Dervan dermatome syndrome often missed but surprisingly common coexistent spine pathology in ‘Knee Pain’, ignore at your own risk

Abstract

Introduction: Knee pain is among the commonest complaints in the outpatient orthopedic department. However the cause does not always originate from knee itself. and knee pain is used by the patient more as an umbrella term. In fact very few patients give the complete list of accompanying symptoms. They have more often than not to be coaxed out of the patient. To make matters more complex, Referred pain from the Spinal nerves, Hip and Ankle joints join the many structures around the knee to make knee pain an umbrella term for this Pandora's Box. Misdiagnosis or partial diagnosis leads to inadequate or wrong treatment and continued suffering for patient and treating doctors Materials & Methods: 78 patients with knee pain attended the OPD of Walawalkar hospital, Dervan. On x-ray, 28 were found to have different grades of osteoarthritis. Of these 25 agreed to be part of this pilot study. They underwent standing x rays & MRI of the lumbosacral spine. Results: This study found an unusually high rate of coexistent knee and spine pathologies. All patients had some degree of disc disease accompanying medial or tricompartmental osteoarthritis. It undermines the need for investigating this important contributor to the umbrella term of knee pain. The commonest affected disc segment was L4-5 i.e 92% with two patients having L5-S1 prolapse 8%. The purpose of this pilot study is only to alert the surgical and rehabilitation colleagues of the frequent coexistence of the spine and knee conditions for Counseling, consent, surgery & rehabilitation and thus improve patient satisfaction.

Dervan simultaneous surgical protocol complete relief of lower limb neuralgic & arthritic pain

“…[11][12][13][14][15] . In a previous publication from this institute, on investigation of causes of dissatisfied patients of knee Arthroplasty, it was found that although the patient complained of pain around the knee, the source & pain generator were mostly from the spine 1 . It was thereafter made mandatory for all patients of knee osteoarthritis to undergo spine investigations & detailed clinical examination preoperatively.…”

“…It was thereafter made mandatory for all patients of knee osteoarthritis to undergo spine investigations & detailed clinical examination preoperatively. Furthermore it was found that great concomitant affliction existed between spinal disc disease & knee Osteoarthritis [1] .…”

“…The exact cause of pain, the origin of the main pain generator has confused many an astute clinician. To confuse matters more, coexistence of the pain generator in both knee joints & spine is often noted [1][2][3][4] . The surgeons practicing specialized knee Arthroplasty are often faced with dissatisfied patients complaining of lingering pain in the knee, often behind the knee [5,6] .…”