Diagnosing knee problems can be complicated, in part because of the large number of possible causes of knee pain. Patients are not always able to pinpoint the exact location of their pain, and injuries may not be clearly visible on imaging tests. In some situations, a physical examination and the information you provide are sufficient. But most diagnoses require at least an x-ray, and in some cases the doctor may recommend more advanced imaging and laboratory tests to determine the cause and extent of damage. But be aware that even expensive tests such as magnetic resonance imaging (MRI) may not be conclusive or even useful. While MRI may reveal an abnormality, it may not be the source of the pain. Studies show that MRI can be too sensitive and often reveals abnormalities in patients who have no pain.
Ross Sherban, DO
Specialty: Orthopedic Surgery
Location and Office HoursExcelsior Orthopaedics LLP
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- Why is it hard to diagnose knee problems?
Can cycling or running wear out my joints?
Anthony Komaroff, MD, Internal Medicine, answeredYour question is a good one. Excessive stress can damage a joint (or nearby structures) and joint damage can lead to arthritis. For example, repeated sprains or cartilage injuries to the knee among football players may lead to arthritis.
Running certainly stresses weight-bearing joints. Your knees support up to seven times your weight while jogging. The stress is even higher with jumping or suddenly starting and stopping, like the motions used in basketball.
But, joints are not like tires. They do not wear out from use. The "wear and tear" type of arthritis (called osteoarthritis) is more likely from age, obesity, injury and genetics.
Running may not stress the joints enough to cause arthritis. There is no evidence that common, repetitive movements among recreational cyclists or joggers will damage or wear out the joints. This goes for most other repetitive movements, such as walking, painting or knitting. Repetitive motion is more likely to cause tendonitis than arthritis.
Research on repetitive physical activity and arthritis is difficult to perform. People who are active often differ from those who are sedentary in important ways. Studies that compare the two groups may come to faulty conclusions. While the results of the available studies are somewhat mixed, long-term runners are not more likely to wear out their weight-bearing joints than people who are sedentary.
A large study of runners was published in 1998. It found that over a nine-year period, members of a running club had no higher incidence of osteoarthritis than a similar group of non-runners. A more recent study found that long-distance runners developed less osteoarthritis over 20 years than non-runners.
As long as there is no injury, repetitive motion may actually protect the joints, perhaps by strengthening nearby muscles.
Similar studies are not available for cycling, though I did find two studies that suggest cycling was associated with a higher risk of knee osteoarthritis.
Considering the health benefits of being active and the fact that obesity is a risk factor for arthritis, most doctors would encourage you to cycle and jog if you enjoy these activities. Unless you have pain or other problems related to cycling or jogging, it's unlikely that a doctor would recommend restricting those activities in the hopes of protecting your joints.
Find out more about this book:Harvard Medical School Arthritis: Keeping your joints healthy
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What tests are used to diagnose knee and hip problems?
While imaging tests can give your doctor a good view of the damage in your knees or hips, laboratory tests are sometimes needed to determine what is causing the damage and how it might be halted.
Arthrocentesis. If you have sudden or unexplained swelling in a knee, hip, or other joint, your doctor may perform an arthrocentesis, removing a little synovial fluid for examination. Excess synovial fluid may indicate infection, crystal deposits, trauma, or inflammation. Before arthrocentesis, the skin is cleaned and an anesthetic spray or injection is used to numb the area. The doctor inserts a needle with a syringe attached into the joint space (you may hear a pop) and withdraws a fluid sample, which is sent to a laboratory for analysis. If you have pain afterward, your doctor may suggest ice and pain-relief medication. The procedure may immediately lessen pain and pressure caused by excess fluid. Knee arthrocentesis can be done in the doctor's office. Hip arthrocentesis is performed by a radiologist, guided by fluoroscopy, a type of x-ray that shows internal structures in motion.
Rheumatoid factor. This blood test detects an antibody present in about 85% of people with rheumatoid arthritis, a systemic autoimmune disease. The same antibody is also present in other medical conditions and in about 3% of healthy people.
Erythrocyte sedimentation and C-reactive protein. These blood tests are general measurements of inflammation of any kind; the higher the result, the more severe the inflammation. Most people with osteoarthritis have normal values, but those who have inflammatory conditions, such as rheumatoid arthritis, usually have elevated levels. High rates may also be an early sign of infection after knee or hip surgery. High levels of C-reactive protein over the long term also indicate an increased risk for heart disease.
Serum uric acid. The serum uric acid test measures uric acid in the blood, which can help diagnose gout, a condition caused by the accumulation of uric acid crystals in a joint.Helpful? 1 person found this helpful.
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