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.
 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 (fibula) 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 fluid-filled sacs, help the knee move

smoothly.

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 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.

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 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 specific
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

• difficulty 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

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 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
first, second, or third degree based upon how much damage has occurred. Grade-one
sprains stretch the ligament but don't tear the fibers; grade-two sprains partially tear
the fibers, 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 inflammation 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 inflamed tendons are poor
prepara- tion for exercise and medical conditions such as arthritis.

BURSITIS
Inflamed bursae may cause knee pain in some people. Bursae are small pockets of fluid 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 significant 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’ fluids. Often confused with gout (another condition formed from fluid crystals), pseudogout may be misdiagnosed in some
people. It produces painful episodes of swelling and inflammation 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 float 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 inflammation 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 flat feet — can make you more prone to knee problems.

• Lack of muscle flexibility or strength. A lack of strength and flexibility 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 first 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 specific 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 fluid 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 fiber-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 artificial joint made of metal
alloys, high-grade plastics and polymers.

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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 inflammation. 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 fluid 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 benefit 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 flexibility 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.

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