An Overview on Knee Pain Causes, Diagnosis & Treatment
Everyone is prone to knee pain at any age, whether you are an Olympic champion or a sedentary desk-bound clerk. Knee injuries could be chronically-developed or sustained as a consequence of an event such as soccer or rugby games. Knee pain develops over time, and may be a result of medical conditions like arthritis or gout and/or mechanical problems.
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Signs and Symptoms
Some signs and symptoms that come along with knee pain include:
Bolting or “jamming” of the knee
Unable to extend the knee or flex fully
Redness and swollen skin
Wobbliness or jelly legs, when changing direction
Cracking noises when flexing the knee or squatting
As the degree and location of knee pain can vary, diagnosing the exact cause is important.
Anatomy of the Knee
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The knee is made up of many parts, working together for us to squat, jump, run or hold our weight. It is the largest joint in the human system and is used very often, making it susceptible to damage.
There are three bones in the knee:
The knee cap, or patella, which sits above the tibia and femur
The shin bone, or tibia
The thigh bone, or femur
Menisci, two thick crescent-shaped pads of cartilage that reduce friction and absorb impact, sits between the femur and tibia much like how car bumpers on cars absorb impact. There is a layer of smooth cartilage at the ends of the bones which reduce friction between them. A joint capsule holds the bones together and has an inner layer secreting synovial fluid to lubricate the knee joint similar to having oil in motor gears.
Stabilizing and supporting bones of the knee joint are multiple tendons, muscles and ligaments:
Anterior and posterior cruciate ligament (ACL & PCL) – Preventing the forward and backward movement of the tibia, found in the centre of the knee joint
Patellar ligament – attaches the tibia to patella
Quadriceps tendon – quadriceps (thigh) muscle attached to the patella
Quadriceps muscles – responsible for unbending the knee and found at the thigh’s front
Medial and lateral collateral ligament (MCL & LCL) – in the outer and inner parts of the knee
Hamstring muscles – responsible for flexing the knee and is found at the back of the thigh
What are the common causes of Knee Pain
Fracture – People who have fragile bones due to osteoporosis may sustain a knee fracture by mis-stepping or tripping. Previous falls or trauma from road accidents can cause the bones of the knee to be broken.
Osgood-Schlatter Disease (OSD) – OSD is caused by inflammation of the patella tendon. OSD is most commonly found in preteen or teenage boys experiencing growth spurts, and especially so if they are active sportspersons.
Meniscal injury – Sports can lead to meniscal tears and ligament injuries. The menisci tear when the knee undergoes a twisting motion while it is bent.
Tendon injury – Overuse of tendons and repeated stress can lead to tendon injuries such as rupture or tendinitis (inflammation of the tendon).
Bursitis – People who play sports such as volleyball and plumbers and gardeners, are at high risk of this condition. Prolonged or frequent kneeling may result in an inflammation of the bursae (small fluid-filled sacs that aid in softening pressure points and reducing friction between the bones and ligaments or tendons).
Ligament injury – PCL injury occurs from direct shock to the front of the knee, such as when the knee hits against the dashboard in a car accident. ACL injury may occur as a result of a sudden change in direction or twisting of the knee such as basketball or football.
Abnormal gait – Changes to the walking gait are commonly seen on people with leg-length discrepancies. Consequently, this increased stress to the knee joint leading to pain in the other joints of the lower limb.
Loose body – Sometimes, knee injuries cause small fragments of bone or soft tissue to break off into the joint space, which may then interfere with joint movement and cause pain.
Patella dislocation – An intense pain on movement, this is an injury that results in the kneecap slipping out of place.
Iliotibial band (ITB) syndrome – Long distance running, due to constant repeated stress, can cause the ITB to rub against the outer part of the femur, resulting in sharp, severe knee pain. The ITB is a band of fibrous tissue that stretches from the outer hip to the outer knee.
Arthritis and other diseases
Gout – Caused by excessive buildup of uric acid crystals in the affected joint, this condition causes intense pain and swelling. Over time, joint erosion results from repeated attacks to the same joint.
Osteoarthritis – The most frequently seen condition of arthritis. It is a chronic degenerative condition characterised by wear and tear of the cartilage and menisci. Deformity, stiffness and severe pain is a result from the bones of the knee joint rubbing directly against each other in the late stage of this condition.
Lupus – A protracted autoimmune disease where the body’s immune system mistakenly creates antibodies to attack healthy tissues. besides the knee and other joints, lupus affects many other internal organs within the body.
Rheumatoid arthritis – In this chronic immune disease, the immune system mistakenly attacks the synovium, a thin membrane that lines our joints. This causes joint pain, deformity, damage and debilitation affecting the knees and any joint in the body.
Septic arthritis – This is a condition that requires urgent treatment. This form of arthritis is a result of bacterial spread from the bloodstream into the joint. Patients usually have a high fever, and gruelling pain.
Patellofemoral Pain Syndrome (PFPS). PFPS, also known as runner’s knee, is common in the younger population, especially in persons who engage in sports like running, cycling and hiking. Usually brought about by changes in the individual’s training regimen and/or intensity, the person may feel pain around and behind the patella.
How to Diagnosis Knee Pain
After a detailed consultation and physical examination of the knee, the following tests may be performed to aid in diagnosis:
Computed tomography (CT) scan. This provides three-dimensional views of the knee joint and provides detailed visualisation of the bones and some of the soft tissues.
Magnetic resonance imaging (MRI) scan. This test is particularly useful for soft tissue injuries as it shows in great depth the various ligaments, tendons, cartilage and menisci.
X-ray. A two-dimensional view of the knee joint and is a dependable and affordable way to diagnose many knee conditions.
Blood tests such as full blood count, inflammatory markers, or rheumatoid factor.
Knee joint aspiration. Used when there is a swelling of the knee. Joint aspiration helps to provide some small relief. A sample of joint fluid is obtained and sent for testing of uric acid crystals. If so, it is a diagnosis of gout, or bacteria suggesting an ongoing infection.
What are the Treatments Available for Knee Pain?
Treatments will depend on the diagnosis of the knee pain:
To reduce pain and stabilize the knee joint, one can do strengthening exercises for the quadriceps or hamstring muscles.
To correct alignment issues using exercises, knee braces and foot orthotics.
Prescription of gout or other knee-specific medications.
Topical and oral paracetamol for symptomatic relief
To reduce inflammation and soft tissue degeneration, one can take oral supplements.
Corticosteroid injections can be performed to provide immediate relief in cases of severe knee pain. The effect is short-term and usually lasts about 3 months.
Hyaluronic acid (HA) injections, also known as viscosupplementation, can be administered for more medium-term, 6 to 9 months relief. HA acts as a lubricant for the joint, is a viscous fluid similar to synovial fluid.
Depending on the diagnosis, some procedures like arthroscopic surgery e.g. for ligament reconstruction, knee replacement or knee osteotomy (reshaping of bone) can be performed.
How to Prevent Knee Pain
To continue doing our favourite activities and maintain an active lifestyle as we grow older, healthy knees are very important. Preventive care is required, so here are a few quick tips:
Warm up before doing any vigorous activities or sports.
Slow down, or take a break, if you feel any knee pain or discomfort while doing any activity. Tailor the intensity of the activity to your own physical ability. Everyone has different levels of fitness.
The lighter the better: Slimming down a few kilograms helps to reduce the weight on the knees.
Take your time to train up your body before pushing yourself further. As different sports use different muscle groups, some sports are more strenuous on the knees than others.