Knee Pain Overview
Chronic Knee Pain
Arthritis: Arthritis of the knee is an inflammatory disorder of the knee joint that is often painful. Arthritis has many causes.
- Description: Osteoarthritis (OA) is caused by degeneration of cartilage in the knee. In its extreme form, the menisci (cartilage) will be completely eroded, and the femur will rub on the tibia, bone on bone.
- Symptoms: Osteoarthritis causes a chronically painful knee that is often more painful with activity.
- Treatment: Treatment is aimed at pain control with over-the-counter pain relievers. Anti-inflammatory medications, either over-the-counter, or by your doctor's prescription, are also quite helpful. More severe OA can be treated with narcotic pain medicines or a knee joint replacement in which a synthetic joint replaces your knee joint.
Rheumatoid Arthritis of the Knee
- Description: Rheumatoid arthritis (RA) is a connective tissue disease of the whole body that affects many joints often including the knee. People who have this disease often have family members who suffer from it as well.
- Symptoms: In addition to knee pain, rheumatoid arthritis may produce morning stiffness and pain in other joints.
- Treatment: Treatment includes pain medications, anti-inflammatory medications, and prescription drugs (such as Rheumatrex (methotrexate)) aimed at slowing disease progression.
Crystalline Arthritis (gout and pseudogout)
- Description: These severely painful forms of arthritis are caused by sharp crystals that form in the knee and other joints. These crystals can form as a result of defects in the absorption or metabolism of various natural substances such as uric acid (which produces gout) and calcium pyrophosphate (pseudogout).
- Treatment: Treatment is aimed at controlling inflammation with anti-inflammatory medications, and at aiding the metabolism of the various chemicals that may lead to crystal formation.
- Description: As a result of trauma, infection, or crystalline deposits, the various bursae of the knee may become inflamed.
- Symptoms: Acute or chronic trauma causes a painful and often swollen knee from the inflammation of the bursae. A particularly common bursitis is prepatellar bursitis. This type of bursitis occurs in people who work on their knees. It is often referred to as housemaid's knee or carpet layer's knee. Another type of bursitis is anserine bursitis. The anserine bursa is located about 2 inches below the knee along the medial side of the knee. More commonly occurring in the overweight and in women, but also affecting athletes and others, anserine bursitis often causes pain in the region of the bursa and is often worse with bending the knee or at night with sleep.
- Treatment: Treatment will usually include home care with PRICE therapy and NSAIDs. Severe forms, however, can be treated with periodic steroid injections to the
Infection (or infectious arthritis)
- Description: Many organisms may infect the knee. Gonorrhea, a common sexually transmitted disease, can infect the knee, as can common organisms residing on normal skin.
- Symptoms: Infection of the knee causes painful knee swelling. In addition, people who develop such infection typically complain of fevers and chills. Less severe infections may not have associated fevers or cause this ill feeling.
- Treatment: New swelling and pain in the knee must be evaluated for infection based on your doctor's opinion. Treatment usually includes intensive antibiotic therapy and may include aspiration of the joint, or surgical drainage of the infection.
Patellofemoral Syndrome and Chondromalacia Patella
- Description: These 2 conditions represent a spectrum of disease caused by patellar mistracking.
- Symptoms: The condition typically occurs in young women and also in athletes of both sexes and elderly people. In patellofemoral syndrome, the patella rubs against the inner or outer femur rather than tracking straight down the middle. As a result the patellofemoral joint on either the inner or outer side may become inflamed causing pain that is worse with activity or prolonged sitting. As the condition progresses, softening and roughening of the articular cartilage on the underside of the patella occurs, and the syndrome is referred to as chondromalacia patella.
- Treatment: Home care with PRICE therapy, NSAIDs, and exercises (such as straight leg raises) that balance the muscles around the patella work for most people. Others may benefit from bracing or taping of the patella, commercial arch supports (for the arch of the foot), or orthotic supports that correct foot mechanics and may reduce abnormal forces on the knee. Severe cases of patellofemoral syndrome or chondromalacia may be treated surgically through a variety of procedures.
- Description: Tendonitis (inflammation of the tendon) of the quadriceps tendon at the upper point of the patella, where it inserts, or tendonitis of the patellar tendon either at the lower point of the patella, or at the place where it inserts on the tibia (called the tibial tuberosity, the bump about 2 inches below the knee on the front side), is termed jumper's knee. Jumper's knee is so named because it is typically seen in basketball players, volleyball players, and people doing other jumping sports.
- Symptoms: Jumper's knee causes localized pain that is worse with activity. It usually hurts more as you jump up than when you land because jumping puts more stress on tendons of the knee.
- Treatment: Home therapy with the PRICE regimen together with anti-inflammatory drugs is the basis of treatment. Particularly important are rest, ice, and NSAID drugs, which will help stop the pain and break the cycle of inflammation. After controlling the pain, you should slowly start an exercise regimen to strengthen the quadriceps and hamstring muscles and resume your sport of choice a few weeks down the line. Also, bracing of the extensor mechanism may help remove stress from the tendons.
- Description: Osgood-Schlatter disease occurs in adolescent athletes where repetitive extension of the knee causes inflammation and injury of the tibial tubercle (the bony protrusion at the top of the shin, just below the kneecap).
- Symptoms: Children suffering from this syndrome report pain at the tibial tubercle. This pain is typically worse when extending the leg. The tibial tubercle is tender to touch and over time begins to protrude more because the chronic inflammation stimulates the bone to grow.
- Treatment: Osgood-Schlatter disease is a self-limited condition that usually resolves as the the tibial tubercle stops growing with the end of adolescence (at about age 17 years in males and age 15 years in females). Treatment includes PRICE and NSAID therapy. In severe cases, splinting the knee for a few weeks may help reduce the pain and halt the inflammation cycle.
Iliotibial Band Syndrome
- Description: A fibrous ligament, called the iliotibial band, extends from the outside of the pelvic bone to the outside of the tibia. When this band is tight it may rub against the bottom outer portion of the femur (the lateral femoral condyle).
- Symptoms: Distance runners typically suffer from this condition. These runners complain of outside knee pain usually at the lateral femoral condyle. Early on, the pain will typically come on 10 minutes to 15 minutes into a run and improve with rest.
- Treatment: The most important aspect of treating iliotibial band syndrome is to stretch the iliotibial band. One way to do this is to place the right leg behind the left while standing with your left side about 2 feet to 3 feet from a wall. Then, lean toward your left for 20 to 30 seconds using the wall to help you support yourself. In addition to stretching the iliotibial band, PRICE therapy and NSAIDs may be of some help.