Good communication with your doctor is essential in order to receive optimal medical care. At KPS, we do our best to explain your diagnosis to you and ensure you understand. Sufficient time is also needed to discuss treatment options, including the risks and benefits of each. At KPS, follow-up consultations are scheduled for 30 minutes in order to allow for building a good doctor-patient relationship, further discussion of your condition, and proper planning of your treatment.
Importance of Knee Pain Specialists
The focal point of experience that knee agony experts have is not normal for your standard broad knee pain doctor Singapore or even orthopedic specialist. Knee agony experts are significantly more able to diagnosing both normal and extraordinary knee issues and have a lot more prominent information on the treatment techniques that are accessible. This is coupled with a lot more noteworthy comprehension of what treatment is probably going to be best for every person. By the idea of their work, a knee torment expert will have seen and treated far a larger number of instances of knee agony than an overall expert or an orthopedic specialist, who may only see these kinds of cases once a day. This gives the expert an experiencing an immense range of issues that can impact the knee, and hence he is significantly more ready to recognize the reason for the torment and suggest a suitable therapy.
Expertise in Diagnosing Knee Pain
As the only publicly funded subspecialty training program in Singapore, the National University Health System (NUHS) Department of Orthopaedic Surgery offers a Knee fellowship with an emphasis on clinical examination and structured diagnostic methods with exposure to a wide spectrum of knee pathologies. NUHS consultants are actively involved in teaching and use of clinical examination. In light of the present and future generations of knee injuries coupled with evidence of suboptimal diagnosis and surgical intervention, it is an ongoing form of education to the public, primary care physicians, and future orthopedic surgeons on the need for and methods in correct and accurate diagnosis to enable the most appropriate treatment of knee injuries. This includes pioneering comprehensive studies in Singapore for common knee pathologies which may differ from that seen in western countries.
Orthopedic specialists are critical in accurately diagnosing and treating complex knee pain. Studies have shown that even primary care physicians, who have comprehensive training in family medicine or internal medicine, are only 45-65% accurate in diagnosing meniscal tears and have a 50% error rate in diagnosing an ACL. While most orthopedic surgeons would consider diagnosis and history taking an essential component of the clinical examination, diagnostic accuracy is heavily reliant on a structured and thorough clinical examination. Unfortunately, a survey of orthopedic surgeons showed that less than 25% could accurately perform a Lachman’s test, possibly the key component of diagnosing an ACL tear. Accuracy in diagnosis is paramount before considering any treatment or surgical intervention. A study of 100 consecutive patients referred for ACL reconstruction found that only 58 actually had a torn ACL. This suggests that MRI scans are heavily relied upon for diagnostic purposes, often resulting in a surgical procedure that may be unnecessary. It is vital that an accurate diagnosis be made as specific knee pathologies require different methods of treatment. With increasing subspecialization within orthopedics, it has become difficult for general orthopedic surgeons to accurately diagnose and offer the most appropriate treatment for specific knee injuries. This is not only due to time constraints in the consultation and a lack of exposure to certain pathologies but also a lack of formal clinical examination training during and after orthopedic residency.
Comprehensive Treatment Options
There are various treatment options available to patients suffering from knee pain. Knee pain specialists are trained in determining the most suitable treatment for each individual’s condition. The initial method of treatment is often non-surgical. These treatment options may involve a lifestyle change, a course of exercises, losing weight, taping or bracing, or an injection. The injection is not a treatment itself, but rather a way to provide relief so that patients may begin a rehabilitation program. These injection options include platelet-rich plasma or PRP, hyaluronic acid (also called visco-supplementation), or a steroid/cortisone. The most common form of cortisone injection is a corticosteroid. The second step in treating knee pain would be surgery, but due to the limits surgery may cause and the risks involved, it is often best to leave surgery as a final option. Rehabilitation post-surgery or post-injury is the most important part of treatment. Patients will need to gain full knee movement, strength, and stability. Any deficits in the way the knee moves, or muscle strength imbalances can lead to further problems such as another injury or arthritis. Rehabilitation will involve a course of exercises aimed to improve knee function and muscle strength. A supervised physiotherapy program may be recommended to ensure that the patient is doing the exercises correctly and to provide further treatments such as manual therapy. Full recovery may take anywhere from a few weeks to over a year depending on the injury and its severity. A return to any high-risk activities or sports should only be planned when the knee has full function and strength, and the best prevention of future knee problems is to avoid any activities that may cause a re-injury.
Personalized Care for Patients
Training and working with the British Olympic Medical Institute and the English Institute of Sport has given us insight into the management of sports-related injuries, which we have used to treat all of our patients with knee problems. So whether you are a keen golfer or a runner of marathons, we can use our experience with athletes to help manage your knee problem and keep you as active as possible.
We fully involve the patient in the decision-making process and believe in full informed consent. We provide information for management for common knee problems and our patients’ information section, which explains clearly the scientific basis of the various treatment options for knee problems. We don’t work in a sports center, but we have a certain affinity with athletes! They have taught us a lot about knee problems and sports injuries, and we have treated athletes of all levels from amateur to professional sportsmen and women.
Personal care in an age of retrieved helpfulness can be elusive, but not at Knee Pain Specialists. Here we keep communication clear and simple and do not confuse the means with the ends. We maintain an unswerving focus on the patient’s agenda and keep the patient fully informed at each stage in the decision-making and treatment planning process. We believe strongly in an evidence-based approach. High-quality scientific research provides the best means to practice, and we keep abreast of the latest research and best practice in our continued strive to improve our patients’ outcomes.
Key Services Provided by Knee Pain Specialists
The knee pain specialist may then organize investigative tests such as X-rays, MRIs, ultrasounds, or blood tests to aid in diagnosis. Once all the findings have been reviewed, they will then discuss the diagnosis with you and ensure that you have a good understanding of your condition. With this information, the knee pain specialist can emphasize realistic goals and set an appropriate plan for the management of your condition.
The first step in the treatment of knee pain is to be properly diagnosed by a medical professional. This is a crucial stage as the cause of knee pain can be for a variety of reasons. Once a clear diagnosis is established, a comprehensive management plan can be implemented. Knee pain specialists are qualified in the diagnosis and management of knee pain and associated symptoms. They will take a comprehensive history of your condition before performing a thorough clinical examination.
When it comes to services provided by a knee pain specialist, it is important to understand what is covered. This will allow you to make a more informed decision when it comes to seeking medical assistance and tailoring it to your specific needs. The following information will describe the services offered by a knee pain specialist.
Diagnostic Evaluations
Overall, the aim of the diagnostic evaluations is to reach an accurate diagnosis of the patient’s knee problem. This will then guide subsequent treatment and will optimize the chances of a good outcome for the patient.
X-rays are usually the first investigation done. They give a good view of the bone structure of the knee joint and are useful for diagnosing arthritis, fractures, and other bony changes. An MRI scan gives a more detailed picture of both bone and soft tissues within the knee. This investigation is particularly useful for diagnosing ligament and meniscal injuries, and it also gives good information about articular cartilage. Blood tests are usually done only if the knee specialist suspects a systemic cause for the patient’s knee problem; for example, in cases of crystal-induced arthritis or infection.
Diagnostic evaluations are a critical phase in patient care. The knee specialist will take a very detailed history of the problem and then will examine the patient. This will involve some specific tests to help reach an accurate diagnosis. Sometimes the problem is clear and no further investigations are required. In many cases, however, the knee specialist may need to organize some tests to get additional information. This can include X-rays, MRI scans, and blood tests. Current funding arrangements in Singapore healthcare mean that some of these investigations can be done at a subsidized cost at the polyclinic or the patient’s general practitioner. The knee specialist will decide the most appropriate investigations for each individual case.
Non-Surgical Treatments
With a wide variety of non-surgical treatment modalities available, patients who consult an SGH knee pain specialist can expect to receive an individualized treatment plan tailored to their specific knee problem and personal circumstances.
Physiotherapy serves to improve muscle strength, restore normal movement patterns, and correct identifiable risk factors for knee osteoarthritis. It is a critical means of treatment for patients with patellofemoral pain, iliotibial band syndrome, muscle weakness, and people who have recently undergone surgical reconstruction for ligament injuries. However, the value of physiotherapy can be reduced in patients with severe osteoarthritis and those with meniscus tears who experience mechanical symptoms such as locking or giving way.
Key non-surgical treatment modalities include physiotherapy, activity modification, weight reduction, use of walking supports (such as canes and unloading braces), and drug therapy. The pain relief experienced with the use of these modalities can vary significantly. In general, activity modification and weight reduction are effective means of pain control but may be difficult to achieve. Similarly, while drug therapy can be very effective for pain relief, it may not be appropriate in patients with certain coexisting medical conditions.
Non-surgical treatments are recommended by knee pain specialists for patients who are ‘low-demand’ and wish to avoid or delay surgery. Non-surgical management is also an option for patients who plan to have surgery but wish to delay it for as long as possible. Finally, non-surgical treatments are considered an appropriate first step in patients who have a condition that cannot be successfully treated with surgery.
SGH’s knee pain specialists take a special interest in managing knee problems using non-surgical treatments. They are well-equipped with the knowledge and expertise to recommend appropriate treatment strategies for each patient’s specific knee problem.
Surgical Interventions
The role of the knee pain specialist extends beyond the surgery itself. On occasions, the patient is referred back to the specialist before and after the operation. This may be to continue with an injection treatment for osteoarthritis to delay the need for a knee replacement, and to provide a second opinion on a particular operation suggested by another orthopedic surgeon. After the operation, the specialist may provide a tailored rehabilitation program to ensure the best possible recovery for the patient.
The different forms of knee surgery include arthroscopy, ligament reconstruction, partial or total knee replacement, and osteotomy. These are explained in more detail in the surgery sections of our individual information pages.
If a surgical intervention is suggested, the patient will be given full details on what the operation involves, the success rates, and any potential complications. The decision to proceed with the operation is always made by the patient and never forced upon them.
Surgical intervention is considered as a last resort for most cases of knee pain. The common forms of knee pain are caused by soft tissue or cartilage damage. Examples include meniscus (cartilage) tears, ligament injuries such as ACL, and wear and tear to the joint surface. These can often be successfully treated without the need for surgery. However, there are particular conditions where the symptoms are severe and greatly affect a person’s quality of life. In these instances, the opinion of knee pain specialists is that the patient should be referred to an orthopedic knee surgeon to discuss the options available to them regarding surgical intervention.
Rehabilitation and Physical Therapy
Knee Pain Specialists are also involved in research projects with the goal of improving rehabilitation techniques and outcomes. The team of physiotherapists are currently in the data collection phase of a research project on ACL rehabilitation. This research involves the use of dynamometry to assess and compare the muscle strength of the injured and non-injured limbs at different stages of rehabilitation. The results will help to guide the rehabilitation of ACL patients, as there is currently little evidence-based research to direct appropriate rehabilitation progression following ACL reconstruction.
While many injuries require traditional physical therapy, there is a growing need for sport-specific rehabilitation, especially for elite and recreational athletes. This involves the physiotherapist working with the athlete to not only regain normal knee function, but also to prepare the injured knee for the specific stresses and demands of their sport. An example is a badminton player who has undergone ACL reconstruction and wishes to return to their prior level of competition. The rehabilitation program would be tailored towards mimicking the actions and movement patterns of badminton, which are very different from those required for a sport such as soccer.
Finding the Right Knee Pain Specialist in Singapore
All our doctors have undergone extensive training to become knee specialists. Dr. Yung did knee surgery fellowships in Canada and Switzerland, while Dr. Dutton did his fellowship in Belgium and the USA. All have stated areas of special interest in knee surgery and are active in academic pursuits such as scientific research and teaching. This is the kind of doctor you should look for, the kind who is a recognized specialist in knee care, with a commitment to continued learning and excellence, and a focus on enhancing his or her expertise in a particular area of interest.
At the Singapore Sports and Orthopaedic Clinic, we have three knee specialists with many years of practice and additional training in knee surgery: Dr. Ambrose Yung, Dr. Andrew Dutton, and Dr. Sean Ng. Board certification in orthopaedic surgery means that a doctor has been judged by his or her peers to have demonstrated a high level of knowledge, skill, and experience in a particular field, and to have passed a thorough and rigorous examination.
Every health-care specialist has to study and train extensively to reach the highest level of proficiency in his or her field. With all the time and money invested in education, it’s never a good idea to see a doctor who isn’t a board-certified specialist. You should also be wary of recently-minted specialists who, while possibly quite competent, don’t have the depth of experience to deal with really challenging cases.
Researching Specialists’ Credentials
The first step when in search of a knee specialist is to get the names of some specialists. You can ask a GP for some names. Many specialists have areas of special interest as well as general orthopaedic training. You should try to find a specialist who routinely deals with your kind of knee problem. One way to do this is to get the names of knee specialists who are involved in teaching and writing about knee problems. Some knee specialists constantly publish articles or textbooks on particular knee conditions. You can get some names from these books and request for the names of other specialists in your vicinity. Another way to identify knee specialists is by attending public forums or seminars organized by hospitals. Every so often, a hospital organizes a public forum for patients to learn about common orthopaedic problems. The forum usually includes a question and answer session and a chance for patients to meet the speaker afterwards. The speaker is often an orthopaedic surgeon with a special interest in the problem being discussed. You can get some names from these sessions and also learn more about the doctor’s experience and treatment approach. These are good chances to meet several knee specialists in person without paying for an appointment.
Considering Patient Reviews and Recommendations
Online directories such as the Yellow Pages and business websites feature a patient review system which allows patients to rate a knee or sports specialist as well as comment on their experience. These websites are good resources. General review sites such as Google Maps feature a similar system, although here all medical professionals may be rated together instead of being separated into their respective fields. Finally, there are medical discussion forums where patients may discuss their experiences with others. This may yield both positive and negative feedback, but can be an excellent tool for learning more about a potential specialist and the experiences others have had.
The best recommendations often come from family, friends, or co-workers who have been satisfied with a similar orthopedic service. When considering a knee pain specialist, it’s also valuable to consider patient testimonials and reviews. There are a number of resources to search for patient reviews. These are valuable tools for providing insight into a physician or surgeon’s competence, professionalism, and ability to provide effective treatment. High ratings and positive feedback may be just the encouragement a patient needs to make an appointment. On the other hand, if a patient is considering a specialist and finds a lot of negative reviews and comments, it might be best to move on to other potential candidates. Keep in mind that it’s impossible for any physician to have 100% positive feedback at all times.
Evaluating Accessibility and Availability of Services
Beyond the location, some patients may be deterred by long waiting times for scheduled appointments. Singapore boasts a public healthcare system that is considerably more affordable than many other developed countries. However, the trade-off is often a longer waiting time for both diagnosis and treatment in public hospital and clinic settings. With the Ministry of Health now allowing the public to access information on the standard waiting times for specialist outpatient appointments, patients are more informed than ever on the predicted waiting time for referral services from a polyclinic to a public hospital specialist outpatient clinic in Singapore. Published in March 2012, this information can be found on the Ministry’s website under the E-appointment Services link.
Before seeking a possible service, a patient will need to know if he or she is able to access that service. This concept includes an understanding of whether the patient will be able to physically travel to the service site, as well as a consideration of waiting times and hours of operation. In the case of finding a knee pain specialist in Singapore, accessibility and availability of services could be a major concern to a potential patient. The location of the specialist’s clinic can be an immediate deterrence, especially if it is not situated near public transport or parking facilities. Depending on the patient’s knee problem and mobility, long walks from public transport stops, or up and down multi-story car park ramps may be an obstacle.
