Knee Popping: Post-Stroke Recovery And Causes

Knee popping is usually harmless and may be caused by ageing joints or the buildup of air or gas bubbles in the fluid around the joints. However, when accompanied by pain, it may indicate a serious injury or an underlying problem such as arthritis, especially in post-stroke recovery patients.

Post-stroke pain is a common issue that is often poorly understood and incompletely managed, which can prevent optimal recovery. It can be easily overlooked due to its variable characteristics, concurrent medical issues, or impairments in cognition or communication.

Central post-stroke pain (CPSP) is the most frequent diagnosis, followed by peripheral neuropathic pain, pain due to spasticity, and joint subluxation. CPSP can be challenging to treat and is often refractory or responds incompletely to medication. It is important to seek medical advice for a proper diagnosis and treatment plan.

Shoulder pain

There are several causes of shoulder pain in post-stroke recovery patients:

• Improper positioning: Poor positioning of the shoulder when sitting, resting, or standing can increase stress on the shoulder joint, leading to pain over time.
• Neglect and learned nonuse: Hemineglect, a lack of attention to one side of the body, can lead to learned nonuse, where survivors stop using their affected arm. Both conditions increase the risk of limited shoulder mobility, injury, and pain.
• Spasticity: Muscle stiffness after a stroke is often caused by spasticity, which can affect the muscles in the arm and shoulder, resulting in shoulder pain.
• Frozen shoulder: Prolonged shoulder immobilization or stress on the joint and ligaments of a partially dislocated shoulder can lead to frozen shoulder, a painful condition.
• Secondary complications: Other health issues, such as diabetes, limited arm function, post-stroke pain, and neuropathy, can increase the risk of shoulder pain. Sensory changes can also worsen shoulder pain.
• Subluxation: This refers to partial dislocation, where the rounded end of the upper arm bone moves slightly out of its socket due to weakened muscles after a stroke. This can cause pain and is more noticeable when sitting.

To manage shoulder pain, it is essential to work with a physical or occupational therapist to learn effective techniques. Rehabilitation methods and pain management strategies are the two primary approaches to relieving shoulder pain:

• Range of motion exercises: Gentle passive range of motion exercises are recommended initially, progressing to more active exercises. These exercises help decrease spasticity, improve mobility, and relieve pain.
• Electrical stimulation: Techniques like transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES) can reduce pain signals, improve movement, and promote brain rewiring.
• Therapeutic taping: Taping can be used to improve poor positioning of the shoulder, providing temporary pain relief and preventing further pain.
• Shoulder braces: A shoulder brace or orthosis may be recommended to support the arm and reduce subluxation and pain.
• Positioning techniques: Appropriate postures and positioning techniques are crucial for individuals with limited movement and strength in the affected arm, as they can help manage the risk of contractures, shoulder subluxation, and pain.
• Massage therapy and acupuncture: Hands-on techniques can help relieve muscle tension and spasticity, reducing shoulder pain.
• Medications and injections: Analgesics (pain relievers), anti-inflammatory medication, or antispastic drugs may be prescribed. Nerve blocks or injections, such as corticosteroid injections or Botox, can also help reduce pain.

Spasticity

The American Heart Association recommends physical therapy and exercise regimens to prevent or lessen spasticity. These treatments can be challenging and uncomfortable at first, but they have been proven to benefit rigid muscles over time. If these methods do not adequately alleviate spasticity, prescription muscle relaxants can be used, although some people may experience side effects such as fatigue or dizziness.

Another treatment option is powerful and targeted injections of muscle relaxants or botulinum toxin (Botox). Injections can be beneficial for some people, but they may need to be repeated regularly as the effects wear off. While Botox may not be cost-effective for all patients, it can improve active or passive limb positioning, reducing the overall caregiver burden.

Overall, spasticity can improve, and exercising affected muscles is believed to help direct brain tissue to heal after a stroke. Early identification and treatment of spasticity are critical to avoid long-term complications and improve patient outcomes.

Central post-stroke pain (CPSP)

The primary symptoms of CPSP are pain and loss of sensation, usually in the face, arms, and/or legs. Pain or discomfort may be felt after being touched, even lightly, or even without any stimulus at all. The pain may worsen due to exposure to heat or cold, or emotional distress. The pain can dramatically hinder a patient's ability to perform daily activities, interfere with sleep, and reduce their quality of life.

The presence of sensory loss and signs of hypersensitivity in the painful area in patients with CPSP might indicate the dual combination of deafferentation and the subsequent development of neuronal hyperexcitability. CPSP is caused by damage that disturbs signals along the pain-transmission pathway, from the sensory cortex to the thalamus.

Treatments for CPSP include common analgesic drugs like ibuprofen, tricyclic antidepressants, anti-convulsants, and potentially narcotics. Neurosurgery, such as deep brain stimulation, can also be used to send stimulation to the pain receptors.

Complex regional pain syndrome (CRPS)

CRPS is uncommon, and its exact cause is not yet fully understood. It is believed to be the result of an abnormal reaction to trauma or injury, and it can occur with or without specific nerve damage. There are two types of CRPS: Type 1, which occurs after an illness or injury without nerve damage, and Type 2, which is associated with damage to a specific nerve. About 90% of people with CRPS have Type 1.

The symptoms of CRPS include continuous burning or throbbing pain, sensitivity to touch or cold, swelling, changes in skin temperature and colour, changes in skin texture, and joint stiffness. The affected limb can become cold and pale, and muscle spasms and tightening may occur. CRPS can also spread to other parts of the body, such as the opposite limb.

While CRPS symptoms may go away on their own in some people, they can persist for months or even years in others. Early diagnosis and treatment are crucial for improving outcomes and increasing the chances of remission. Treatment approaches include physical rehabilitation, pain relief, psychological support, and education about the condition and self-management strategies.

Pain associated with spasticity

While knee popping is often harmless, it can sometimes be a symptom of an underlying problem, such as arthritis or a knee injury. For example, a torn meniscus, cartilage damage, or a patellar tendon tear can all cause knee popping and pain.

Spasticity is a muscle control disorder characterised by tight or stiff muscles and an inability to control those muscles. It is caused by an imbalance of signals from the central nervous system to the muscles. Spasticity can affect muscles in any part of the body but is most common in the leg muscles. The pain associated with spasticity can vary from mild feelings of tight muscles to severe, painful spasms, usually in the legs. Spasticity can also cause low back pain and pain or tightness in and around joints.

Spasticity can result in permanent joint deformities, which can be painful and disabling, especially in children. In addition, spasticity can lead to reduced mobility and independence, as well as emotional health issues such as anxiety, depression, and low self-esteem.

Spasticity treatment typically involves a combination of exercise, physical therapy, medication, or surgery. The goal of treatment is to improve comfort, mobility, and independence, and to prevent further complications such as pain, permanent joint deformity, and pressure sores.

Frequently asked questions