Knee pain is something that affects many of us! Surely a discomfort that makes you think twice before taking another step. But did you know that understanding what's going on in your knee can make the difference between a good day and a painful one? In this blog, I will detail everything you need to know on how to take better care of your knees and relieve that pain.
Recurrent or persistent knee pain is a common cause of consult; it accounts for up to 25% of consultations in adults and has a significant impact on quality of life and productivity. In this article, we will explore in detail the possible causes of knee pain, the key aspects of its anatomy and the recommendations for its management.
It is essential to remember that this content is informative and does not replace evaluation and diagnosis by a specialist.
Knee Anatomy Diagram
Anatomy of the knee
The knee is a complex joint made up of multiple vulnerable elements that can be injured and cause discomfort. These include:
• Bones: femur, tibia and patella.
• Ligaments: strong and elastic fibers that provide support by joining different bones.
• Tendons: Allow movement by attaching muscles to bones.
• Articular cartilage: It is a thin layer of elastic and resistant tissue that covers the bone ends; in addition, it facilitates and cushions movement.
• Meniscus: act as shock absorbers between the femur and tibia bones.
• Synovial fluid and bursa: lubricate the joint and reduce friction.
Main causes of knee pain
Knees pain can originate for many reasons, from direct trauma or chronic wear and tear. This are some common reasons:
• Mechanical injuries: such as ligament ruptures, plica syndrome, meniscus tear, and patellar subluxation.
• Chronic conditions: such as osteoarthritis, patellofemoral syndrome, bursitis, and tendinopathies.
• Inflammatory: such as gout and pseudogout.
• Infections: deteriorate the normal anatomy of the knee and damage the cartilage and meniscus.
Diagnosis and Clinical Considerations
It is essential to differentiate the origin of the pain according to the region of the knee affected to understand what is happening; however, it is important to consider that the definitive diagnosis will be obtained with the physical examination in the office and, in some cases, with complementary tests.
Possible causes according to the origin of the pain in the different parts of the knee
Rear: Pain in the posterior portion of the knee is usually associated with a Baker's popliteal cyst. When associate with trauma, we suspect injuries to ligaments or meniscus, damage to the quadriceps tendon, or affection to the nerves. Chronic pain in this area may be due to hamstring tendinopathy.
Front: This may be due to problems with the patella, tendons, or ligaments. Patellofemoral syndrome is suspected when pain is associate with sitting for long periods of time or climbing stairs. In athletes or adults who run or jump frequently, patellar or quadriceps tendonitis may develop. In adolescents, this type of pain may be related to the growth and overuse of the joint, developing an apophysis syndrome. Another common cause is patellar bursitis, which, in addition to pain, produces inflammation.
Lateral or medial part: Pain in the lateral or medial part of the knee can be caused by acute injuries due to trauma or chronic damage. Can be from injuries that affect the meniscus, collateral ligament, or cause by bursitis due to overuse.
In this area, the pain is aggravated during knee flexion and extension. When the pain is located in the medial portion (inner part of the knee) and is accompanied by hip pain in adolescents, it is important to consider the possibility of an injury to the femoral epiphysis. This area is where growth occurs and is vulnerable to fractures. On the other hand, chronic pain in the lateral portion can be common in cyclists and runners, as well as in activities that involve continuous bending of the knee. In these cases, the presence of an iliotibial band syndrome is suspected.
Diffuse pain: in patients over 50 years of age with chronic diffuse knee pain, we suspect degenerative osteoarthritis of the joint, especially if the pain intensifies at the end of the day. On the other hand, acute pain that appears suddenly within hours or days and is not associated with trauma could indicate an infection, gout, or rheumatoid arthritis. Especially, we suspect arthritis when it affects several joints, including both knees. In adolescents, diffuse knee pain without direct trauma, which worsens with activity, could be osteochondritis. Any similar pain that persists or worsens overnight should be evaluated to rule out possible malignant conditions.
Tips for relieving knee pain
This are general recommendations to relieve knee pain, from the least invasive to the most complex. If you are experiencing disabling pain, trauma, or lack of improvement, it is crucial to seek medical attention.
• Rest: Avoid leaning on the affected knee for several days, using a cushion under it. It is important to remember that the knee is nourished by walking, so excessive rest should be avoided.
• Ice: To reduce inflammation, apply ice wrapped in fabric in cycles of every other minute, up to 20 minutes several times a day. Avoid applying ice directly to the skin.
• Compression: A light bandage can provide stability and temporarily relieve the joint. If permanent compression is required, it is necessary to consult with a specialist.
• Elevation: In cases of inflammation, elevate your knee above the level of your heart when lying down.
• Use of analgesic creams or gels: these can be useful in cases of osteoarthritis and complement other recommended therapies.
In addition to these measures, your doctor may recommend additional therapies such as:
• Immobilization: A splint or orthopedic system may be used to prevent movement of the knee; in case of fractures, a cast is used.
• Physical therapy: After a thorough evaluation, exercises may be recommended specific to restore knee function and strengthen the muscles that support it. If physiotherapy is carried out prior to the assessment of an orthopedist, there is a risk of aggravating the injury in certain cases if proper assessment is not done.
• Oral anti-inflammatories: These medications can help reduce inflammation and pain, but it is recommended to use them for short periods and under medical supervision. Especially in cases of heart disease and clotting disorders self-prescribing these types of therapies should avoid.
In more severe cases, interventions may be considered such as arthroscopy, open surgery or even the Total knee replacement, depending on the severity of the injury.
• Arthroscopy: A minimally invasive procedure that uses a camera and other instruments to access the knee through small holes in the skin, allowing have a direct view of the damage knee and repair injuries. For more information, visit our blog: What is an Arthroscopy?
• Open surgery: Used in cases of extensive injuries or fractures that require direct access for a adequate repair.
• Total Knee Replacement: It involves the removal of the damaged part of the joint and its replacement with an artificial joint in situations of severe and irreversible damage.
When scheduling a consultation with a specialist, keep the following in mind:
• Wear athletic clothing that allows you to examine your knees easily.
• Prepare all of your questions and concerns to discuss during the consultation.
• The consultation will include a thorough medical history and a detailed physical examination, as well as possible imaging tests.
• Once the diagnosis is established, we will explain the problem is and the different treatment options available.
• When treatment is determined, follow-up will be given to ensure an effective recovery and improve their quality of life.
It will be a pleasure to assist you and accompany you in your recovery process.
Referencias:
1. Common Knee Injuries - OrthoInfo - AAOS https://orthoinfo.aaos.org/en/diseases-- conditions/common-knee-injuries/
2. Knee Pain in Adults and Adolescents: The Initial Evaluation, CHRISTOPHER W. BUNT, MD, CHRISTOPHER E. JONAS, DO, AND JENNIFER G. CHANG, MD. Am Fam Physician. 2018;98(9):576-585.
Knee Pain in Adults and Adolescents: The Initial Evaluation | AAFP
3. Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons. Rosemont, IL: AAOS; February 2014. Based on data from the National Ambulatory Medical Care Survey, 2010; Centers for Disease Control and Prevention.
Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience - PMC (nih.gov)