combined with non-pharmacological interventions such as structured exercise, weight management, and activity modification. 1

Pharmacological Management

First-Line Medications

• Acetaminophen: Start with up to 4g daily in divided doses due to its good safety profile 2, 1
• Topical NSAIDs: Apply 3-4 times daily for localized knee pain, offering good efficacy with minimal systemic absorption 1
• Oral NSAIDs: Consider when acetaminophen or topical NSAIDs provide inadequate relief 1
  • Use the lowest effective dose for the shortest duration
  • For patients ≥60 years or with increased GI risk (comorbidities, history of peptic ulcer/GI bleeding, concurrent corticosteroid or anticoagulant use), use:
    • Nonselective oral NSAIDs with gastroprotective agent, or
    • COX-2 inhibitors 2, 1

Second-Line Medications

• Intra-articular corticosteroid injections: Particularly effective for knee pain with effusion, providing rapid relief of inflammatory symptoms for 1-3 weeks 2, 1
• Tramadol: Consider when NSAIDs and acetaminophen are ineffective or contraindicated
  • Start with 50mg every 4-6 hours as needed (maximum 400mg/day, 300mg/day for elderly >75 years)
  • Use with caution due to high risk of addiction and side effects 1

Medication Considerations

• Naproxen has been shown to effectively reduce joint swelling, pain, and improve mobility in patients with osteoarthritis 3
• Studies show that both naproxen sodium and ibuprofen at over-the-counter doses effectively relieve knee osteoarthritis pain, with naproxen potentially providing better relief for night pain 4
• Regular monitoring of renal and hepatic function is necessary with prolonged NSAID use 1

Non-Pharmacological Interventions

Exercise and Physical Therapy

• Structured exercise program: Include land-based aerobic exercises, quadriceps strengthening, and range of motion exercises 1
• Aquatic exercises: Beneficial for patients with mobility limitations 1
• Contrast therapy: Application of alternating heat and cold therapy can help reduce knee swelling, improve range of motion, and decrease pain 5

Weight Management

• Weight loss is strongly recommended for overweight and obese patients
• Each pound lost reduces four pounds of pressure on the knee joint 1

Supportive Measures

• Bracing: Soft braces or valgus/varus knee braces can improve pain and physical function 1
• Walking aids: Consider if mobility is significantly affected 1
• Appropriate footwear and insoles: Important for patients with knee pain 1
• Activity modification: Avoid aggravating movements 1
• Thermal interventions: Locally applied heat or cold for short-duration benefits 1

Treatment Algorithm

1. Initial Assessment:

   • Determine if swelling is due to inflammation, infection, or structural abnormality 6
   • Locate pain and tenderness to help identify underlying pathology 6
   • Consider aspiration for diagnosis and pain relief if significant effusion is present 6

2. First-Line Treatment:

   • Start acetaminophen (up to 4g/day) and/or topical NSAIDs
   • Implement non-pharmacological measures (exercise, weight management)
   • Apply local thermal therapy (heat/cold)

3. If Inadequate Response:

   • Add or switch to oral NSAIDs (with gastroprotection if indicated)
   • Consider intra-articular corticosteroid injection, especially if effusion is present

4. For Persistent Symptoms:

   • Consider tramadol if other analgesics are ineffective or contraindicated
   • Reassess diagnosis and consider referral to specialist if no improvement after 6-8 weeks of conservative treatment 1

Common Pitfalls and Caveats

• NSAIDs and GI risk: Failure to provide gastroprotection in high-risk patients can lead to serious GI complications 2, 1
• Acetaminophen dosing: Exceeding 4g/day increases risk of hepatotoxicity 2, 1
• Prolonged NSAID use: Can lead to renal dysfunction, especially in elderly patients or those with comorbidities 1
• Reliance on medications alone: Non-pharmacological interventions are essential components of effective treatment 1
• Delayed specialist referral: Consider orthopedic referral if conservative treatment fails after 6-8 weeks 1
• Overlooking infection: Always consider septic arthritis in acute knee swelling, especially with fever or risk factors 6