What kind of doctor do I need to see for my knee/hip pain?
July 24, 2013 7:45 AM Subscribe
I am 28 and female. Overweight, but no other health problems. I've had deep, aching knee and hip pain since around 2003. Most of the time since then, I have been un- or under-insured. I'd like to finally get this figured out and treated, but not sure what kind of specialist I should go to. My latest trip to a primary-care doctor was useless.
The Pain:
It's a bone-deep, intense ache that radiates from knee to hip. At its worst, I would rate it a 7 on a 1-10 pain scale. I can't really tell where it "starts". It tends to be achey in the morning or later at night. It seems to correlate with cold and damp weather. It often correlates with not enough sleep. It sometimes correlates with days where I stand or walk a lot, but the pain won't usually set in until night. The joint isn't physically swollen or hot on the outside, but it feels "inflamed" on the inside. Sounds like arthritis?
BUT:
it never feels stiff or difficult to move. It's not weak and it doesn't give out
it doesn't hurt more when I go up stairs or exercise the joint
None of my other joints have abnormal pain
The medical history:
I was born with one hip turned slightly inward. The dr said I should grow out of it. I never did and now I have a duck walk and a definite "turned in" left foot when I walk. I haven't needed orthopedic shoes or anything but I think this might be a cause. However, while I think the left knee/hip hurts more often, the right one definitely does too sometimes.
In 2010 I got a blood test for rheumatoid arthritis. It was negative. The dr. then recommended that I get X-rays. I couldn't afford it at the time.
I went to a general physical last month in a new city and talked about this with the dr. He recommended that I lose weight. That was it. Yes, I am overweight, but I've also had this pain on and off since I was 18 years old, when I was significantly lighter, and I've been walking a lot recently and that hasn't seemed to increase the pain. You would think it would, if it was just from carrying too much weight when using the joint. I tried to ask what other options I could seek for other possible causes and he pretty much blew me off and kept telling me to lose weight.
I really feel that while weight might be exacerbating my pain, there is something else underlying this. But I'm not sure what kind of doctor I should be seeing next. An orthopedist? A rheumatologist, even though I supposedly tested negative? I want someone who specializes in knee and hip pain, who can tell me what other possibilities besides arthritis this might be, and whether it's a bone problem, a joint problem, or something else.
The Pain:
It's a bone-deep, intense ache that radiates from knee to hip. At its worst, I would rate it a 7 on a 1-10 pain scale. I can't really tell where it "starts". It tends to be achey in the morning or later at night. It seems to correlate with cold and damp weather. It often correlates with not enough sleep. It sometimes correlates with days where I stand or walk a lot, but the pain won't usually set in until night. The joint isn't physically swollen or hot on the outside, but it feels "inflamed" on the inside. Sounds like arthritis?
BUT:
it never feels stiff or difficult to move. It's not weak and it doesn't give out
it doesn't hurt more when I go up stairs or exercise the joint
None of my other joints have abnormal pain
The medical history:
I was born with one hip turned slightly inward. The dr said I should grow out of it. I never did and now I have a duck walk and a definite "turned in" left foot when I walk. I haven't needed orthopedic shoes or anything but I think this might be a cause. However, while I think the left knee/hip hurts more often, the right one definitely does too sometimes.
In 2010 I got a blood test for rheumatoid arthritis. It was negative. The dr. then recommended that I get X-rays. I couldn't afford it at the time.
I went to a general physical last month in a new city and talked about this with the dr. He recommended that I lose weight. That was it. Yes, I am overweight, but I've also had this pain on and off since I was 18 years old, when I was significantly lighter, and I've been walking a lot recently and that hasn't seemed to increase the pain. You would think it would, if it was just from carrying too much weight when using the joint. I tried to ask what other options I could seek for other possible causes and he pretty much blew me off and kept telling me to lose weight.
I really feel that while weight might be exacerbating my pain, there is something else underlying this. But I'm not sure what kind of doctor I should be seeing next. An orthopedist? A rheumatologist, even though I supposedly tested negative? I want someone who specializes in knee and hip pain, who can tell me what other possibilities besides arthritis this might be, and whether it's a bone problem, a joint problem, or something else.
You want an orthopedic doctor of some kind.
Most of them are surgeons, but in general, orthopedics treat musculoskeletal issues like you describe.
You could also try a referral to a PT to see if that doesn't help in the meantime. But most definitely an orthopedic.
posted by zizzle at 7:51 AM on July 24, 2013
Most of them are surgeons, but in general, orthopedics treat musculoskeletal issues like you describe.
You could also try a referral to a PT to see if that doesn't help in the meantime. But most definitely an orthopedic.
posted by zizzle at 7:51 AM on July 24, 2013
Best answer: This sounds more like a structural issue, and so I agree that orthopedics or sports-medicine would be reasonable.
But, I would note that the blood test is only for rheumatoid arthritis, which is only one of a wide spectrum of joint diseases that rheumatologists treat. So, seeing a rheumatologist wouldn't be unreasonable as well.
posted by cacofonie at 7:55 AM on July 24, 2013 [2 favorites]
But, I would note that the blood test is only for rheumatoid arthritis, which is only one of a wide spectrum of joint diseases that rheumatologists treat. So, seeing a rheumatologist wouldn't be unreasonable as well.
posted by cacofonie at 7:55 AM on July 24, 2013 [2 favorites]
My guess is that an orthopedic surgeon is probably going to x-ray you, find nothing significant, then be pretty brusque.
Your description sounds like neuropathic pain to me (pain related to nerve compression or impingment). You could go see a neurologist about it -- they're the experts in that sort of pain.
posted by killdevil at 7:58 AM on July 24, 2013
Your description sounds like neuropathic pain to me (pain related to nerve compression or impingment). You could go see a neurologist about it -- they're the experts in that sort of pain.
posted by killdevil at 7:58 AM on July 24, 2013
Sounds like you need an orthopedist who specializes in the joints in question.
Also, I see you already know how dismissive some doctors can be about your health concerns when you're a larger person. Don't ever be afraid to decide to see another doctor if the one you initially choose is more interested in being sneery.
posted by elizardbits at 8:17 AM on July 24, 2013 [1 favorite]
Also, I see you already know how dismissive some doctors can be about your health concerns when you're a larger person. Don't ever be afraid to decide to see another doctor if the one you initially choose is more interested in being sneery.
posted by elizardbits at 8:17 AM on July 24, 2013 [1 favorite]
Best answer: Don't rule out physical therapists, either -- even if nothing is "wrong" per se, they can often suggest ways to stretch ligaments and strengthen muscles to make joints and limbs work better and ache/creak/etc. less.
posted by acm at 8:19 AM on July 24, 2013 [2 favorites]
posted by acm at 8:19 AM on July 24, 2013 [2 favorites]
If it could be bones or it could be nerves, your best bet may be to start with a sports medicine physician who is also an osteopath. They're great at pinpointing the problem(s) and then can send you to the right specialist(s) for dealing with it (whether that be an ortho, neuro, or PT). It doesn't matter if you don't do "sports". Even walking is a sport. Try these folks, if your profile location is correct.
posted by beagle at 8:23 AM on July 24, 2013 [3 favorites]
posted by beagle at 8:23 AM on July 24, 2013 [3 favorites]
Orthopedics is a surgical specialty, and some orthopedists lose interest when a problem is not amenable to surgery. I'd work with a rheumatologist. Rheumatologists treat many musculoskeletal disorders, not just rheumatoid arthritis.
posted by Wordwoman at 9:25 AM on July 24, 2013
posted by Wordwoman at 9:25 AM on July 24, 2013
Best answer: I had exactly these symptoms, except I'm not overweight. Exactly. It turned out to be simply a biomechanical problem--I've developed incredible tightness in my entire hip area which affects everything and eventually caused inflammation and resulting fluid buildup under the kneecaps because they were being pulled out of alignment. I saw an orthopedist, he ordered an MRI, then sent me to PT. The PT has been very intense and it took a while to see results, but I'm so much better now.
posted by HotToddy at 9:45 AM on July 24, 2013 [1 favorite]
posted by HotToddy at 9:45 AM on July 24, 2013 [1 favorite]
Response by poster: It turned out to be simply a biomechanical problem--I've developed incredible tightness in my entire hip area which affects everything and eventually caused inflammation and resulting fluid buildup under the kneecaps because they were being pulled out of alignment.
This is interesting, because my 'home remedy' has been to try to stretch my hip outward as much as possible, and that seems to alleviate it sometimes. And yes, inflammation of the knee is exactly what it feels like - like the whole thing is just throbbing, but there's no outward sign of it. Thanks!
posted by nakedmolerats at 9:52 AM on July 24, 2013
This is interesting, because my 'home remedy' has been to try to stretch my hip outward as much as possible, and that seems to alleviate it sometimes. And yes, inflammation of the knee is exactly what it feels like - like the whole thing is just throbbing, but there's no outward sign of it. Thanks!
posted by nakedmolerats at 9:52 AM on July 24, 2013
What finally solved a similar problem for was getting orthotic inserts for my shoes. Protip: A chiropractor will use exactly the same procedure and send the cast of your feet to the same factory as a regular doctor for much less.
posted by Mr. Yuck at 10:05 AM on July 24, 2013
posted by Mr. Yuck at 10:05 AM on July 24, 2013
I have had similar pains, but for me, it is definitely related to my menstrual cycle and was greatly helped by hormonal birth control. Also, do you tend to sleep on that side? I do, and squishing my hip all night does not help. I also got rid of my crappy shoes. These aren't the primary causes of the pain, but they are contributing factors to it.
posted by florencetnoa at 10:11 AM on July 24, 2013
posted by florencetnoa at 10:11 AM on July 24, 2013
I too had vaguely similar problems and physical therapy has helped them immensely. For me, it turned out to be a combination of various gait issues stemming from muscle weakness. My left knee rotated inward because my left hip muscles were weaker than my right and weren't maintaining proper alignment. My right ankle had started to pronate inward to compensate. Focused, intense physical therapy has been a huge help. I started with an orthopedic surgeon who didn't even mention the word "surgery." He did take several x-rays to start but when those were negative, he immediately suggested physical therapy.
posted by pecanpies at 11:28 AM on July 24, 2013
posted by pecanpies at 11:28 AM on July 24, 2013
Response by poster: Update for future people: I went to an orthopedist. He took X-rays. I don't have arthritis, yay! I go to physical therapy twice a week to strengthen my hip muscles, mostly. Soon I should be able to do everything at home rather than going into the office. So far, it hasn't completely cured me of the pain, but I'm definitely stronger than I was.
posted by nakedmolerats at 11:48 AM on September 13, 2013
posted by nakedmolerats at 11:48 AM on September 13, 2013
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posted by summerstorm at 7:51 AM on July 24, 2013