Knee pain

1
KNEE PAIN
Knee pain is a common complaint that affects
people of all ages. Knee pain may be the result
of an injury, such as a ruptured ligament or torn
cartilage. Medical conditions including
arthritis, gout and infections also can cause
knee pain. Many types of minor knee pain respond
well to self-care measures. Physical therapy and
knee braces also can help relieve knee pain. In
some cases, however, your knee may require
surgical repair.
2
ANATOMY

• The knee is one of the largest and most complex
  joints in the body. The knee joins the thigh bone
  (femur) to the shin bone (tibia). The
• smaller bone that runs alongside the tibia
  (?bula) and the kneecap (patella) are the other
  bones that make the knee joint.
• Tendons connect the knee bones to the leg muscles
  that move the knee joint. Ligaments join the knee
  bones and provide stability to the knee

• The anterior cruciate ligament prevents the femur
  from sliding backward on the tibia (or the tibia
  sliding forward on the femur).
• The posterior cruciate ligament prevents the
  femur from sliding forward on the tibia (or the
  tibia from sliding backward on the femur).
• The medial and lateral collateral ligaments
  prevent the femur from sliding side to side.
• Two C-shaped pieces of cartilage called the
  medial and lateral menisci act as shock absorbers
  between the femur and tibia.
• Numerous bursae, or ?uid-?lled sacs, help the
  knee move
• smoothly.

3
PREVALATION
Older adults with bone or joint conditions may
experience pain in the knees. Women who are over
65 years old may be at a higher risk than those
who are younger. Young adults and teenagers may
also experience knee pain if they participate in
sports or activities that require jumping,
running, or similar types of active movements
that produce stressful situations on the
body. Children in their teens or preteens may
experience pain from active play. The pain is
more frequent in children who jump, run, or
participate in activities that require repetitive
movements.
4
SYMPTOMS

• The location of the knee pain can vary depending
  on which structure is involved. With infection,
  the whole knee might be swollen and
• painful, while a torn meniscus or fracture of a
  bone gives symptoms only in one speci?c location.
• The severity of the pain can vary as well from a
  minor ache to a severe and disabling pain.
• Some of the other signs and symptoms that
  accompany knee pain are
• stiffness
• skin feels warm to the touch
• an audible popping, clicking or some other
  abnormal sound when moving the knee(s)
• Serious signs and symptoms
• pain accompanied with noticeable swelling,
  redness, and fever
• inability to stand
• locking of the knee- the inability to bend or
  straighten the knee(s)
• limping
• dif?culty walking due to instability of the knee
  
• falling down while attempting to stand
• feeling numbness in the affected leg (knee)
• visible signs of injury, such as an abnormal
  appearance or malformation

5
CAUSES
A number of issues that affect the proper
functioning of one or both knees may cause pain.
Injury is the most common cause, but other
conditions such as arthritis may lead to joint
deterioration and discomfort KNEE PROBLEMS,
CAUSED BY INJURIES
DAMAGED MENISCI Menisci are thin layers of
cartilage located between the tibia and femur.
Resembling a crescent or disc, this connective
tissue absorbs most of the stress placed on the
lower extremities, but may tear if too much
stress is placed on the knees. Menisci also
stabilize the knees by prevent- ing abnormal
movements that may lead to injury. Tearing of the
menisci may interfere with their proper
functioning.
FRACTURES Direct trauma to the bony structure can
cause one of the bones in the knee to break. This
is usually a very obvious and painful injury.
Most knee fractures are not only painful but will
also interfere with the proper functioning of the
knee (such as kneecap fracture) or make it very
painful to bear weight (such as tibial plateau
fracture). All fractures need immediate medical
attention. DISLOCATION The knee joint can be
dislocated, which is a medical emergency that
requires immediate attention. This injury often
occurs during a motor-vehicle accident when the
knee hits the dashboard.
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Causes Knee problems, caused by injuries
SPRAINS OR STRAINS IN THE LIGAMENT AND MUSCLE
TISSUE These types of injuries often occur when
the knee receives blunt trauma or is twisted in
the wrong direction. Sprains and strains most
often arise during contact sports but may occur
during any abrupt or sudden movement. These
injuries are graded as ?rst, second, or third
degree based upon how much damage has occurred.
Grade-one sprains stretch the ligament but don't
tear the ?bers grade-two sprains partially tear
the ?bers, but the ligament remains intact and
grade-three tears completely disrupt the
ligament.An anterior cruciate ligament injury or
medial collateral ligament injury may cause
bleeding into your knee, which makes the pain
worse.
TENDINITIS Tendinitis is an in?ammation that
produces redness, tenderness to the touch, and
intense pain in the tendons around the knees or
any area of the body that have tendons.
Activities that require repetitive movements may
increase the risk of tendinitis. Other factors
for in?amed tendons are poor prepara- tion for
exercise and medical conditions such as
arthritis. BURSITIS In?amed bursae may cause knee
pain in some people. Bursae are small pockets of
?uid that lubricate the tendons of the hips,
shoulders, and knees in order for them to move
freely along joints. BLEEDING INTO THE JOINT An
injury that causes signi?cant damage to the knee
joint may cause bleeding into the joint spaces,
known as haemarthrosis. This can happen if a
cruciate ligament is torn or if there is a
fracture to one of the bones of the knee.Signs of
haemarthrosis are swelling of the knee, warmth,
stiffness and bruising. You should go to hospital
immediately to have your knee treated if you have
a very swollen knee.
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Causes
KNEE PROBLEMS, CAUSED BY ARTHRITIS OSTEOARTHRITIS
(OA) OA is a common form of arthritis that may
appear in one or more joint bones in the body. It
may affect men, women, and children. Women over
the age of 55 are at the highest risk for OA. The
condition induces pain from the loss of
cartilage, which causes the bones to rub together
and produce intense discomfort. It may also form
from joint malformations present at birth,
injuries caused in active sports, or work
conditions that require repetitive
movements. RHEUMATOID ARTHRITIS The most
debilitating form of arthritis, rheumatoid
arthritis is an autoimmune condition that can
affect almost any joint in your body, including
your knees. Although rheumatoid arthritis is a
chronic disease, it tends to vary in severity and
may even come and go. GOUT This type of arthritis
occurs when uric acid crystals build up in the
joint. While gout most commonly affect the big
toe, it can also occur in the knee.
PSEUDOGOUT Pseudogout, a common type of arthritis
in the knees, develops when calcium pyrophosphate
crystals (a type of salt) form in the knees
?uids. Often confused with gout (another
condition formed from ?uid crystals), pseudogout
may be misdiagnosed in some people. It produces
painful episodes of swelling and in?ammation in
the knees as well as other joints. SEPTIC
ARTHRITIS Sometimes your knee joint can become
infected, leading to swelling, pain and redness.
There's usually no trauma before the onset of
pain. Septic arthritis often occurs with a fever.
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Causes
MECHANICAL PROBLEMS
Some examples of mechanical problems that can
cause knee pain include LOOSE BODY Sometimes
injury or degeneration of bone or cartilage can
cause a piece of bone or cartilage to break off
and ?oat in the joint space. This may not create
any problems unless the loose body interferes
with knee joint movement, in which case the
effect is something like a pencil caught in a
door hinge.
DISLOCATED KNEECAP This occurs when the
triangular bone (patella) that covers the front
of your knee slips out of place, usually to the
outside of your knee. In some cases, the kneecap
may stay displaced and you'll be able to see the
dislocation. HIP OR FOOT PAIN If you have hip or
foot pain, you may change the way you walk to
spare these painful joints. But this altered gait
can place more stress on your knee joint. In some
cases, problems in the hip or foot can refer pain
to the knee.
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Causes
OTHER PROBLEMS
CHONDROMALACIA OF THE PATELLA Chondromalacia is a
general term used to describe the breakdown or
soften- ing of the cartilage found in the body.
Chondromalacia of the patella affects only the
kneecaps. Damaged kneecaps may become misplaced
from constant or persistent use. It often affects
females more than males, but may cause bouts of
pain for anyone who is very active in life.
OSGOOD-SCHLATTER DISEASE Osgood-Schlatter disease
is an in?ammation of the bone, cartilage, and/or
tendon at the top of the shinbone (tibia), where
the tendon from the kneecap (patella) attaches.
It is most often seen in young adolescents. Most
often only one knee is affected.
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RISK FACTORS

• A number of factors can increase your risk of
  having knee problems, including
• Excess weight. Being overweight or obese
  increases stress on your knee joints, even during
  ordinary activities such as walking or going up
  and down stairs. It also puts you at increased
  risk of osteoarthritis by accelerating the
  breakdown of joint cartilage.
• Biomechanical problems. Certain structural
  abnormalities such as having one leg shorter
  than the other, misaligned knees and even ?at
  feet can make you more prone to knee problems.
• Lack of muscle ?exibility or strength. A lack of
  strength and ?exibility are among the leading
  causes of knee injuries. Tight or weak muscles
  offer less support for your knee because they
  don't absorb enough of the stress exerted on the
  joint.
• Certain sports. Some sports put greater stress
  on your knees than do others. Alpine skiing with
  its rigid ski boots and potential for falls,
  basketball's jumps and pivots, and the repeated
  pounding your knees take when you run or jog all
  increase your risk of knee injury.
• Previous injury. Having a previous knee injury
  makes it more likely that you'll injure your knee
  again.

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DIAGNOSTIC

• During the physical exam, your doctor is likely
  to
• Inspect your knee for swelling, pain,
  tenderness, warmth and visible bruising
• Check to see how far you can move your lower leg
  in different directions
• Push on or pull the joint to evaluate the
  integrity of the structures in your knee IMAGING
  TESTS
• In some cases, your doctor might suggest tests
  such as
• X-ray. Your doctor may ?rst recommend having an
  X-ray, which can help detect bone fractures and
  degenerative joint disease.
• Computerized tomography (CT) scan. CT scanners
  combine X-rays taken from many different angles,
  to create cross-sectional images of the inside of
  your body. CT scans can help diagnose bone
  problems and detect loose bodies.
• Ultrasound. This technology uses sound waves to
  produce real-time images of the soft tissue
  structures within and around your knee, and how
  they are working. Your doctor may want to
  maneuver your knee into different positions
  during the ultrasound, to check for speci?c
  problems.

• Magnetic resonance imaging. MRI uses radio waves
  and a powerful magnet to create 3-D images of the
  inside of your knee. This test is particularly
  useful in revealing injuries to soft tissues such
  as ligaments, tendons, cartilage and muscles.
• LAB TESTS
• If your doctor suspects an infection, gout or
  pseudogout, you're likely to have blood tests and
  sometimes arthrocentesis, a procedure in which a
  small amount of ?uid is removed from within your
  knee joint with a needle and sent to a laboratory
  for analysis.

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TREATMENT
SURGERY

• If you have an injury that may require surgery,
  it's usually not necessary to have the operation
  imme- diately. Before making any decision,
  consider the pros and cons of both nonsurgical
  rehabilitation and surgical reconstruction in
  relation to what's most important to you. If you
  choose to have surgery, your options may
  include
• Arthroscopic surgery. Depending on your injury,
  your doctor may be able to examine and repair
  your joint damage using a ?ber-optic camera and
  long, narrow tools inserted through just a few
  small incisions around your knee. Arthroscopy may
  be used to remove loose bodies from your knee
  joint, remove or repair damaged cartilage, and
  reconstruct torn ligaments.
• Partial knee replacement surgery. In this
  procedure (unicompartmental arthroplasty), your
  surgeon replaces only the most damaged portion of
  your knee with parts made of metal and plastic.
  The surgery can usually be performed with a small
  incision, and your hospital stay is typically
  just one night. You're also likely to heal more
  quickly than you are with surgery to replace your
  entire knee.
• Total knee replacement. In this procedure, your
  surgeon cuts away damaged bone and cartilage from
  your thighbone, shinbone and kneecap, and
  replaces it with an arti?cial joint made of metal
  alloys, high-grade plastics and polymers.

13
Treatment
HOME REMEDIES

• Self-care measures for an injured knee include
• Rest. Take a break from your normal activities to
  reduce repetitive strain on your knee, give the
  injury time to heal and help prevent further
  damage. A day or two of rest may be all you need
  for a minor injury. More severe damage is likely
  to need a longer recovery time.
• Ice. Ice reduces both pain and in?ammation. A bag
  of frozen peas works well because it covers your
  whole knee. You can also use an ice pack wrapped
  in a thin towel to protect your skin. Although
  ice therapy is generally safe and effective,
  don't use ice for longer than 20 minutes at a
  time because of the risk of damage to your nerves
  and skin.
• Compression. This helps prevent ?uid buildup in
  damaged tissues and maintains knee alignment and
  stability. Look for a compression bandage that's
  lightweight, breathable and self-adhesive. It
  should be tight enough to support your knee
  without interfering with circulation.
• Elevation. To help reduce swelling, try propping
  your injured leg on pillows or sitting in a
  recliner.

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PREVENTION

• Although it's not always possible to prevent knee
  pain, the following suggestions may help
  forestall injuries and joint deterioration
• Keep extra pounds off. Maintain a healthy weight
  it's one of the best things you can do for your
  knees. Every extra pound puts additional strain
  on your joints, increasing the risk of injuries
  and osteoarthritis.
• Be in shape to play your sport. To prepare your
  muscles for the demands of sports participation,
  take time for conditioning. Work with a coach or
  trainer to ensure that your technique and
  movement are the best they can be.
• Get strong, stay limber. Because weak muscles are
  a leading cause of knee injuries, you'll bene?t
  from building up your quadriceps and hamstrings,
  which support your knees. Balance and stability
  training helps the muscles around your knees work
  together more effectively. And because tight
  muscles also can contribute to injury, stretching
  is important. Try to include ?exibility exercises
  in your workouts.
• Be smart about exercise. If you have
  osteoarthritis, chronic knee pain or recurring
  injuries, you may need to change the way you
  exercise. Consider switching to swimming, water
  aerobics or other low-impact activities at
  least for a few days a week. Sometimes simply
  limiting high-impact activities will provide
  relief.