Sunday, April 1, 2012

Knee pain

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Knee Pain

Well-functioning knees are vital to everyone because they carry a person’s weight while walking and running. They absorb the shock from jumping. Increased pressure is placed on the knees when kneeling, getting up from a sitting position, and walking up and down stairs. Severe knee problems may restrict a person’s life and functioning significantly.

There are two joints in the knee. One is between the femur or the thigh bone and the tibia or the shinbone, and one between the femur and the patella or the knee cap. The femur and tibia form a hinge joint protected in front by the kneecap. There are cushions in the form of cartilage that covers the surfaces of the bones in the joints. The lateral and medial menisci are C-shaped cartilage discs which act like shock absorbers in the knee.

Ligaments help to stabilize the knee. The median collateral ligament is on the inner side and the lateral on the outer side of the knee joint. They limit the movements sideways. The so called cruciate ligaments support the knee stable in forwards-backwards motion and rotation between the bones of the knee joint. There is the anterior cruciate ligament, or ACL and the posterior cruciate ligament, or PCL.

The quadriceps femoris is a large muscle group on the front of the thigh acting as powerful extensor of the knee joint. It is attached to patella which provides mechanical leverage to its function. There are also groups of muscles acting as knee flexors, adductors drawing the knee inward and abductors drawing the knee outward.

Those still growing may experience disorders of the growth plate as well as ossification disorders, which may cause pain during stronger exertion. X-rays or MRI will confirm the diagnosis. Treatment usually consists of reducing exertion levels. The symptoms typically disappear within a few years. With aging, problems of the knees are met more.


Overuse Pains

When stress on the legs is rapidly increased, it may cause temporary irritation in the muscles and joints. In the acute phase, cold compresses are useful. Prolonged pain may require the use of physical therapy, pain medication, and injections. Cortisone injections will usually work quickly when the structure that causes the problem is located.

Injuries

Knee problems in young people are often associated with sports where the knees are stressed and injury-prone. These include football, downhill skiing, soccer, and racquetball.

The kneecap may be dislocated when the leg gets twisted. In this case, there is sharp pain in the knee and the kneecap twists into an abnormal position. Often the kneecap returns in place by itself. Sometimes a doctor needs to set it.

A visit to a doctor’s office, however, is necessary in any case. Surgery may be an option for preventing future problems. If the kneecap gets dislocated several times, the situation needs to be looked at, and rehabilitation or surgery should be considered.

A fracture can break any bones around the knee in an accident with a blow, a fall or a sudden stumbling. Usually there is significant pain and the injured one is not able to bear weight on the knee. A suspicion of a fracture needs to be checked by a doctor.


Meniscus Tears

The meniscus may quite easily tear in connection with knee injuries. The medial meniscus is injured more often than the lateral one. The usual mechanism is a rotation of the load bearing knee. This may occur for example when squatting and twisting the knee at the same time. Tearing while extending and twisting does not happen so often. Direct trauma on the knee can be the cause of a meniscus tear.

There might be heard a sound when a meniscus tears. Often walking or playing is still possible. In some days, the symptoms may become clearer little by little. The typical symptoms are pain, a limited range of motion, stiffness and swelling.

Sometimes rest improves the situation fairly quickly, but there may be additional symptoms following, such as a feeling of the knee locking, rattling, swelling, and pain during exertion.

During examination, pain is found in the joint line and when twisting the knee into positions where the torn area is being pinched. Endoscopy and MRI are established methods of diagnosis. Also the contrast medium method is used for this purpose but not often. The advantage of endoscopy is that it allows for simultaneous treatment of most of the injuries.


Ligament Injuries

With similar forces also other ligaments of the knee may get injured with or without the menisci. This may occur for instance when extending a knee too far, landing on a flexed knee, stopping or shifting weight suddenly. Symptoms resemble those of meniscus injuries. Additionally instability of the knee joint may begin with a feeling of looseness in the joint.

When anterior or posterior cruciate ligaments tears, suffers the forwards-backwards and rotational stability between the bones of the knee joint. The cruciatum anterior ligament may get injured in connection with meniscus injuries. If this happens, especially during intense effort there may be rattling or a sense of unsteadiness.

With collateral ligament injuries there may be avulsion from the bony attachment of the ligament. If this is significant the knee may become unstable sideways and additional movement is noted. If not, there is only pain in the location of the injured ligament or its connection to the bone.

Treatment usually consists of the same kind of pain treatment as with the meniscus injuries and of improving muscle strength in the thighs and limiting the stress with the knee to the tolerance level. Surgery is used primarily with athletes.


Patellofemoral Pain Syndrome and Chondromalacia

Patellofemoral pain syndrome or pain from the contact of the back of the kneecap with the thigh bone is a familiar problem especially with sportsmen. The reason may be a partial dislocation or prolonged, repetitive strain of this joint. This can make the cartilages thin and soft and cause a condition called chondromalacia. Also fractures, functional disorders, arthritis of the bearing knee joint and tumors in the knee area may assist in developing this disorder.

Symptoms initially include pain when descending stairs or when bending down at the knees. Usually the knee starts aching when sitting still for longer periods of time when the knee cannot be straightened.

Examination shows tenderness and a cracking sound when pressing the kneecap down toward the knee joint and when moving it. Treatment includes strengthening of the muscles especially the quadriceps on the front of the thigh and anti-inflammatory drugs. Taping or bracing may be useful together with physiotherapy. Surgery may be considered in most difficult cases. Working in an appropriate occupation and job are essential as well as modifying hobbies and sports regime to the proper sorts and level.


Arthritis

The main source for knee problems in older people is arthritis. It usually is seen in middle-aged and older people. There are two types of arthritis of the knee. The most common is osteoarthritis, slowly progressive wear-and-tear arthritis or degenerative joint disease. With it, the cartilage of the joint is wearing away with age. After this, a bone exposes in the joint, and it becomes painful and stiff. Degenerative arthritis may develop after a fracture, ligament injury, or meniscus tears. It can take years after the injury to be born. Hereditary causes and overweight may also play a role in the formation.

The second type is inflammatory arthritis. It can be caused by rheumatoid arthritis or other systematic diseases and is usually found in both knees. In these cases, there is usually also pain in other joints and other symptoms as well. Usually inflammatory arthritis demands specific drug treatment depending on the disease causing it.

The first indication of arthritis is usually gradual development of pain connected to exertion like walking or climbing stairs or to staying in the same position for a long time. The symptoms may include stiffness, a cracking sound and mild swelling during the most difficult phases. Pain and swelling may be worse in the morning. Later there may be a feeling of locking and weakness. In severe cases, the knee may become overly mobile and incorrectly positioned.

X-rays or MRIs can confirm arthritis. However, even mild degenerative condition may cause symptoms; on the other hand, a joint that shows degeneration in the x-ray or MRI may produce few symptoms. The knee problems should not allow limit one's life unnecessarily. In most severe cases, it pays to have the problem checked thoroughly once. Different types of aid are available.

There is, unfortunately, no total cure for arthritis. Self-treatment includes OTC anti-inflammatory medicine in short courses as well as rubbing anti-pain ointments in the painful area. Cold compresses several times a day can be effective. Anti-inflammatory medicines ease the pain. Cold or heat treatment and electric therapy may also relieve the pain.

Glucosamine is a substance found in the cartilage, and it may reduce the arthritis pain in the early stages. Corticosteroids provide a strong anti-inflammatory effect. They may be used injected into the joint in moderate and severe pain.

Lifestyle should be optimized taking into an account the condition. Losing weight is beneficial for the joint and sometimes can reduce pain and make functioning significantly better. Vigorous stress on the knee should be avoided. Hobbies demanding running and jumping should be changed to less strenuous activities.

Using devices reducing burden on the knee can be useful. A cane, energy-absorbing shoes, or insoles may be used for this purpose. Braces also can be effective in decreasing pain and improving the ability to walk. Different knee supports are available. Soft supports are slightly warming and remind that one should be careful with the knee. Sturdier supports are available, but they need to reach over the knee into the thigh and toward the calf and should be tailor-made.

If no other treatments work, surgery may be an option. The results from artificial joint surgery are good. Rehabilitation of the knee after the operation is necessary.

Exercising the muscles around the degenerated knee is vital. Improving muscle strength is necessary and, despite the pain, the knees should be used in a moderate fashion. Exercises under the guidance of a physiotherapist or a personal trainer may be optimal for improving muscle strength. Massage may be helpful when the muscles around the knee are tender.

In the case of arthritis, it is indispensable to use all means to lower knee strain level during the worst pain episode. One can get higher chairs for the home, so it is easier to get up. It is possible even to raise the toilet seat higher. When ascending stairs, it is best to put the good leg forward and when descending, put the bad leg forward.

In case of knee problems, it is essential to strengthen the quadriceps. In the worst pain phase, it can be done contracting the quadriceps while holding the leg still and the knee straight. Contractions can initially last for 10 seconds and may be done as many times as wanted to per day.

From the beginning, one may lift the leg up while holding the knee quite straight while lying on your back. It can be tried with one set of lifting to see how many can be done, and then continue with daily sets of two thirds of the maximum number of lifts. If this seems to take too much time, one can add 2-4 lb. leg weights so that there is time for other things to do as well.

While lying down, legs can be lift up in different directions to exercise all the leg muscles. When lying on the side one can hold the leg straight and lift it up or lie on the stomach and lift the leg upwards. Leg weights may be used with these exercises also.

When the knee is better, one can consider adding knee-straightening exercises without extra weights at first, and then with weights. This will work if one holds the leg up under the thigh so that the foot does not touch the ground.

When this gets easier and does not make the knee hurt, one can continue to exercise the leg muscles at the gym to make them stronger than ever before. The condition of the thigh muscles is not as critical in someone who has no knee problems, but those who do have them should keep the leg muscles in an excellent shape.


Baker’s Cyst

Bulges consisting of a fluid-filled cyst that create a feeling of pressure or pain can often be found at the back of the knee after or without an injury. They are usually associated with the knee joint. If such a cyst bursts between the calf muscles, it may cause severe pain that is hard to distinguish from thrombosis.

The clinical picture gives a decent idea of the diagnosis and an ultrasound or MRI can be used to verify it. The bulge may be drained simultaneously, and a cortisone injection can be administered. If this does not solve the condition, surgery is an option. Possible ongoing causes such as meniscus injury should be ruled out, because they may prevent eliminating the problem.

Loose Fragments

There are some loose fragments in the knee that may cause pain and locking symptoms in the knee. If the lock releases, upon examination the knee may be almost asymptomatic. X-ray, MRI, or endoscopy may confirm the diagnosis. The loose particle can also be removed during the endoscopy.


Inflammation

Bacteria may cause a suppurating inflammation in the knee. This may occur due to a knee injury, a shot, or via blood circulation.

Symptoms are swelling in the knee, pain and burning. Examination shows swelling and possible redness of the knee. Laboratory tests show increased inflammation levels, and the synovial fluid is opaque and harbors bacteria.

Intravenous antibiotics may be necessary for treating this condition, and this is usually done in a hospital. The knee may need to be drained continuously and needs rest. Once the infection heals, knee exercises can be started.

Emergencies

Knee injury after which walking is extremely painful.
Dislocation of the knee.
Severe swelling in the knee accompanied with fever.
Knee remains in a locked position.

See a Doctor

Prolonged knee pain in children.
Knee injuries that generate more severe symptoms.
Knee pain accompanied by fever.
Repeated pain and swelling.
Repeated pain and locking of the knee.
Bothersome pain that is not alleviated with self-treatment.

Knee pain, more information:


Knee exercise videos Tv-gym.com.
American Academy of Orthopedic Surgeons on growth plate fractures.
webMD about runners knee.
webMD about how to avoid damaging your knees.
McKinley Health Center overuse knee injuries.
American Academy of Orthopedic Surgeons on arthritis of the knee.
Familydoctor.org article about pain.
Patient.co.uk about patellofemoral softening of the kneecap cartilage.
Ehealthmd.com article what's wrong with your knee.
Ehealthmd.com article about anterior cruciate ligament injuries.
Mayoclinic.com pages on Baker's cyst.
American Academy of Orthopedic Surgeons on Osgood-Schlatter disease.
Intelihealth.com article about infectious arthritis.
Medicinenet.com pages about knee bursitis.
Emedicine article about knee dislocation.
webMD about knee dislocation.
Mdguidelines.com article about loose bodies.
HealthDesk.com about knee arthroscopy.
Wikipedia page on knee arthroscopy.
About.com on knee replacement surgery.
Ezinearticles.com about knee pain exercises for women.

NEW!

You can make the most of your doctor's appointment if you are well prepared. It may be helpful to bring along a list of your symptoms and complaints. We made forms for neck, shoulder, low back and knee pain you can fill in advance, send to your email and print as a reminder, or forward to your doctor if she/he accepts email.

This may help you to remember better all the relevant information. Your doctor may get a clearer picture and have more time to examine and to think about your problems. The security of the form is on the level of an email, so please do not send any sensitive information. We do not use, store or give this information to anyone or use your email address for any other purposes. It is used only to send the form to you. You may also print an empty form and fill it by hand.

The service does not cost anything. It is in the testing phase. If it is a useful, we will create similar forms for other areas of pain. Tell us what you think. What is missing, or there is too much of something? Can this be beneficial?

The form or any other material on this site is not intended to substitute professional medical advice, diagnosis, or treatment. You should never disregard professional medical advice or delay in seeking it because of something you have read on this site.

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6 comments:

  1. Is is at all possible for a doctor to damage your knee further by twisting and turning it after surgery. I had surgery over a year ago and still limp and in pain every day. I don't trust anymore doctors. I had a tear repaired from a fall which after surgery I was almost healed then one visit to the doctor and he twisted it and I have been limping ever since! Whom can I get an honest answer could he of hurt me worse?

    ReplyDelete
  2. Sorry to hear it.

    These things may happen also during doctor´s examination. If it was a meniscal tear operated, maybe some new part of the meniscus has now suffered. I understand your distrust. However, if your doctor did not use extreme force, this probably might have happened anywhere if the knee had been twisted for instance in some sporting activity. The torn meniscus is not healthy and may quite easily tear again even with minor stress. I understand that this does not make your life any easier.

    Usually new meniscal tears can be easily operated and results are usually good if this would be the case.

    ReplyDelete
  3. Yes it is true that severe knee injuries can create problems in a person’s life and the treatment for it is physiotherapy exercise that can help in movement and better range of mobility to the injured muscles. Most of the knee injuries are the result of result of sports injuries, work or slips and falls. I have seen many people who suffer from knee pain after surgery and if they take physiotherapy exercise then they can get relief from the pain. Nowadays laser therapy is recommended for treatment of knee injury as it is painless treatment and it speeds the recovery rate by up to four times.
    http://www.dynamicphysiotherapy.ie/

    ReplyDelete
  4. Yes, laser therapy has supporters. Scientific evidence of efficacy is however still fairly thin.

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  6. Anterior Cruciate Ligament surgery(ACL) is a common type of knee injury in athletes. Its symptoms are joints that easily move beyond the normal range expected for a particular joint. For immediate solution
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