Knee and Joint Pain Care in Southlake, TX

Most joint pain in adults is managed perfectly well in primary care, and a surprising amount of it gets sent straight to orthopedics for an MRI that changes nothing. We work out what is actually going on, treat it properly, and refer when a referral will change the plan.

Working out the cause

The examination does most of the work. Where it hurts, what makes it worse, whether the joint is swollen or warm, how it moves, whether one joint or many are involved, and whether stiffness is worse in the morning or after activity.

Morning stiffness lasting more than an hour points toward inflammatory arthritis. Stiffness that lasts a few minutes and worsens with use points toward osteoarthritis. That single question separates two conditions with completely different treatments.

A great deal of what people call knee pain is referred from the hip, and hip pain felt in the groin behaves differently from lateral hip pain, which is usually bursitis or gluteal tendinopathy. Getting the location right prevents treating the wrong structure.

Imaging, used sparingly

X-rays help when we suspect osteoarthritis or after an injury.

MRI is reserved for cases where the result would change what we do next. Incidental meniscus tears are extremely common in adult knees, present in a large share of people with no pain at all, and finding one often leads to a procedure that does not outperform physical therapy.

When it looks inflammatory

When the pattern suggests inflammatory disease rather than mechanical wear, we run inflammatory markers, rheumatoid factor, anti-CCP and uric acid, and we move quickly.

Rheumatoid arthritis treated early does far better than rheumatoid arthritis treated eventually. The window matters, and a rheumatology referral in month two is worth more than one in year two.

Treatment that helps

• Strengthening. Quadriceps and hip strength for knees, rotator cuff and scapular work for shoulders. Physical therapy is the highest-yield referral we make for joints and it is badly underused.
• Weight. Every pound off the body takes roughly four pounds of load off the knee with each step, which is why joint care and our medical weight management work overlap so heavily. See obesity.
• Topical NSAIDs first for knees and hands. They work, and they skip most of the stomach and kidney risk.
• Oral anti-inflammatories in short courses when needed, with attention to your kidney function, blood pressure and any blood thinner.
• Injections. Corticosteroid injections done in our office for flares, which buy enough relief to do the rehab that lasts. See joint injections.

Gout

Sudden, severe, single-joint pain, usually the big toe or knee, often starting overnight and exquisitely tender to even a bedsheet.

It is frequently mistaken for infection or injury. We treat the flare, then decide about long-term urate-lowering therapy, which most people with recurrent gout should be on and are not. Treating the flare without addressing recurrence is why people keep having them.

When we refer

Locked joints, instability or giving way, a suspected fracture, an infected joint, or pain that has not responded to a genuine trial of therapy, medication and injection.

A hot, swollen, exquisitely painful joint with fever is a possible septic joint. That is an emergency, not an appointment.

Bone density concerns are covered under osteoporosis and fracture risk. Recent injuries are on our strains and sprains page.

Joint care runs through our in-office joint injections and chronic care programs. See our primary care Southlake practice overview.