Doctor : Hi, I am Dr Nur, may I know your name sir?

Patient : I’m Mr Nasir , 63 years old.

Doctor : May I know why you come to clinic today ?

Patient : Mmmm, Dr, I’ve had experienced knee pain for the past 2 months.Plus, I’ve
also noticed my knee become a little bit swollen which only my right knee.

Doctor : May I know more about knee pain, ? How it is feel, the onset is it sudden
onset/gradual onset ?

Patient : Yeah, it’s started gradual onset since 2 months ago & the pain come & goes
which it’s more like a throbbing pain . I would rate the pain of 5/10. At first, I would
just think some simple pain. I took PCM for pain and it’s relieve,,,however, the PCM
doesn’t give the pain reliever effect lately so I start to feel anxious.

Doctor : Oh okay, may I know how about what aggravate the condition & do you need to
use walking aid to walk ?

Patient : It’s aggravate with movement , which I really don’t like walking too much , I
just want to rest at home. I can move and walk without walking aid but if I walk too
much in 1 day, I need to use walking sticks because sometimes.

Doctor : I see, may I know do you had any recent trauma prior to the knee pain
symptom?

Patient : No Dr, I didn’t have any history of falling down on my knee or falling down
from stairs . It just happen with unknown cause dr ..

Doctor : Okay2 , may I know does this pain could aggravate if you eat like seafood or
meat ?

Patient : No Dr, I can eat seafood but it does not a triggering factor for the knee pain.

Doctor : Alright , any history of having disease or medical history related with our
knee?

Patient :Oh, this one I want to tell you Dr, I am very active person long ago , I am very
active.. but since 43 years ago which when my age around 2o years old, I’ve had sport
injury while playing football. It’s turned out I’ve had MCL tear . At that time Dr, I can’t
bear the pain.. So I go to Emergency department at hospital & Dr suggest me
sometimes to rest and 1 months following that , I do the MCL reconstruction. It was
the first time in my life undergone surgery and being admitted to hospital. Luckily, no
complication during surgery & then I just continued the physiotheraphy class to gain my
knee function well back. Since then Dr, I become inactive.Hahahah.. I just continued
study in college and become teacher.
Doctor : Oh , so you had previous history of ligament tear, I see. Anything else that
maybe you’ve suffered with?

Patient : No Doctor, other’s disease like DM, HPT & Dyslipidemia I just been diagnosed
around 10 years ago during medical checkup screening. I am very compliance with
medication .. But Dr, may I know why I have this knee pain.. What’s the disease that
I’ve been suffered?

Doctor : Okay, based on the history that you generously told me, plus with
investigations .. I would come out and say that your knee pain is because you’re having
knee osteoarthritis which it’s more likely due to wear & tear degenerative disorder of
your joint specifically your knee joint.

Patient : Oh , is it Dr? What Again the diagnosis ?

Doctor : It’s osteoarthritis , it’s like happen when your joint space become narrow , you
know that inside your joint… it’s had some lfluid which we called it as synovial fluid that
help to lubricate your joint but with OA,it’s become less viscous, so less lubricant , so
your joint space narrowed and it’s like rubbing one another your bone ( femur & tibia )
that’s why you feel the pain. Plus, you had history of Right knee MCL tear which
predisposed you to have this OA.

Patient : Oh like that Dr, anything that you can offer me to overcome this knee pain.

Doctor : Hmm, since PCM is not effective anymore to reduce this pain, I will give you
tramadol which also the same to reduce the pain but more stronger the effect.
However, you still need to have good control for all the underlying disease of DM, HPT
& Dyslipidemia . You can also practice some simple & minimal knee joint exercise to
strengthen your knee, OR maybe practice brisk walking for atleast 20-30 minutes
everyday to ensure good circulation & also you know what if you like do the exercise like
that , you will help your body to release endorphin which act as natural reliever for the
pain. You can apply some cold or warm compression around your knee when you have the
pain ,