Rapid Orthopedic Care

Knee Pain

Knee pain is very common and can affect people of all ages. In young persons, knee pain is usually the result of an injury, such as a ruptured ligament or torn cartilage. In older persons, knee pain can also be due to osteoarthritis, or other medical conditions such a gout.

Symptoms

The location and severity of knee pain will vary depending upon the cause of the pain. Symptoms associated with the pain may include swelling, fluid accumulation (effusion), redness, warmth, abnormal sensations such as popping or grinding, and loss of range of motion. When the knee joint is injured or inflamed, simple walking or standing can be nearly impossible.

Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries

The most common knee injuries include:

• ACL injury.An ACL injury is a tear of the anterior cruciate ligament (ACL) — one of four ligaments that connect the tibia (shinbone) to the femor (thigh bone). An ACL injuries are very common in sports, and usually happen during a sudden change in direction.
• Fractures of the patella (knee cap) can occur during falls. Persons with weak bones from medical conditions, such as osteoporosis, can develop fractures more easily, such as stepping onto stairs, or getting up from a seated position.
• Injured meniscus. The cartilage between the femur and the tibia is very tough, and allows the joint to handle the body’s weight without extra stress on the cartilage lining the joint. Sudden twisting injuries can cause tears in the meniscus. The meniscus can also be “worn out” by osteoarthritis.
• Knee bursitis.Occasionally the lining of connective tissue between the tendons of the knee can become inflamed. This is common in persons who are in a kneeling position for a prolonged period of time.
• Tendinitis causes irritation and inflammation of one or more tendons — the very strong tissue that attaches muscle to bone. This inflammation can happen when repeated flexion/extension of the leg is required in many sports. Repetitive jumping, kicking, and running inclines can cause stress to this tendon and resulting tendinitis.

Mechanical problems

Some examples of mechanical problems that can cause knee pain include:

• Loose body.Occasionally bone spurs or fragments of cartilage detach from their origins and “float around” in the knee joint. This can cause symptoms of pain or a sensation of locking in the joint.
• Iliotibial band syndrome.The iliotibial band is the strong connective tissue that extends from the greater trochanter (the outside of the hip) to the lateral knee joint (outside of the knee). The iliotibial band can become very tense following prolonged stress, and create inflammation and pain the outside of the leg & knee. Certain sports, especially long-distance running and cycling, are to iliotibial band syndrome.
• Patellar Conditions: The kneecap (patella) can come out of place and cause severe pain and deformity of the knee. This is called patellar dislocation. “Patellofemoral syndrome” is a condition associated with chronic pain and inflammation in the knee cap/tendon complex in the front of the knee joint. The joint space between the knee cap and the femor (thigh bone) becomes inflamed due to abnormal “tracking” of the knee cap in front of the knee joint. It can be hereditary, or due to specific activities. Patellofemoral pain can be a result of arthritis of this part of the knee.

Types of arthritis affecting the Knee Joint

• This is the most common type of arthritis. Osteoarthritis increases with age, and slowly progresses over time. In many individuals, osteoarthritis develops in a knee that has been previously injured. This may occur even years after the injury.
• Other forms of arthritis include rheumatoid arthritis, psoriatic arthritis, gout, pseudogout, septic arthritis, and arthritis/arthropathy associated with chronic medical conditions (such as diabetes and kidney disease).

Risk factors

The risk of having knee problems increases with:

• Body weight.Being heavy, or obese increases the stress on the knee joints. It is believed that obesity increases the risk of cartilage degeneration by the excessive weight load to cartilage, and the inflammation caused by excessive body fat.
• The lack of adequate leg muscle strength and flexibility can increase the risk of knee injuries, and wear and tear on cartilgae. Muscle strength provides joint protection, and exercise helps to strengthen ligaments and tendons. Flexibility allows for an improved range of motion.
• Certain sports and occupations place a greater burden on the knees than others. High-impact activities and sports are going to place higher demands on the knees, as well as jobs with higher levels of heavy physical activity.
• Prior injury or surgery.Having a previous knee injury with or without the need for surgery can place the knee at an elevated risk for re-injury.

Prevention

Prevention is the key component in reducing the burden of disability associated with many musculoskeletal conditions, including knee pain. It is believed that the following elements of prevention can eliminate or reduce the incidence, or burden of knee pain:

• Weight management. The maintenance of an ideal body weight is one of the most important elements of knee pain prevention.
• Those participating in sports or jobs associated with stress on the knees should participate in these activities in association with a program of strengthening, stretching, and conditioning. These are the essential elements to sports and work injury prevention. A good fitness coach, trainer, physical therapist, or job trainer can assist with developing techniques that reduce joint stress and the risk for injury.
• Flexibility in Activities.Persons with knee pain may need to modify their routines to reduce stress on the knees. Modifications due not necessary mean the elimination of work or exercise. For example, limiting higher impact exercise, or climbing associated with work may be very beneficial.

When should I go to ROC for knee pain?

• Any increase in the usual amount of knee pain experienced can be evaluated at ROC.
• Loss of stability or ability to bear weight on the affected leg
• New or unusual swelling in the knee
• Pain with limited ability to extend or flex the knee

When should I go to the Emergency Room for knee pain?

• If there is an injury with an obvious deformity
• A broken bone than is protruding through the skin
• Chills, fever, in addition to redness, pain and swelling in your knee
• Have severe knee pain following a that is associated with a knee injury while on anticoagulant medication (possible bleeding in the knee joint)