What knee pain usually means
Knees carry your whole weight through every step, so they wear. The most common reason patients come to us is osteoarthritis: the smooth cartilage that cushions the joint thins over years, the bone underneath thickens, and the joint becomes stiff, swollen and painful. It tends to be worst first thing in the morning, after sitting for a while, and on stairs.
Not every sore knee is arthritis. Other causes we see regularly include:
- Meniscus tears and old injuries. A cartilage tear from a twist or a fall, or a ligament injury from years ago, can leave a knee that catches, gives way or swells.
- Bursitis and tendon pain. Inflammation of the fluid sacs around the knee, or of the patellar tendon below the kneecap, causes sharp, localized pain with kneeling or jumping.
- Referred pain. Some knee pain is actually coming from the hip or lower back, and the consultation makes sure we treat the right joint.
If you have been told your knee is "bone on bone", it means the cartilage in part of the joint has worn through. That is a real finding, but it is not the same as saying nothing can be done. Many patients with advanced arthritis on X-ray still get meaningful relief from injections and are able to put off surgery for years.
How our pain physicians treat it
We treat knee arthritis as a ladder. You start at the step that fits your knee and your goals, and you move up only if you need to.
- Consultation and X-ray. The doctor examines the knee, checks the hip and back, and reviews or orders standing X-rays to grade the arthritis. If a tear is suspected, an MRI may be ordered.
- Steroid joint injection. A corticosteroid injected into the joint calms inflammation and typically gives weeks to months of relief. It is often the first step.
- Knee gel injections (viscosupplementation). Hyaluronic acid, the same substance found in healthy joint fluid, is injected to cushion and lubricate the joint. Given as a series, it can provide relief for six months or more. Medicare covers it for knee osteoarthritis when the documentation supports it, and a repeat series is not given sooner than six months after the last.
- PRP injections. Platelet-rich plasma prepared from your own blood, injected into the joint. Some patients with mild to moderate arthritis choose it after gel injections. PRP is a cash service.
- Genicular nerve blocks. The small nerves that carry pain from the knee are numbed under guidance. This is useful for advanced arthritis, for patients who cannot have surgery, and for pain that persists after a knee replacement.
- StemWave shockwave therapy. Acoustic wave treatment for patients who want a non-drug, non-injection option for arthritic and soft tissue knee pain. Available at our Davie clinic.
Does insurance cover it? Consultations, X-rays, steroid joint injections and genicular nerve blocks are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna when medically necessary. Knee gel injections are covered by Medicare and many commercial plans for documented knee osteoarthritis, and in-network plans require prior authorization, which our front desk handles. PRP and StemWave are cash services and are not covered by insurance. Read more about insurance and self-pay.
What to expect
- Before you come in, we verify your insurance and ask you to bring photo ID, your medication list and any knee X-rays, MRI reports or orthopedic records.
- At the consultation, the doctor examines both knees, reviews your imaging and explains where you sit on the ladder and why.
- You leave with a plan. Many patients have a steroid injection at that first visit. Gel injections are scheduled once authorization is confirmed.
- Follow-up tracks how long each step holds. We record your pain and function so the next decision is based on your results, not guesswork.
Avoiding or delaying knee replacement
A knee replacement is a good operation for the right patient at the right time, and if you need one, we will say so. But many people are told they need surgery before trying the steps above, and others cannot have surgery because of age, weight, heart disease or the need to keep working. For those patients, gel injections, nerve blocks and medication can keep a knee functional for years. Results vary, and the doctor will be honest about what your X-ray suggests.
My knee is "bone on bone". Can injections still help?
Often, yes. Gel injections and genicular nerve blocks are both used for advanced arthritis, and many patients with severe changes on X-ray still get months of relief. The doctor will tell you after examining you whether your knee is a reasonable candidate.
How often can I have knee gel injections?
A series can be repeated no sooner than six months after the previous one, which is the interval Medicare and in-network plans require. Many patients have a series twice a year.
Are knee gel injections covered by Medicare?
Yes, for knee osteoarthritis confirmed on X-ray, when other treatments such as anti-inflammatories or a steroid injection have been tried and the visit notes document it. We take care of the paperwork and prior authorization.
Do you do radiofrequency ablation for the knee?
Not in our offices. If a genicular nerve block gives you strong but short-lived relief, the doctor will discuss whether a longer-lasting procedure is worth pursuing and coordinate a referral.
Which clinic should I go to for knee pain?
Both clinics offer consultations, X-rays, steroid and gel injections, PRP and nerve blocks. Davie serves Broward County and Boynton Beach serves Palm Beach County. StemWave shockwave therapy is available at Davie only.