All You Need To Know About Knee Pain - Page 7 of 10

Knee pain is one of the most common types of joint pain, and many people will have at least one episode in their lifetime. It is a bothersome symptom that is not quickly relieved and sometimes requires urgent medical attention. But if you or any other member of your family suddenly experience knee pain, is there anything special you need to know? What is causing knee pain? What can you do about it?

What is knee pain?

As the name implies, knee pain is an ache and discomfort in one of the most highly mobile articulations of the lower limbs. The knee is composed of various parts. In this area, we have two different bones attached to each other: the lower end of the femur and the upper end of the tibia. The articulation that joins these bones is called a hinge synovial joint, and it is highly mobile, allowing for flexion, extension, medial rotation, and lateral rotation. Various ligaments cover the articulation, it is protected and stabilized by the patella, and there are many others inside the articulation called cruciate ligaments, which prevent dislocation of the tibia.

Knee pain is often associated with a traumatic event, but may also be caused by a systemic disease as in rheumatoid arthritis and systemic lupus erythematous. In any case, there are different types of knee pain for each diagnosis, and not all of them are felt the same way. For example, we can have knee pain in various parts of the articulation (anterior, posterior, or lateral knee pain). It can be felt near the skin or deep beneath the skin in the articulation, and it may or may not be associated with the movement of the articulation.

But is it dangerous? In most cases, knee pain is not dangerous, but we should look for the appropriate ways to diagnose and treat the causes in order to avoid complications.

What causes knee pain?

There are various causes of knee pain, but we can divide them into traumatic and non-traumatic causes.

A. Traumatic causes of knee pain

These are more common that non-traumatic causes, especially in athletes and active people but also in obese and sedentary individuals with an excessive load on their articulations. These are the more common causes of traumatic knee pain:

◘ Musculoskeletal injuries: Muscle pain is a common cause of knee pain when it is associated with the quadriceps, the most important muscle in the thig. This muscle is attached to the patella, and tearing of this muscle near the patella may lead to knee pain located in the anterior part of the knee.

◘ Fractures: Any bone that is associated with the articulation of the knee may suffer a fracture from a sudden contusion. The femur, tibia and the patella may be subject to excessive pressure resulting in fractures and acute knee pain that compromises walking and other functions performed by this articulation.

◘ Stress fractures and repetitive movements: Another important source of knee pain is stress fractures and repetitive movements, which is especially the case in athletes and active individuals. Repetitive movements, primarily when associated with heavy loads and contusions, may lead to microscopic fractures that slowly impair the normal function of the articulation and lead to chronic knee pain.

◘ Obesity: Obese individuals often suffer from knee pain, and the mechanism of disease is similar to what happens in stress fractures. Carrying excessive load in the articulation of the knees leads to wear down of the articulation and may also trigger a form of degenerative arthritis called osteoarthritis of the knee.

◘ Ligament tears: This cause is especially common in athletes. The most commonly involved ligament is the anterior cruciate ligament, but there is a posterior cruciate ligament and lateral ligaments that may be torn as well. Each one of them leads to a distinct type of pain and different findings in the physical exam.

B. Non-traumatic causes of knee pain

◘ Rheumatoid arthritis: Rheumatoid arthritis and other types of arthritis usually involve the knee at some point of the disease. Knee pain in rheumatoid arthritis slowly progresses and ultimately becomes a severe disability that won’t allow patients to walk or climb stairs. It usually appears in adults, but there are juvenile forms of arthritis that may affect children as well.

◘ Osteoarthritis: It is the most common type of arthritis that is associated with knee pain. Osteoarthritis is a degenerative type of arthritis, which means that it results from wear-and-tear of the articulation. It usually appears in older adults and progresses as the articulatory cartilage wears down and leaves the bony ends of the femur and the patella meeting and rubbing against each other with each movement.

◘ Post-traumatic arthritis: Some patients may develop a form of post-traumatic arthritis after a traumatic event in the articulation of the knee. The mechanism of disease is similar to osteoarthritis, usually related to degeneration of the joint surface leading to joint instability and progressive damage and wear down of the articulation.

◘ Gout: It is another form of arthritis that is based on the accumulation of uric acid crystals in the articulations. Gout is often associated with pain in the articulations of the lower extremities, especially the foot and the toes, but may also lead to knee pain. Similar to other forms of arthritis, patients with gout often have a swollen and reddened articulation associated with sudden and severe joint pain.

◘ Pseudogout: The mechanism of disease of pseudogout is similar to that of gout, but instead of uric acid crystals there are deposits of calcium crystals in the articulations.

◘ Bursitis/synovitis: When there’s an inflammation in the synovial membrane or bursa, knee pain may be prolonged, recurrent, and difficult to treat. Inflammation may be due to infectious diseases, and autoimmune reaction, or wear-and-tear of the articulation.

◘ Systemic Lupus Erythematous: There are also uncommon causes of knee pain, as in systemic lupus erythematous. This is an autoimmune disease that affects different body systems and tissues, and patients would have different symptoms depending on the type of SLE. Rheumatoid arthritis is often associated with SLE, and both conditions may ultimately lead to knee pain.

Who is at risk for knee pain?

All of us may have an episode of knee pain due to traumatic causes, arthritis, or any of the abovementioned causes. However, there are certain risk factors that would increase the likelihood of suffering from knee pain due to various reasons.

According to a study published in the journal Osteoarthritis and Cartilage, the most critical risk factors are as follows:

• Older age: The incidence of knee pain increases as people age, which is especially the case of osteoarthritis, and osteoporosis-related pain.

• Being a woman: Women have a higher prevalence of knee pain compared to men. Rheumatoid arthritis and other forms of arthritic pain are more common in women.

• Overweight and obesity: A higher body mass index is usually associated with a higher risk of knee pain. Obese individuals and those with a body mass index of 26 kg/m2 or higher are at increased risk of developing knee pain.

• Smokers: People with the habit of smoking have a higher chance of suffering inflammatory causes of knee pain due to the inflammatory nature of tobacco smoke.

• Previous knee injuries: Patients who sustained knee injuries have a higher risk of knee pain, either for traumatic causes or post-traumatic arthritis.

• Work-related factors: Depending on the type of work, certain people may have a higher risk of experiencing knee pain. For example, people who need to stand or remain flexed for a very long time, lift heavy loads or perform strenuous work have a higher incidence of knee pain.

If you have one of these risk factors, it does not mean you will suffer from knee pain. It only means your probability is higher than the average, and it would be a good idea to talk about it to your doctor and notify your symptoms if you start experiencing knee pain.

What are the symptoms of knee pain?

By itself, knee pain is a symptom that is often included in the diagnosis of various diseases. However, each particular case might be accompanied by other symptoms that may be important to lead the diagnosis.

Therefore, it is essential to understand knee pain as a symptom as well as many others that you may experience in the process. The most important symptoms are as follows:

► Knee pain: As mentioned, knee pain is variable depending on each disease. It varies in intensity and location, and all of these factors are important for the diagnosis.

► Stiffness: The majority of patients with knee pain would also describe an inability to move the affected joint. Stiffness of the joint is often related to arthritis and osteoarthritis, but each case should be evaluated individually.

► Swelling of the knee: Swelling of the articulation is common in various diseases, including rheumatoid arthritis, gout, bursitis, and traumatic knee pain. Accumulation of fluid in the knee is often associated with inflammation of the joint, but other causes of swelling should be evaluated, including hepatic problems and kidney disease.

► Reddened and hot skin: Inflammation is the leading cause in cases of knee pain associated with swelling and reddened hot skin. Among inflammatory causes we have rheumatoid arthritis, gout, infectious diseases, and much more.

► Skin rash: Certain cases of knee pain are associated with skin rash and other skin manifestations. When this happens, it is probably an autoimmune disease that is causing both symptoms at the same time, as in psoriatic arthritis. However, a skin rash may be due to a different cause, and only a doctor would be able to tell the difference.

► Enlarged lymph nodes: Infectious causes of knee pain are often associated with enlargement of lymph nodes. Enlarged lymph nodes are commonly found in the inguinal area, and it happens in cases of septic arthritis or arthritis associated with cellulitis or bursitis.

► Joint tumors: In some cases of arthritis, a series of tumors may start appearing in the skin of the affected joint. For example, this is common in patients with gout, and the tumors are no more than accumulations of uric acid crystals in the skin.

► Deformation of the articulation: Rheumatoid arthritis is associated with deformation of the articulations, which is particularly noticeable in the hands. The most common types of deformities in the hand include the ulnar drift, in which the fingers become inclined towards the pinky, and the Swan-neck deformity, where the top and base joint of the fingers start bending downward as the middle joint remains straight.

► Skin itch (tick bites): In some cases, we can associate knee pain with other events such as tick bites and exposure to certain contaminants. Lyme disease is an important cause of joint pain associated with tick bites.

Diagnosing knee pain

As you can see, there are many different manifestations that may be associated with knee pain, and depending on the combination of signs and symptoms you have, you will get a diagnosis. Moreover, your diagnosis will be further confirmed by a series of tests depending on each particular case to know whether or not this is the real cause of pain.

Basically, doctors would need to take a look at the signs and symptoms and evaluate if the patient has a primarily inflammatory disease or if knee pain is associated with a traumatic event. In cases of inflammatory pain, skin rash, exposure to certain environments, deformation of the articulations, and careful analyses is essential for the diagnosis.

It is essential to evaluate whether the patient has acute or chronic knee pain and whether it is continuous or appears in episodic flare-ups. In cases of flare-ups, the duration and intensity of the symptoms are important, and it is essential to evaluate other symptoms in the articulation and far from the articulation when knee pain is becoming more severe.

After this evaluation, doctors might order a few diagnostic tests and imaging studies:

• X-rays: They are commonly prescribed in patients who are suspicious of fractures or bone dislocations.

• Magnetic resonance imaging: This diagnostic imaging study is particularly important to evaluate soft tissues of the knee, including the tendons and menisci, and it is used alongside with X-rays because it often fails to provide a clear picture of fractures.

• Synovial fluid analysis: It is important when your doctor has a high suspicion of infectious or inflammatory causes or if your doctor wants to see whether or not there are crystals in the articulation.

• Arthroscopy: In some cases, your doctor might recommend arthroscopy, a surgical procedure with small cameras to see inside the joint. While performing this procedure, your doctor may be able to diagnose and repair the problem in some cases.

• Blood tests: If your doctor suspects arthritis, he will probably order tests such as rheumatoid factor, anti-cyclic citrullinated peptide, Antinuclear antibodies, and other blood tests associated with inflammation such as C-reactive protein and erythrocyte sedimentation rate. Each one of them will provide data about what is causing knee pain and will be useful for the diagnosis of arthritis.

We have already covered the most relevant signs and symptoms and how each one usually points out to a particular disease. But another thing a doctor needs to consider before diagnosing knee pain is where the pain is located. This is particularly important when knee pain is associated with overuse of the articulation and traumatic causes.

There are different diagnoses depending on the location of knee pain:

• Anterior knee pain: In cases of knee pain in the patella or the surrounding area, it is important to rule out a jumper’s knee and patellofemoral pain syndrome (runner’s knee). Runner’s knee is an overuse injury that affects your kneecap while jumper’s knee is a problem in the tendon that is located below your kneecap.

• Posterior knee pain: In cases of posterior knee pain, it is important to rule out hamstring tendonitis as one of the most common overuse injuries affecting the posterior portion of your knee. Baker’s cyst is another possibility when there’s a swollen bulge in the area.

• Lateral knee pain: In cases of knee pain located on either side of the knees, we should differentiate between the outer side and the inner side of the knee. In cases o knee pain in the outer side of the knee, doctors might consider a diagnosis of iliotibial band syndrome, especially in cyclists or distance runners. An injury to the lateral collateral ligament is also a possibility, and it usually results from a sudden and violent twisting motion or a sudden impact to the inside of the knee.

• Medial knee pain: In cases of knee pain located in the inner side of the knee, one of the most common causes is a sprain or tear of the medial collateral ligament. This is typically caused by a sudden impact to the outer side of the knee, and it is often associated with instability and swelling. Other diagnostic possibilities your doctor might need to rule out are irritation of medial plica and pes anserine bursitis.

Treating knee pain

As you have seen, there are several causes of knee pain your doctor may need to think about before establishing a final diagnosis. Each diagnosis has a set of medical recommendations to follow and medications to take. For example:

◘ Rheumatoid arthritis: It is an inflammatory problem that requires anti-inflammatories and often steroids and other drugs to control the progression of the disease.

◘ Osteoarthritis: The majority of cases are significantly improved with anti-inflammatories and knee braces. In some cases, doctors might recommend hyaluronic acid, and advanced cases of osteoarthritis require placing an artificial joint.

◘ Bursitis: It is often solved with home measures and non-steroidal anti-inflammatory drugs. In some cases, doctors might prescribe steroid injections in the articulation.

◘ Infectious arthritis: In cases of knee pain associated with an infectious disease, antibiotics are an essential part of the treatment. Your doctor might also recommend aspiration of the articulation in some cases.

◘ Jumper’s knee: It is often solved by following a series of medical recommendations to improve the inflammation and pain symptoms along with over-the-counter drugs and physiotherapy exercises.

In some cases, knee pain may require surgery, and it is often arthroscopic surgery to fix ligament problems. Each case should be evaluated by the treating doctor and would receive a different treatment approach.

How can knee pain be prevented?

Since we already know about the risk factors associated with knee pain, it is possible to prevent several causes of knee pain, including obesity and certain activities.

These recommendations will help you reduce the incidence of knee pain in your case:

Stay fit and avoid being overweight or obese.
Stretch and strengthen your articulations before physical exercise, especially in high-impact sports.
Consider low-impact exercises if you have previous injuries or already have chronic knee pain.
Be careful when performing twisting motions or changing directions in group sports.
Protect your knee according to the activity you’re performing.

Natural Home Remedies for Knee Pain

It is imperative to be evaluated by a physician if you have knee pain and do not know the exact cause. In some cases, mild knee pain after certain traumatic events or repetitive movements might not be alarming, but be sure to report your symptoms to your doctor if you notice anything that does not feel normal.

In any case, it is possible to improve knee pain alongside medical recommendations and therapies by applying these simple home measures and natural remedies:

♦ Apply the RICE strategy: RICE stands for Rest, Ice, Compression, and Elevation of the affected limb, and it is a common strategy that improves most types of knee pain, mainly when they are associated with a traumatic event.

♦ Exercise moderately: Strengthening the muscles has been found to improve knee pain and speed up the recovery of athletes who sustain various types of injuries. Thus, consider the possibility of exercising, but do it according to the recommendation of your doctor and physiotherapist.

♦ Use acupuncture: Chinese medicine has been proven beneficial in some cases of knee pain, and it is worth it to try acupuncture as a safe side treatment along with your medical therapy.

♦ Hot and cold therapy: Applying hot and cold packs in the knee is beneficial to numb the pain and improve the inflammation. Alternating hot and cold every 20 minutes is likely to help reducing pain symptoms and improve your condition.

♦ Herbal ointments: There are many types of herbal ointments and essential oils you can try in cases of knee pain. Among the most widely used, we have sesame oil, cinnamon, and ginger extract. You can also try natural numbing ointments such as arnica, which is known to improve the inflammatory symptoms in some cases of knee pain.

References

Cutbill, J. W., Ladly, K. O., Bray, R. C., Thorne, P., & Verhoef, M. (1997). Anterior knee pain: a review. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 7(1), 40-45.

Miranda, H., Viikari-Juntura, E., Martikainen, R., & Riihimäki, H. (2002). A prospective study on knee pain and its risk factors. Osteoarthritis and cartilage, 10(8), 623-630.

Synnott, K., Kelly, E., Kelly, P., & Quinlan, W. (2003, February). THE RED, HOT, SWOLLEN KNEE. IS THE PRESENCE OF PALPABLE INGUINAL LYMPHADENOPATHY USEFUL IN DIFFERENTIATING SEPTIC ARTHRITIS FROM SUPERFICIAL CELLULITIS AND BURSITIS?. In Orthopaedic Proceedings (Vol. 85, No. SUPP_II, pp. 132-132). The British Editorial Society of Bone & Joint Surgery.

García-De La Torre, I., & Nava-Zavala, A. (2009). Gonococcal and nongonococcal arthritis. Rheumatic Disease Clinics, 35(1), 63-73.

Johnson, M. W. (2000). Acute knee effusions: a systematic approach to diagnosis. American family physician, 61(8), 2391-2400.