Knee Pain

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Young woman holding her knee and experiencing knee pain

Knee joint pain is unfortunately a fact of life for many of us at some point in our lives. It affects between 25% and 37% of adults over 50 years of age. This is according to a 2007 paper by Bedson, Mottram, Thomas & Peat. It is also the most common complaint among older adults seen by general or family practitioners of medicine.

Part of the reason it is so prevalent is because the knee plays pivotal roles in so many everyday activities. It is also (like our ankles) responsible for bearing weight.

Knee pain can take many forms and be accompanied by different symptoms depending on the underlying cause. The good news is that many of the common causes of knee pain are treatable conservatively, and surgery is not needed.

However, a small proportion of knee pain cases is due to serious long term medical conditions. These may require urgent medical attention from your health care advisors. Some of them may also require surgery.

We will first describe the general approach your doctor may use to diagnose  the cause of your knee pain.

We will then summarize the most common underlying causes of this pain. We will also briefly describe the most common treatments for each of them.

Diagnosing Knee Pain

Your doctor will probably start with a thorough review of your medical history. Of particular interest in this review will probably be any knee injuries you may have previously suffered.

Your doctor may also ask how the pain started, i.e. what you were doing when it started.

The doctor will also perform a physical examination of your painful knee. This will include palpating the knee to understand the precise location of the pain. This will also help the doctor to determine whether there is any swelling or inflammation along with the knee pain.

You may also be asked to explain whether the pain gets worse at specific times. For example, does it worsen at night or when you are performing certain activities?

Finally, your doctor may request an imaging scan of your knee. This will help him or her to get a better idea of any internal damage that may be present. The study may be an X Ray, CT scan or MRI.

Possible Causes Of Your Knee Pain

We will now briefly review some of the more common causes of knee pain. We will also mention the treatments that are usually recommended for each.

Knee Arthritis

There are several types of arthritis that can affect the knee, including osteoarthritis, rheumatoid arthritis, gout, septic arthritis and more. The first two are the most prevalent types and are discussed below.

Knee Osteoarthritis

Knee osteoarthritis is a wear and tear condition that affects the cartilage covering the bones inside the knee joint. In a healthy knee, this cartilage prevents the bones coming into direct contact with each other. This allows you to flex and extend your knee without pain.

Eventually, the cartilage becomes worn and the bones start to rub against each other. At this point, you will experience increasing knee pain and stiffness.

There is no cure for the underlying problem. However, doctors can recommend lifestyle changes and medications to ease the pain and slow the progress of the disease.

For example, your doctor may suggest that you lose weight to reduce the stress on the knees. He or she may also recommend wearing an unloader knee brace. This will help shift the point of contact between the bones to an area with healthier cartilage.

Once the condition reaches an advanced stage, you may be asked to consider knee replacement surgery. Your doctor may also be able to suggest another type of surgery. This would alter the contact between the bones in the joint.

Rheumatoid Arthritis

This type of arthritis is actually an auto immune condition. The body’s immune system attacks the knee joint lining and gradually destroys it. The joint lining is intended to “lubricate” the joint and allow you to move your knee smoothly. So the effect of its destruction is knee pain and stiffness.

To treat this disease, your doctor may recommend immune suppressing drugs to reduce the aggressiveness of your immune system. Unfortunately, these medications may also  leave your body more vulnerable to other types of infection.

Knee Soft Tissue Injuries

There are 4 main soft tissue injuries that can commonly lead to knee pain. These are meniscus tears, knee sprains, knee bursitis and patella tendonitis.

Meniscus Tears

The knee’s menisci are actually pieces of cartilage situated between the thigh bone and the shin bone. They act as “shock absorbers” between the 2 bones and allow them to move frictionlessly and smoothly in the joint.

Sometimes, one or more of these menisci tears (usually as a result of sporting activity). When this happens, the result of torn cartilage is usually knee pain plus a clicking or popping sound in the joint. You may also have difficulty walking freely.

Knee Sprains

This is a knee ligament injury that tends to be associated with sports activity. Probably the most common type of sprain is the tearing or stretching of the anterior cruciate ligament (acl).

The result of a knee sprain is pain and swelling around the joint. You may also experience a loss of range of motion. If the injury is severe, walking without a limp may be difficult.

Knee Bursitis

The knee joint contains fluid filled sacs that allow the tendons of the joint to glide frictionlessly over adjacent bones. These sacs are known as bursae.

However, due to overuse of the knee, the bursae can become irritated and inflamed. This can lead to knee pain as well as swelling. This is known as knee bursitis.

Patella tendonitis

This is another overuse injury due to irritation of the tendon that connects the kneecap (pattela) to the shinbone below it.

Patella tendonitis tends to mainly affect athletes n sports that require plenty of running and jumping. When it develops, the result is knee pain (below the patella). The pain will likely get worse during sports activity that includes running or jumping.

Treatment Of Knee Soft Tissue Injuries

Most knee soft tissue injuries are treatable at home with rest and icing of the painful knee. Compression with a tensor bandage and elevating the knee above heart level when possible can also be helpful.

A knee brace (hinged for knee sprains or meniscus injuries, or a strap for patella tendonitis) may also be recommended.

Your doctor may also recommend pin reducing medications like Tylenol. If inflammation is present, you may be prescribed an anti inflammatory medication such as Advil.

Knee Fractures

Your knee pain can be a result of a fractured kneecap. This type of injury will generally require more invasive treatment than the soft tissue injuries described above.

Knee Dislocations

Patella dislocations can also give rise to knee pain. The patella (kneecap) may become dislodged from the trochlear groove in which it is designed to sit in a healthy knee. The pain may be accompanied by clicking or popping noise. You will likely hear these as you try to bend the knee. Alternatively, they may occur when you sit or rise from a seated position.

Your doctor may be able to simply push the patella back into the groove. Your knee will then need to be immobilized for a period to allow healing to occur. A patella stabilizer knee brace can help to prevent the injury from recurrence. However,  recurrence of this type of injury is always a possibility for individuals who have experienced it before.

Floating Pieces Of Bone Or Cartilage

Your knee pain can be a result of some previous injury or medical condition. This may have left a piece of bone or cartilage floating around in the joint. As a result, you may experience unusual noises or sensations (in addition to pain) when trying to bend the knee.

This problem will generally require surgery to remove the foreign matter and repair any other internal damage that may have occurred.

Other Causes

Other potential causes of knee pain may be chondromalacia, patellofemoral pain syndrome or other medical conditions.

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