[44F] With chronic knee pain radiating to hip and associated numbness

Patient Description

A 44-year-old female has been experiencing knee pain that radiates to her hip and causes numbness for about a year. The pain is described as a constant dull, stiff pain with occasional sharp pains shooting to the hip, rated as 9 out of 10 in severity. The pain worsens with activities such as sitting for long periods, walking, and climbing stairs, and is particularly bad in the mornings when the knee feels stiff and hard to move. Various treatments including Mobic, tramadol, Norco, Voltaren gel, Tylenol, and ibuprofen have provided only slight relief. Elevating the knee while lying down helps the most. The numbness, which feels like pins and needles or an electric shock, started before the pain and has been present for a little over a year. The patient also experiences back pain, especially when walking or standing for at least 15 minutes, and muscle weakness in the legs and feet, along with restless legs and a zapping sensation in the feet. Additionally, she has been constipated and has some bladder control issues when coughing or laughing too hard. There is no history of surgeries or medical conditions related to the back, hips, or knees, and she does not smoke. The patient has gained 50 lbs recently and her diet includes meat, bread, potatoes, and a lot of Sprite. There is a family history of high blood pressure and diabetes on her mother's side. Current medications include Cymbalta 60mg once a day, Clonidine 0.1mg once a day, and Klonopin 1mg three times a day, along with acetaminophen, ibuprofen, and Voltaren gel as needed. No known medication allergies.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Knee Pain Radiating to Hip with Numbness

Osteoarthritis: This is a common cause of knee pain, especially if it worsens with activity and is associated with stiffness in the morning. Osteoarthritis can also cause pain to radiate to the hip.
Sciatica: The numbness and sharp, shooting pain you describe could be due to sciatica, which occurs when the sciatic nerve is compressed or irritated. This can cause pain to radiate from the lower back down to the legs.
Patellofemoral Pain Syndrome: This condition can cause knee pain that worsens with prolonged sitting and activities like climbing stairs. It can also be associated with a feeling of stiffness.

Unifying Diagnoses

Obesity and Sedentary Lifestyle: Your recent weight gain and sedentary lifestyle could be contributing to both your knee pain and back pain. Excess weight puts additional stress on your joints, and a lack of physical activity can lead to muscle weakness and stiffness.
Peripheral Neuropathy: The pins and needles sensation and zapping feeling in your feet could be due to peripheral neuropathy, which can be caused by diabetes or other metabolic conditions. Given your family history of diabetes, this is a possibility worth exploring.

What you can do

Knee Pain and Radiating Pain

See a Doctor: Given the severity of your pain (9/10) and the duration (over a year), it's important to consult a healthcare professional for a thorough evaluation. They may recommend imaging studies like X-rays or MRIs to get a better look at your knee and hip.
Physical Therapy: A physical therapist can help you with exercises to strengthen the muscles around your knee and hip, improve flexibility, and reduce pain.
Weight Management: Losing weight can significantly reduce the stress on your joints. Consider consulting a dietitian for a personalized weight loss plan.
Pain Management: Continue using over-the-counter pain relievers like acetaminophen and ibuprofen as needed. Voltaren gel can also be helpful for localized pain relief.

Numbness and Pins and Needles Sensation

Neurological Evaluation: A neurologist can help determine if your symptoms are due to sciatica or peripheral neuropathy. They may recommend nerve conduction studies or other tests.
Diabetes Screening: Given your family history, it would be wise to get screened for diabetes, as it can cause peripheral neuropathy.

Back Pain

Posture and Ergonomics: Ensure that your sitting and standing postures are correct. Ergonomic adjustments to your workspace can help reduce back pain.
Exercise: Engage in low-impact exercises like swimming or cycling to strengthen your back muscles without putting too much strain on your joints.

General Tips

Stay Active: Even light activities like walking can help improve your symptoms. Aim for at least 150 minutes of moderate aerobic activity per week.
Diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Reducing your intake of sugary drinks like Sprite can also help with weight management.

What you should look out for

Given the severity and duration of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Severe or worsening pain: If your pain becomes unbearable or significantly worsens.
Loss of bladder or bowel control: This could indicate a serious condition like cauda equina syndrome, which requires immediate medical attention.
Sudden weakness or numbness: If you experience sudden or severe weakness or numbness in your legs, seek medical attention immediately.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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