Knee pain
Each of us has experienced knee pain at least once in our lives. It’s a very unpleasant feeling when you have difficulty getting up from a chair, cry out from pain in your knee when walking up the stairs, or start limping when walking normally. Ignoring knee pain is dangerous, since many diseases of the knee joint are completely curable only in the early stages
Remember that the health and mobility of your knee depends on timely treatment. Only a specialist can make an accurate diagnosis and prescribe competent treatment. When you have knee pain, the main thing is not to miss a serious illness, which can lead to surgery and disability.
Anatomy of the knee joint. The knee joint has a complex anatomical structure; it bears a very large functional load. Therefore, it is considered the most vulnerable of all joints.
The knee joint is formed by the femur, tibia and patella. The articular surfaces of the bones are covered with a layer of cartilage. Additional cartilage pads between the bones are called menisci, they perform a shock-absorbing function. The knee joint has the largest synovial membrane, which forms large inversions and bursae.
The joint cavity is filled with synovial fluid, which nourishes the articular cartilage. Synovial fluid contains hyaluronic acid, which is necessary for normal gliding of articular surfaces. Normally, the knee joint contains 3-5 ml of synovial fluid. When there is pain in the joint, there is an increased production of inflammatory fluid. The amount of effusion can reach 30-70 and even more than 100 ml. Ligaments, muscles and their tendons direct and limit movement in the joint.
Knee pain can occur when any of the components of the joint (ligaments, tendons, articular cartilage, synovium, menisci, bones, and nearby muscles) are damaged.
Knee pain: causes.
There are a great many diseases that manifest as knee pain. Some are associated with injury, others with cartilage destruction, and others with inflammation or infection. In this article we will not consider traumatic causes of knee pain. Fractures, bruises, hemorrhages into the joint cavity (hemarthrosis), damage to the meniscus, and ligament rupture require treatment by a traumatologist.
Knee pain: symptoms.
The clinical picture largely depends on the disease that caused the knee pain. Knee pain can be aching, dull, sharp, burning and even unbearable. Sometimes the pain in the joint bothers you only when there is excessive load, others only when walking up the stairs, bending or straightening the leg. Sometimes pain occurs even at rest, at night, disrupting sleep. The nature of knee pain, as well as the cause that caused it, can be different.
Which doctor should I consult for knee pain? If the knee has been injured, then consultation with a traumatologist or surgeon is necessary. If there is no history of trauma, you should visit a general practitioner, who will prescribe an examination and, if necessary, refer you for a consultation with a rheumatologist, orthopedist or neurologist.
Which doctor should I consult for knee pain? If the knee has been injured, then consultation with a traumatologist or surgeon is necessary. If there is no history of trauma, you should visit a general practitioner, who will prescribe an examination and, if necessary, refer you for a consultation with a rheumatologist, orthopedist or neurologist.
In what case should you immediately consult a doctor?
- when there is very severe pain in the knee;
- with knee pain for more than 7 days;
- the intensity of knee pain increases over time;
- if you experience pain in the knee after an injury, sore throat, or tick bite;
- with redness, swelling of the knee;
- with morning stiffness in the knee for more than 30 minutes;
- with an increase in body temperature.
- Diseases that cause knee pain.
- Arthrosis of the knee joint. The main symptoms of arthrosis are pain, limited mobility and deformation of the knee joints. Osteoarthritis of the knee joints occurs over a long period of time, with a slow, irreversible increase in symptoms. If pain in the knee occurs sharply, suddenly, for the first time, then this is not arthrosis.
Osteoarthritis of the knee joint begins gradually with minor pain in the knee when overloaded. With rest, the pain goes away quickly. In the second stage, knee pain appears even with normal load. The range of active movements in the knee joint decreases. The shape of the joint changes due to bone deformation and the accumulation of pathological fluid in the joint.
In the third stage, the pain becomes chronic, occurring not only during movement, but also at rest, and disrupting night sleep. Gradually, a deformity typical of arthrosis develops with curvature of the leg and severe functional insufficiency of the knee joint.
Arthritis of the knee joint occurs with rheumatic diseases, psoriasis, gout, and infections. Arthritis affects people of any age. A characteristic feature of arthritis is a rapid onset, severe pain in the knee, swelling, redness, and increased local temperature.
Rheumatoid arthritis and psoriasis are characterized by severe morning stiffness. With sexually transmitted infections (ureaplasmosis, chlamydia), Reiter's syndrome develops. Knee pain is combined with eye damage and urethritis. Knee pain can also accompany intestinal infections (dysentery, salmonellosis).
With Lyme disease, knee pain occurs 4 to 12 months after the tick bite. The joint variant is characterized by the formation of chronic arthritis, which is quite resistant to treatment.
A gout attack usually develops after drinking alcohol and overeating. Suddenly at night very sharp pain appears in the knee joint. The joint quickly swells, the skin over it turns purple and becomes hot. Body temperature often rises to 38-39 degrees. The attack lasts up to several days and may go away on its own without treatment.
L4 radiculopathy occurs when the L3-L4 disc herniates. When the L4 root is compressed, pain spreads along the front surface of the leg below the knee. The knee reflex disappears, sensitivity on the front surface of the thigh, knee and lower leg is impaired.
"Jumper's Knee" This is an inflammation of the quadriceps tendon where it attaches to the superior pole of the patella. Also, changes characteristic of “jumper’s knee” can occur at the point of attachment of the patellar tendon to the tibial tuberosity below the patella.
The cause of the disease is acute or chronic professional or sports overload. “Jumper’s knee” is more often observed in track and field athletes, volleyball players, basketball players, and football players. Risk factors include repeated jumps on a hard surface and forced knee extension. Stress overload also occurs during weekend sports and many types of household activities (carrying heavy objects, repairs, cleaning).
In older patients, knee pain develops during normal daily activities. Clinically, local tenderness is noted in the front of the knee at the upper or lower pole of the patella. Knee pain intensifies when straightening the knee, walking up or down stairs, or standing up from a sitting position. Squatting is very painful. The pain intensifies when squeezing the car pedals, making driving difficult. The pain often intensifies with prolonged sitting, which forces people to stand up and look for a more comfortable position for the leg.
When palpated, the affected tendon is sharply painful. In the anterior part of the knee joint, a slight swelling can be detected in the projection of the patella and its own ligament. In case of a sports injury, you must stop training, immobilize the knee joint and immediately seek medical help.
Crow's foot syndrome.
The tendons of the gracilis, semitendinosus and sartorius muscles attach to the inner surface of the tibia 5 cm below the joint space of the knee joint, forming a superficial “crow's foot”. With arthrosis of the knee joint, as well as with excessive rotation of the tibia in football players, dancers, and gymnasts, tendon overload occurs with reactive local inflammation and pain in the knee when bending, walking and standing. On palpation, a dense, painful ridge is detected at the point of attachment of the tendons; the patient himself points with his finger to the place that bothers him.
Bursitis is an inflammation of the periarticular bursa (bursa) , which contains joint fluid. Symptoms of bursitis include redness, swelling, and pain above the kneecap. In the area of the knee joint there are several synovial bursae.
Housewife's knee or prepatellar bursitis. The prepatellar bursa is located between the anterior surface of the patella and the skin, so it is often injured during prolonged kneeling. Clinically it manifests itself as a limited, painless and inactive tumor in front of the patella.
If the bursa is large enough, there is limited movement in the knee joint and pain with maximum knee flexion. In other bursitis, the swelling may be located below the patella, on either side of the patellar ligament.
Hoff's disease.If you are overweight, the fat pad can be pinched between the articular surfaces of the knee joint. The disease manifests itself as pain in the knee during movements that occur strictly behind the patellar ligament or slightly inward. The greatest pain is observed with maximum knee extension. The swelling is noticeable on both sides of the patellar ligament and is painful on palpation.
Osgood-Schlatter disease occurs in boys 12-15 years old who play sports (football, hockey). The disease manifests itself as pain in the knee during physical activity, while walking or squatting. Below the kneecap, a painful swelling appears in the area of the tibial tuberosity.
Full bending of the knee is possible, but severely painful. The pain does not go away even with rest. In most cases, spontaneous recovery occurs after bone growth stops. This pathology does not occur in adults.
Very rarely, knee pain occurs due to tumors, osteomyelitis, and tuberculosis.
Bursitis is an inflammation of the periarticular bursa (bursa) , which contains joint fluid. Symptoms of bursitis include redness, swelling, and pain above the kneecap. In the area of the knee joint there are several synovial bursae.
Housewife's knee or prepatellar bursitis. The prepatellar bursa is located between the anterior surface of the patella and the skin, so it is often injured during prolonged kneeling. Clinically it manifests itself as a limited, painless and inactive tumor in front of the patella.
If the bursa is large enough, there is limited movement in the knee joint and pain with maximum knee flexion. In other bursitis, the swelling may be located below the patella, on either side of the patellar ligament.
Hoff's disease.If you are overweight, the fat pad can be pinched between the articular surfaces of the knee joint. The disease manifests itself as pain in the knee during movements that occur strictly behind the patellar ligament or slightly inward. The greatest pain is observed with maximum knee extension. The swelling is noticeable on both sides of the patellar ligament and is painful on palpation.
Osgood-Schlatter disease occurs in boys 12-15 years old who play sports (football, hockey). The disease manifests itself as pain in the knee during physical activity, while walking or squatting. Below the kneecap, a painful swelling appears in the area of the tibial tuberosity.
Full bending of the knee is possible, but severely painful. The pain does not go away even with rest. In most cases, spontaneous recovery occurs after bone growth stops. This pathology does not occur in adults.
Very rarely, knee pain occurs due to tumors, osteomyelitis, and tuberculosis.
Diagnosis for knee pain.
A general blood test (leukocytes, ESR) confirms inflammatory processes in the body. The higher the white blood cells and ESR (erythrocyte sedimentation rate), the stronger the inflammation. An increase in ESR in combination with night pain indicates inflammation and is more common in rheumatic disease. If the level of white blood cells increases, the cause of knee pain may be infectious diseases. With arthrosis, the indicators of a general blood test remain unchanged.
Blood test for rheumatic tests. In rheumatic diseases, the level of CRP, seromucoid, is sharply increased. Negative rheumatic tests exclude rheumatic causes of knee pain. Positive rheumatoid factor confirms the association of knee pain with rheumatoid arthritis.
An increase in uric acid levels in the blood can confirm the connection between knee pain and gout.
A blood test for antibodies to chlamydia and ureaplasma and scraping from the urethra can exclude infectious causes of knee pain.
For Lyme disease, the diagnosis is confirmed by serological methods. IgG persists for months or years.
An x-ray shows bone changes in the knee joint and excludes traumatic causes of knee pain, tumors, and bone tuberculosis. Each disease has its own specific changes on radiographs. With arthrosis of the knee joint, bone deformations and osteophytes (“spikes”) are clearly visible, and the width of the joint space is determined.
An ultrasound of the knee joint allows you to assess the condition of the ligaments, tendons, muscles, and cartilage. Using ultrasound, you can determine the amount of intra-articular fluid, damage to the menisci, and the presence of a Baker's cyst.
MRI of the knee joint helps to detect the earliest changes in cartilage and visualizes soft tissues (muscles, ligaments, menisci).
Knee arthroscopy is the most accurate method for diagnosing knee pain. A special probe is inserted into the joint cavity and under a microscope the doctor assesses the degree of cartilage destruction.
Puncture of the knee joint with microscopic examination of intra-articular fluid and microflora culture.
Blood test for rheumatic tests. In rheumatic diseases, the level of CRP, seromucoid, is sharply increased. Negative rheumatic tests exclude rheumatic causes of knee pain. Positive rheumatoid factor confirms the association of knee pain with rheumatoid arthritis.
An increase in uric acid levels in the blood can confirm the connection between knee pain and gout.
A blood test for antibodies to chlamydia and ureaplasma and scraping from the urethra can exclude infectious causes of knee pain.
For Lyme disease, the diagnosis is confirmed by serological methods. IgG persists for months or years.
An x-ray shows bone changes in the knee joint and excludes traumatic causes of knee pain, tumors, and bone tuberculosis. Each disease has its own specific changes on radiographs. With arthrosis of the knee joint, bone deformations and osteophytes (“spikes”) are clearly visible, and the width of the joint space is determined.
An ultrasound of the knee joint allows you to assess the condition of the ligaments, tendons, muscles, and cartilage. Using ultrasound, you can determine the amount of intra-articular fluid, damage to the menisci, and the presence of a Baker's cyst.
MRI of the knee joint helps to detect the earliest changes in cartilage and visualizes soft tissues (muscles, ligaments, menisci).
Knee arthroscopy is the most accurate method for diagnosing knee pain. A special probe is inserted into the joint cavity and under a microscope the doctor assesses the degree of cartilage destruction.
Puncture of the knee joint with microscopic examination of intra-articular fluid and microflora culture.
Treatment for knee pain.
Knee pain is considered one of the most unfavorable in terms of therapy. It is very important to notice the first signs of damage to the knee joint. With timely and correct treatment, you can completely get rid of pain, restore mobility of the knee joint, prevent joint deformation and maintain ability to work.
Treatment for knee pain depends on the cause. Different diseases require different approaches to treatment; there is no single universal method. However, there are general rules for reducing knee pain.
First of all, it is necessary to limit physical activity and relieve the sore knee. For this purpose, elastic bandages, knee pads, and canes are used. Currently, taping is becoming increasingly popular. This is a treatment method that is based on attaching special adhesive tapes (tapes) to the knee, which relieve the load on the knee joint.
Non-steroidal anti-inflammatory drugs are the best way to relieve or relieve knee pain. But these drugs cause many side effects and should only be prescribed by a doctor. Long-term use of some of them contributes to the destruction of articular cartilage. Therefore, be very careful when self-medicating.
For external use, compresses with dimexide or medical bile, ointments with NSAIDs are recommended. You should be careful with warming ointments and compresses. In case of injuries or joint swelling, warming procedures are contraindicated. In this situation, it is better to apply an ice pack wrapped in a towel to the sore knee for 10-15 minutes.
In case of swelling, redness of the joint, sharp pain and inflammation are quickly relieved by therapeutic blockades with corticosteroids. But they must be carried out by competent surgeons or rheumatologists strictly according to indications, no more than 3 procedures in one joint.
I consider leeches to be useful as an alternative to hormones, which also relieve swelling, inflammation and reduce knee pain in any disease, including rheumatoid arthritis. For arthrosis of the joints, interstitial electrical stimulation is very effective. Acupuncture relieves joint pain well.
For gout, the first place in treatment is a diet with a sharp limitation of alcohol and foods containing purines. In the acute period, non-steroidal anti-inflammatory drugs are indicated, and when the pain in the joint subsides, the rheumatologist will prescribe you a special drug that reduces the level of uric acid in the blood.
For rheumatoid arthritis, treatment should be prescribed by a rheumatologist. Continuous use of specific basic drugs, non-steroidal or steroidal anti-inflammatory drugs is indicated.
For urogenital infections, you should be treated by a dermatovenerologist. For the articular form of Lyme disease, antibiotics are prescribed.
The prognosis depends on the cause of knee pain and how advanced the disease is. You should not hope for immediate results. Only you, in cooperation with your doctor, can cope with knee pain.
Treatment for knee pain depends on the cause. Different diseases require different approaches to treatment; there is no single universal method. However, there are general rules for reducing knee pain.
First of all, it is necessary to limit physical activity and relieve the sore knee. For this purpose, elastic bandages, knee pads, and canes are used. Currently, taping is becoming increasingly popular. This is a treatment method that is based on attaching special adhesive tapes (tapes) to the knee, which relieve the load on the knee joint.
Non-steroidal anti-inflammatory drugs are the best way to relieve or relieve knee pain. But these drugs cause many side effects and should only be prescribed by a doctor. Long-term use of some of them contributes to the destruction of articular cartilage. Therefore, be very careful when self-medicating.
For external use, compresses with dimexide or medical bile, ointments with NSAIDs are recommended. You should be careful with warming ointments and compresses. In case of injuries or joint swelling, warming procedures are contraindicated. In this situation, it is better to apply an ice pack wrapped in a towel to the sore knee for 10-15 minutes.
In case of swelling, redness of the joint, sharp pain and inflammation are quickly relieved by therapeutic blockades with corticosteroids. But they must be carried out by competent surgeons or rheumatologists strictly according to indications, no more than 3 procedures in one joint.
I consider leeches to be useful as an alternative to hormones, which also relieve swelling, inflammation and reduce knee pain in any disease, including rheumatoid arthritis. For arthrosis of the joints, interstitial electrical stimulation is very effective. Acupuncture relieves joint pain well.
For gout, the first place in treatment is a diet with a sharp limitation of alcohol and foods containing purines. In the acute period, non-steroidal anti-inflammatory drugs are indicated, and when the pain in the joint subsides, the rheumatologist will prescribe you a special drug that reduces the level of uric acid in the blood.
For rheumatoid arthritis, treatment should be prescribed by a rheumatologist. Continuous use of specific basic drugs, non-steroidal or steroidal anti-inflammatory drugs is indicated.
For urogenital infections, you should be treated by a dermatovenerologist. For the articular form of Lyme disease, antibiotics are prescribed.
The prognosis depends on the cause of knee pain and how advanced the disease is. You should not hope for immediate results. Only you, in cooperation with your doctor, can cope with knee pain.
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