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When Knee Pain isn't from Arthritis

In this study doctors report on three cases of insufficiency fractures of the tibia in older adults. Insufficiency fractures occur when the bone isn't dense enough or strong enough to withstand everyday stresses. They occur most often in older women (over age 65) who have osteoporosis.

All three patients had knee joint pain along the medial (inner) tibial line. The tibia is the lower leg bone. The pain came on without cause or injury in two cases. The third woman reported pain that occurred when she was stepping down off the bus.

X-rays didn't show any changes in the early stages of the insufficiency fractures. Bone scans were used to diagnose the problem. Treatment was with pain relievers, rest, and crutches for support. Six months to two years later, all three patients continue to have mild pain from time to time. Pain relievers are all that's needed to manage.

The authors conclude that knee pain from insufficiency fractures is unique and difficult to diagnose. Early stages of this condition don't show up on X-rays. It's easy to think the patient is suffering from osteoarthritis. Early diagnosis with advanced imaging is needed to avoid full fractures from occurring.

References: Shai Luria, MD, et al. Osteoporotic Tibial Plateau Fractures: An Underestimated Cause of Knee Pain in the Elderly. In The American Journal of Orthopedics. April 2005. Vol. 34. No. 4. Pp. 186-188.

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