Knee Pain: Symptoms, Causes and treatment
Knee pain is a common complaint that can occur in people of all ages. Knee pain can be the result of an injury, such as a torn ligament or cartilage injury, osteoarthritis, or inflammatory joint disease.
Other diseases (such as infections) can also cause knee pain. Often, minor pain responds well to reduced physical exertion on the joint. Physiotherapy techniques and the use of knee braces can also relieve knee pain. However, in most cases, it is necessary to consult a rheumatologist, and in some cases, surgical treatment may be required.
Knee Pain Symptoms
The intensity of pain in the knee depends on the degree of joint damage due to a degenerative or inflammatory process.
Signs and symptoms that may accompany knee pain:
- Swelling and stiffness.
- Redness of the joint and increase in skin temperature above it.
- Weakness or instability of the joint, weakening of the muscles surrounding the joint.
- Crunch when moving.
- Inability to fully straighten the knee.
Severe pain in the knee, swelling, the inability to completely bend or bend the knee, the visible deformity of the limb, the presence of concomitant fever is a reason to go to a rheumatologist.
Causes of Knee Pain
Damage to the knee can affect any ligaments, tendons, or fluid-filled sacs (bursa) that surround the knee joint, as well as bones, cartilage, and ligaments that form the joint itself. Some of the most common knee injuries include: anterior cruciate ligament integrity problems; ACL injury is anterior cruciate ligament rupture (ACL) – one of the four ligaments that connect the joint to the femur, the ACL injury is especially common among people who play basketball, football or other sports that require drastic changes in the direction of motion; fractures of the bones of the lower limbs, including the patella due to collisions or falls; meniscus gap. The meniscus is formed from hard, rubbery cartilage and acts as a shock absorber between the lower leg and the femur,
Knee pain often occurs due to inflammation in the bursa, small sacs of fluid that surround the outside of the knee joint, so that the tendons and ligaments slide smoothly over its surface.
Tendonitis is an inflammation of one or more tendons — thick, fibrous tissues that attach muscles to bones. Runners, skiers, cyclists and those who participate in sporting events, jumping, tend to develop inflammation in the patellar tendons, which connects the quadriceps muscle along the front of the thigh with the bones of the lower leg.
Trauma or degeneration of the bone or cartilage can lead to the separation of a fragment of bone or cartilage and the formation of a “joint mouse” in the joint.
This syndrome occurs when the fascia lata, extending across the outside of the lower limb from the upper thigh to the knee (iliotibial band), becomes so tight that it rubs against the outside of the thigh and causes pain. Long-distance runners are particularly susceptible to the development of the or tibi syndrome.
Patellofemoral pain syndrome is a general term that is characterized by pain arising between the patella and the underlying femur. This is a common occurrence in athletes; and in older people, as a result of knee arthritis.
Pain in the thigh or foot
If a person has pain in the hip joint or foot, the gait can often change. This occurs compensatory, for unloading painful joints. But this altered gait can increase pressure on the knee joint. In some cases, problems with the hip joint or the foot may damage the knee joint.
Different types of arthritis. There are more than 100 different types of arthritis and each of them can lead to pain in the knee.
Types of arthritis that most often damage the knee:
- Osteoarthritis. The most common type of arthritis. This is a condition of cartilage wear and tear that occurs when the thickness of the cartilage decreases with age.
- Rheumatoid arthritis. It is an autoimmune disease that can affect virtually any joint in the body, including the knees.
- Gout. This type of arthritis occurs when uric acid crystals accumulate in the joint due to its high concentration in the blood. Gout often affects the joints of the big toe, but arthritis can also develop in other joints, including the knee.
- Pseudogout Often has mistaken for gout, pseudogout is caused by the deposition of calcium in the form of crystals. The knees are more likely than other joints to be subject to pseudogout.
- Septic arthritis. It leads to swelling, pain, and redness of the knee joint as a result of its infection with a microorganism. Septic arthritis is often accompanied by fever.
Knee pain risk factors
- Excess weight. Being overweight or obese increases the pressure on the knee joints, even in normal daily activities, such as walking or going up and down the stairs. Excess weight increases the risk of osteoarthritis, accelerating the degradation of articular cartilage.
- Decreased strength in the thigh muscles. Weak muscles provide less support for your knee joint during physical activity, which leads to its instability.
- Certain sports. Some sports cause more damage to the knee joints than others. Skiing with hard ski boots, jumping during basketball, and running also increase the risk of knee injury.
- Previous damage. Having a previous knee injury increases the likelihood that the injury will occur again.
Knee pain complications
Complications on the background of pain in the knee joint depend on the cause of its occurrence. Not all conditions lead to serious complications. However, some injuries and injuries, as well as chronic diseases of the joints (such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis ) can lead to serious damage to the joint and its contractures.
Knee pain diagnostics
During the physical examination, the rheumatologist will examine the knee joints for swelling, pain, sensitivity, localized fever and discoloration of the skin above them; will check the range of motion in them.
Instrumental research methods
Radiography of the knee joints. A rheumatologist may recommend an X-ray examination that can detect a change in the configuration of the bones that make up the joint, due to degenerative or inflammatory changes in them.
Computed tomography (CT). CT is a more accurate method, which allows you to see the bones and soft tissues surrounding the joint in different sections and diagnose problems with the bones and ligaments.
Ultrasound of the joints helps to determine the presence of:
- excess fluid in the joint cavity,
- tendon inflammation, bursa (bursitis),
- inflammation in the area of attachment of the tendons to the bones (enthesitis),
- changes in the configuration of the bones constituting the joint,
- changes in cartilage thickness.
Ultrasound control is also used for local therapy: diagnostic puncture of the joint, followed by fluid evacuation, intra-articular injection of glucocorticoids, hyaluronic acid.
Magnetic resonance imaging (MRI). MRI allows you to create a three-dimensional image of the joint. This method is especially useful for detecting damage to soft tissues, ligaments, tendons, cartilage, and muscles.
Laboratory research methods
To identify the causes of knee pain, a rheumatologist will prescribe blood and urine tests, if necessary, analysis of synovial fluid removed from the knee joint.
Knee pain treatment
Treatment will depend on the diagnosis.
Non-steroidal anti-inflammatory drugs — such as acetaminophen, ibuprofen, naproxen, diclofenac, and many others — can help relieve pain and reduce inflammation in the knee for various joint diseases. They are also effective in the form of ointments and gels when applied to the skin of the joint.
In osteoarthritis, glucosamine or chondroitin may be recommended. The effectiveness of these drugs is rather ambiguous regarding the relief of pain in osteoarthritis. However, they are recommended by the European Antirheumatic League, so in many countries, including Ukraine, they are prescribed for osteoarthritis.
In rheumatoid arthritis, the rheumatologist will prescribe systemic drugs (methotrexate, leflunomide, etc.).
Strengthening the muscles around the knee will make it more stable. For this purpose, it is possible to use various simulators, swimming, carrying out manual massage, electrical stimulation of muscles. Training should be focused on the muscles of the front of the thigh.
In some cases, a rheumatologist may suggest injectable treatments.
Examples of such treatment include:
- Glucocorticoids. Injection of the prolonged glucocorticoid drug into the knee joint in the presence of an inflammatory
- process in the joint can reduce the symptoms of inflammation.
- Hyaluronic acid (a gel-like fluid similar to that naturally present in the joints) can be introduced intra-articularly into the
- knee joint to improve mobility and relieve pain. Relief can last up to 6-12 months.
- Platelet-rich plasma (PRP). PRP contains a concentration of many different growth factors that appear to reduce
- inflammation and promote healing. These types of injections tend to work better in young people with sports injuries.
- Acupuncture. Studies show that acupuncture can help relieve knee pain caused by osteoarthritis.
In case of joint injury, surgical intervention may be required. Options for surgery may include:
- Arthroscopic surgery. Depending on the injury, the doctor can examine and repair the damage to the joint using an optical camera and special tools inserted through several small incisions around the knee. Arthroscopy can be used to remove fragments of a damaged meniscus, correct damaged cartilage and reconstruct ligament ruptures.
- Partial replacement of the knee joint. In this procedure (one-component arthroplasty), the surgeon replaces only the most damaged part of the knee joint with metal and plastic parts. Surgery can usually be performed with small incisions, so the postoperative rehabilitation period is shorter than after total endoprosthesis.
- Total knee replacement (total knee arthroplasty). In this procedure, the surgeon removes the damaged bone and cartilage of the femur, lower leg, and patella, and replaces it with an artificial compound made of metal alloys, high-quality plastics, and polymers.
Help at home
- Relaxation. Take a break from your usual activities to reduce repetitive pressure on the knee. May need a day or two rest. When transferred large loads on the joints, leading to pain in them, it will take a longer period of time to recover.
- Ice. Cold reduces both pain and inflammation. A bag of frozen vegetables is well suited for these purposes. You can also use a packet of ice wrapped in a thin towel to protect your skin. Although this therapy is generally safe and effective, do not use ice for more than 20 minutes at once due to the risk of damage to the nerves and skin.
- Fixation. This helps prevent fluid accumulation in damaged tissues and maintain knee stability. Choose a compression bandage that is light, breathable and self-adhesive at the same time. It should be tight enough to support the knee, while not interfering with blood circulation.
- Raised position. To reduce swelling, try using a special raised position (use a pillow at night, for example).
Knee pain prevention
Although it is not always possible to prevent knee pain, the following recommendations will help prevent injuries and joint deterioration:
- Keep the weight in the normal range. Maintain a healthy weight – this will reduce the load on the knee joints and relieve pain. Each additional kilogram puts additional strain on the joints, increasing the risk of injury and osteoarthritis.
- Be fit to play sports. It takes time to prepare your muscles for the requirements of a particular sport. Work with a trainer so that the technique and movement are correct.
- Practice. Make sure that the techniques and movement patterns that you use in your sports or activities are the best in your case. Professional lessons can be very helpful.
- Stay strong, stay flexible. Because weak muscles are one of the main causes of knee injuries, you will need strong quadriceps and hamstrings that support your knees. Training in balance and stability helps the muscles around the knees work together more efficiently. Try incorporating flexibility exercises into your workouts.
- Be careful while training. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you workout. Consider switching to swimming, water aerobics, or other sports with low knee pressure. Sometimes a simple limitation of physical activity will help to improve the situation for the better.