I often have people come to the Urgent Care who have problems due to knee pain. Pain that originates in the knee can be complex because there are quite a few areas within the knee that can cause pain. The knee is a “hinge” type joint that is at the greatest risk of injury, age-related wear and tear, arthritis as well as infection related arthritis.
Causes: As I mentioned above, there are many causes of knee pain. Several are listed below:
1) Patellofemoral pain syndrome – Group of symptoms that is sometimes caused from overuse of the knee. It can affect running athletes, and is more common in women. The pain is usually in the front of the knee and is made worse with squatting, running, prolonged sitting or when climbing or going down stairs. We also call this Patellar tracking syndrome because it is related to the knee cap (patella) sliding out of the groove that it normally sits in.
2) Meniscal tears – The meniscus is a specialized shock absorber that provides cushion on both sides of the knee. They can become damaged or torn from an acute knee injury or from overuse that comes with age. They have a very poor blood supply, so they don’t heal very quickly
3) Bursitis – The knee is lubricated by joint fluid that is produced by a lubricating bursa (or sac). These bursa sacs can become irritated as a result of injury or even overuse. Inflammation of the bursa is called bursitis
4) Arthritis – This refers to inflammation of the cartilage covering the ends of the bones and undersurface of the knee cap. When it gets worn down, irritated or irregular, it can become painful and is known as arthritis.
5) Tearing of a ligament – The knee is held together by a combination of ligaments including the anterior and posterior cruciate ligaments as well as the medial and collateral lateral ligaments. These ligaments function to hold the bones together and prevent side-to-side or back and forth motion.
6) Muscle strain – If the muscles on the front or back of the knee area become injured, or in spasm they can cause pain around the knee joint. These muscle groups are the quadriceps (located on the front of the top of the knee) and the hamstrings (located on the back part of the leg). These muscle groups work to give support to and move the knee joint
7) Fractures – Broken bones around the knee can obviously cause pain
8) Infection – If bacteria get into the knee joint, this can cause pain, swelling and decreased range of motion
9) Gout – This is caused by the formation of uric acid crystals that build up within the knee joint and is less common in the knee than some other joints
10) Baker’s Cyst – a cyst in the back of the knee can cause pain
Diagnosis: Since there are so many different possible causes of knee pain, it is important to make an accurate diagnosis to treat the underlying problem. In addition to getting a good history from the patient about their pain, a physical evaluation will be performed and sometimes knee x-rays, an ultrasound, or an MRI will be ordered. Additionally, a small sample of synovial fluid is sometimes removed from the knee using a needle. This fluid can be examined under a microscope and/or sent for culture to look for bacteria, crystals or signs of inflammation.
Treatment: The individual patients injury will dictate the kind of treatment that they need to recover the fastest. Physical therapy is often used because it speeds recovery and regain motion. We also often recommend ice, elevation of the leg and muscle-toning exercises when appropriate. Sometimes a knee brace or immobilizer may be appropriate. Medications such as ibuprofen, Aleve or Tylenol may be appropriate for knee injuries. If infection is present, antibiotics may also be prescribed. If injury to the bone or ligaments is the cause, surgery can be helpful in some patients.
Limiting certain activities: Speeding the recovery and helping prevent further injury sometimes involve limiting activities temporarily. Excessive pressure on the knee joint by the following activities should be avoided to help recovery:
4) Twisting and pivoting
6) Playing stop and go sports such as basketball or racquet sports
7) Swimming with frog leg or whip kick techniques
8) Rowing machine
9) Stationary bike
10) Stair stepper
11) Leg extensions with weights
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO