Knee Pain

Man with knee pain, arthrosis of the knee.

Introduction

Knee pain is one of the most common problems that sends people to seek care. The knee is a complex structure that helps distribute weight. It allows not only for flexing and extending the leg, but also rotation.  It is made up of 4 bones: the femur or thigh bone, the patella or kneecap, and 2 bones in the leg: the tibia and fibula.

The knee is held together by ligaments (which hold bones together), tendons that attach muscle to bone, and a shock absorber between the tibia and femur called the meniscus.  In addition, there are bursae which help cushion the knee.

Knee pain is caused by injury or overuse to any of these structures.


Treatment Options

Evaluated on the RESCU Rating Scale

R = Risk      E = Effectiveness      S = Self-Care

C = Cost     U = Usefulness (overall rating)

1 = Least Favorable     5 = Most Favorable

R E S C U
Physical Therapy  4  3   5   4 4
Braces 5 4 5 4 4
Laser 5 4 0 4 4
NSAIDs 2 3 5 3 4
PRP 4 4 0 2 4
Steroids 2 3 0 3 4
Manipulation 4 2 0 3 3
Knee Replacement 3 4 0 1 3
Arthroscopy 3 4 0 2 2

Knee Conditions

SEVERE PAIN OR TRAUMA

If you cannot bear weight on your leg, or have signs of infection such as fever, redness or severe swelling, you should go to the hospital to rule out a fracture (broken bone) or infection.

KNEE SPRAIN/STRAIN

These are common in sports, but there can be other causes.  Sprains and strains involve tearing of the ligaments (sprain) or muscles that support the knee.  Typically, they follow a sudden trauma, and are accompanied by swelling, pain and inflammation. A severe form of this problem includes rupture of a tendon or ligament, which is sometimes accompanied by a “pop” and severe pain and swelling.

OSTEOARTHRITIS

Over time, the meniscus that cushions the space between the tibia and femur can wear down, affecting those bones as well, resulting in “wear and tear” arthritis to the knee.  In time, this can lead to bone-on-bone arthritis, but even mild arthritis can be painful and limit movement. It affects nearly 30 million people or almost 25% of the adult population in the US.

OSGOOD-SCHLATTER DISEASE

When we are young and still growing, people, especially teens, can develop a painful bump over the tibia just below the kneecap, where a tendon attaches muscles to the legbone. It is usually related to overactivity, such as running or jumping on a trampoline.

MENISCUS TEAR

The cartilage between the tibia and femur can become damaged or torn due to a sudden trauma, like a twisting injury, or from repetitive small traumas over time.  Parts of the torn meniscus can become stuck between the bones, producing a “catching” sensation in the knee as well as pain and swelling. 

BURSITIS

A bursa is a small fluid filled sac that prevents injury when different structures of the knee slide past each other, or protect the kneecap from pressure, such as with kneeling. When injured they can become inflamed and swollen. It is sometimes called “nursemaid’s knee” or “preacher’s knee.

ILIOTIBIAL (IT) BAND ISSUES

Common among runners, this is due to injury of the tough fibrous tissue that runs from the hip to the outside of the thigh and leg. When overused, the band can become painful and swollen.

Knee Pain Symptoms

Acute injuries and even chronic injuries typically produce pain, swelling, and limitation in the ability to bend or extend the foot.  Significant redness may indicate possible infection, and if you cannot put any weight on the leg, there may be a fracture.  Both of these circumstances indicate a need to get checked at the hospital or an urgent care center.

Diagnosis of Knee Pain

Your provider will have a pretty good idea of what is wrong with your knee based on your history and a clinical examination. This will include palpating or feeling the area of pain, how well you can move your knee, and specific orthopedic tests. Typically, these stress specific tissues, such as the meniscus, and if they cause pain help to pinpoint the problem.

He or she may obtain x-rays to rule out a fracture, and if the problem persists despite rest and treatment, or if the injury is severe, will obtain an MRI to evaluate the soft tissues, including the tendons, muscles, ligaments and meniscus.

First Line Treatment for Knee Injuries

First line treatment is based on the acronym PRICE. It stands for:

  • Protect: Stop doing the things that cause pain! Use pads for example if you must kneel frequently.
  • Rest: Give your knee a chance to heal. Most knee injuries involve inflammation, where certain chemicals that are part of the healing process are released. Continuing to do the same activities causes further inflammation, which can result in additional damage and chronic knee pain. 
  • Ice:  Ice can reduce pain and swelling. It can be used in both acute and chronic knee pain.  You can use a store-bought ice pack, or a bag of frozen peas or corn. Typically, this is done for 20-30 minutes 3-4 times a day. The common recommendation is to put ice on the area for 20 minutes, then remove ice for 40 minutes.
  • Compress:  wearing an Ace wrap or neoprene sleeve, or a brace helps protect the knee, limit movement and provide support.
  • Elevate:  Swelling often accompanies knee injuries, and elevating the knee allows gravity to help move that extra fluid out of the injured area., especially if the knee is higher than the heart.   Prop your leg up on pillows.

Specific Treatment Options 

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