Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Causes, Symptoms, Signs, Treatment, Prognosis, and Types of Chronic Knee Pain
Arthritis: Arthritis of the knee is an inflammatory disorder of the knee joint that is often painful. Arthritis has many causes.
Description: Osteoarthritis is caused by degeneration of cartilage in the knee. In its extreme form, the menisci (cartilage) will be completely eroded, and the femur will rub on the tibia, bone on bone.
Symptoms and signs: Osteoarthritis (OA) causes a chronically painful knee that is often more painful with activity. It can be stiff with prolonged sitting and may become enlarged from new bone formation at the edge of the degenerated cartilage.
Treatment: Treatment is aimed at pain control with over-the-counter pain relievers. Anti-inflammatory medications, either over the counter, or by your doctor's prescription, are also quite helpful. Knee bracing can be beneficial for more mobile patients. Injections of hyaluronic acid (viscosupplementation; Synvisc-One) can be helpful in relieving chronic pain from OA. More severe OA can be treated with narcotic pain medicines or a knee joint replacement with a synthetic joint.
Description: Rheumatoid arthritis (RA) is a disease of the whole body that affects many joints, often including the knee. People who have this disease often have family members who suffer from it as well.
Symptoms and signs: In addition to knee pain, rheumatoid arthritis may produce morning stiffness and pain in other joints. The knee can be warm to the touch and swollen.
Treatment: Treatment includes pain medications, anti-inflammatory medications, and prescription drugs. (These drugs either try to slow the progression of the disease or try to suppress the immune system or decrease inflammation.) Newer medications, called biologics, are proteins that specifically target the substances that stimulation rheumatoid inflammation. Your health care professional will need to evaluate which one of these medications is best suited for you.
Prognosis: It is essential that patients with rheumatoid arthritis be evaluated and treated aggressively early for best outcomes. This generally will include a thorough evaluation by a rheumatologist.
Description: These severely painful forms of arthritis are caused by crystals that form in the knee and other joints. These crystals can form as a result of defects in the absorption or metabolism of various natural substances such as uric acid (which produces gout) and calcium pyrophosphate (pseudogout).
Symptoms and signs: Gout and pseudogout cause a rapid-onset, markedly inflamed knee joint. The knee can be exquisitely painful, swollen, and warm with loss of range of motion.
Treatment: Treatment is aimed at controlling inflammation with anti-inflammatory medications and at aiding the metabolism of the various chemicals that may lead to crystal formation. Alcohol should be avoided and gout-specific dietary changes can be successful in avoiding flare-ups.
Description: As a result of trauma, infection, or
crystalline deposits, the various bursae of the knee may become inflamed.
Symptoms and signs: Acute or chronic trauma causes a painful and often swollen knee from the inflammation of the bursae. A particularly common bursitis is prepatellar bursitis. This type of bursitis occurs in people who work on their knees. It is often referred to as housemaid's knee or carpet layer's knee. Another type of bursitis is anserine bursitis. The anserine bursa is located about 2 inches below the knee along the medial side of the knee.
Though it occurs more commonly in the overweight and in women,
it also affects athletes and others. Anserine bursitis often causes pain in the region of the bursa and is often worse with bending the knee or at night with sleep.
Treatment: Treatment will usually include home care with PRICE therapy and NSAIDs. Severe forms, however, can be treated with periodic steroid injections to the bursae.
Prognosis: With optimal treatment and management, patients generally do very well.
Infection (or infectious arthritis)
Description: Many organisms can infect the knee. Gonorrhea, a common sexually transmitted disease, can infect the knee, as can common organisms residing on normal skin, especially when the immune system is suppressed by underlying diseases or certain medications.
Symptoms and signs: Infection of the knee causes painful knee swelling. In addition, people who develop such
an infection typically complain of fevers and chills. Less severe infections may not have associated fevers.
Treatment: New swelling and pain in the knee must be evaluated for infection based on your doctor's opinion. Treatment usually includes intensive antibiotic therapy and may include aspiration of the joint or surgical drainage of the infection.
Prognosis: The outlook depends on how early the appropriate antibiotic therapy is begun. Infection in a knee joint can lead to permanent cartilage damage.