Guide to Knee Pain - The Ultimate Pain Management Guide

Guide to Knee Pain

What is Knee Pain?

Knee pain is any type of pain felt in the knee area regardless of severity and characteristic of pain sensation.
Knee pain can be a result of injury, mechanical problem or an underlying disease condition.
Knee pain may present similar symptoms but may need a specific diagnosis for the appropriate treatment measures.
Knee pain may be caused by several factors and may affect one or both legs depending on the cause of pain whether it is a primary disease or a secondary illness.
There are several medical conditions that can cause knee pain:
- Arthritis (Osteoarthritis, Rheumatoid Arthritis, Gout, Pseudogout, Septic Arthritis)
- Iliotibial band syndrome
- Chondromalacia patellae
- Osgood-Schlatter disease
- Osteochondritis dissecans

Who Suffers From Knee Pain?

Knee pain can be experienced by the young and old alike, whether male or female.
Knee pain may affect people of all ages but, are particularly common among elderly people and those who are involved in hazardous activities and sports.
Women have a higher percentage of suffering from knee pain especially during menopause due to the hormonal changes that affects the production and use of calcium needed by the bones.

Your Knee and Knee Pain

The knee is the largest joint in the body that plays an important role in simple daily activities like walking, running, stretching and bending. When the knees are not healthy a person may experience excruciating pain that can impair work and cause disability. Other than the knees, the muscles, tendons, bones and cartilages perform a complex network of movements and any problem in these structures may result to knee pain.

Anatomy of a Healthy Knee, Zimmer IndiaDiseased Knee with Damaged Cartilage, Zimmer India

Here are additional links that discusses the anatomy of the knee:

Causes of Knee Pain:

Knee pain usually starts with the wear and tear of the cartilage that protects the knee cap and keeps the bones from rubbing together that creates friction and inflammation. Damages to the cartilages and other parts of the knee are commonly caused by conditions like:

Infections causing inflammation, swelling and joint stiffness.
Direct injuries from trauma and accident that lead:
- ACL (Anterior Cruciate Ligament) injury
- Torn meniscus
- Bursitis
- Patellar tendinitis.
Mechanical problems that can be caused by bone degeneration or fracture resulting to conditions like knee locking, loose bones or cartilages and knee dislocation.
All types of arthritis (osteoarthritis, rheumatoid arthritis, gout, pseudogout) as a result of wear and tear and bone degeneration can lead to cartilage deterioration causing bone friction and knee pain.
Other conditions:
- Iliotibial syndrome or tight ligaments connecting the pelvic area and the tibia
- Chondromalacia patellae (patellofemoral pain syndrome) caused by a misalignment of the knee cap
- Osgood-Schlatter disease, a condition where inflammation occurs due to excessive running or jumping
- Osteochondritis dissecans caused by a reduced blood flow to the knee area.

Can Knee Pain Be Prevented?

Knee pain will most likely affect all persons at some point in life but, there are ways to manage the pain and prevent it from aggravating. A word of caution however must be exercised especially if there are underlying conditions causing the knee pain. In such cases consultation with a healthcare practitioner is very important. Some of the ways to prevent knee pain are:

Rest. A very basic management to allow the knee swelling to subside. It will be best to elevate the legs while resting.
Heat and cold application. Cold application is usually applied immediately after an injury or within the first 24 hours to prevent further damage to the knee. Heat application is applied after the first 24 hours of the injury to relieve the swelling and knee pain.
Stretching. This is very helpful in strengthening the muscles, tendons and ligaments surrounding the knee.
Weight control. It is just as important as exercise to maintain the ideal weight to prevent burden and too much weight bearing to the already painful knee.
Activities. It is wise to choose activities and sports that will not further cause injury to the knee especially if there is already a history of knee injury or illness.
Knee Protection. Further injury to the knee may be prevented with the use of a walking aid.
Positioning. When sleeping it will help relieve the pain if a pillow is placed under the knee.

Symptoms of Knee Pain

Generally, all types of knee pain with whatever cause and varying severity will present the following manifestations:

Swelling and joint stiffness
Redness and warmth to the touch
Weakness or loss of function
Popping noise on movement
"Knee Locking"

Here are links that discusses in detail the following symptoms

How to Diagnose Knee Pain

Knee pain can be established initially through the location of pain:

Front. Knee pain over the front involves the knee cap.
Inside. Knee pain inside may involve injuries in the medial meniscus or ligaments.
Sides. Knee pain that is outside of the knee may be a sign of tendinitis, a tear in the lateral meniscus or arthritis.
Back. Knee pain felt at the back could be a sign of referred pain from the knee cap or could be due to a formation of a cyst.

Further laboratory and diagnostic examinations:

X-ray. Uses electromagnetic radiation to capture knee structure images
Sonographic Examination. Uses ultrasound echo (sounds) to capture an image of the knee structures.
Computerized Axial Tomography Scan. Uses computer digital imaging in three dimensional x-ray to capture the knee structure.
Magnetic Resonance Imaging. Uses nuclear magnetic resonance to visualize in detail the knee structure.
Arthrocentesis. Collection of the synovial fluid through an ultrasound guided needle.
Fluid Culture and Sensitivity. Laboratory examination of the synovial fluid to determine presence of an infection.

What are the Risk Factors of Knee Pain?

Development of knee pain is predisposed by the following:

Obesity
Age especially older adults
Women in their pre-menopause
Certain sports like skiing and basketball
Lack of exercise
History of previous injury
Smoking

When should you See a Doctor for Knee Pain?

§ Inability to walk or bear weight on knees
§ Knee swelling
§ Inability to flex and extend knees
§ Knee deformity
§ Fever accompanied with knee redness, pain and swelling
§ Immobility or loss of balance
§ Chronic knee pain that lasts for weeks

Treatment for Knee Pain:

Treatment of knee pain depends largely on the cause that is why proper diagnosis is important.

Medical management includes prescription and over the counter medications like analgesics, non-steroidal anti-inflammatory drugs and steroids.
Rehabilitative management includes physiotherapy and range of motion exercises to rehabilitate the knee.
Surgical management involves total knee replacement for patients with severe disability due to knee pain. Arthrocentesis or removal of the synovial fluid may be done as a diagnostic or therapeutic surgical procedure. Other surgical procedures include repair of damaged tendons and ligaments, which can be done as an open knee surgery or as an arthroscopic procedure (surgical procedure using a small fiber optic instrument that is inserted through a small incision). Surgical repair can be done through simple suture, grafting or through the use of prosthetic grafts.
Alternative therapies include acupuncture therapy in specific knee points. Another is through electromagnetic therapy using controlled pulses of electricity to improve blood circulation in the knees. Massage is an all time therapy that improves circulation and help relieve pain and swelling. Lastly, there are herbal, dietary and plant stem cell extracts available to help relieve symptoms of knee pain. Among them include aloe vera, comfrey, arnica Montana, bryonia alba and many others.

References:

Harrison's Principles of Internal Medicine - 17ed - McGraw-Hill 2008 (ISBN 978-0071466332) [DA86C362]
Medical-Surgical Nursing, 10th ed - Brunner & Suddarth

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