Knee Pains

Knee pains and injuries are very common problems. They are pain in the butt for most of us. Well any injuries are. This more so because I am and have been suffering with it for years. A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Because of the knee’s complexity, the number of structures involved, the amount of use it gets over a lifetime, and the range of injuries and diseases that can cause knee pain, the signs and symptoms of knee problems can vary widely.

Some of the more common knee injuries and their signs and symptoms include the following:

Ligament injuries. Your knee contains four ligaments — tough bands of tissue that connect your thighbone (femur) to your lower leg bones (tibia and fibula). You have two collateral ligaments — one on the inside (medial collateral ligament) and one on the outside (lateral collateral ligament) of each knee. The other two ligaments are inside your knee and cross each other as they stretch diagonally from the bottom of your thighbone to the top of your shinbone (tibia). The posterior cruciate ligament (PCL) connects to the back of your shinbone, and the anterior cruciate ligament (ACL) connects near the front of your shinbone. A tear in one of these ligaments, which may be caused by a fall or contact trauma, is likely to cause:

• Immediate pain that worsens when you try to walk or bend your knee
• A popping sound
• An inability to bear weight on the injured knee
• A feeling that the knee might buckle or give way

Tendon injuries (tendinitis). Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Athletes, such as especially runners, skiers and cyclists, are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the larger lower leg bone (tibia). If your knee pain is caused by tendinitis, some of the signs and symptoms include:

• Pain, in one or both knees
• Swelling in the front of the knee or just below the kneecap
• Worsening pain when you jump, run, squat or climb stairs
• An inability to completely extend or straighten your knee

Meniscus injuries. The meniscus is a C-shaped piece of cartilage that curves within your knee joint. Meniscus injuries involve tears in the cartilage, which can occur in various places and configurations. Signs and symptoms of this type of injury include:

• Pain
• Mild to moderate swelling that occurs slowly, as long as 24 to 36 hours after the injury
• An inability to straighten the knee completely; the knee may feel locked in place

Bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint. Bursitis can lead to:

• Warmth
• Swelling
• Redness
• Pain, even at rest
• Aching or stiffness when you walk
• Considerable pain when you kneel or go up and down stairs
• Fever, pain and swelling if the bursa located over your kneecap bone (prepatellar bursa) becomes infected

Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement — the effect is something like a pencil caught in a door hinge — leading to pain and a locked joint.

Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. You’ll be able to see the dislocation, and your kneecap is likely to move excessively from side to side. Signs and symptoms of a dislocated kneecap include:

• Intense pain
• Swelling
• Difficulty walking or straightening your knee

Osgood-Schlatter disease. Primarily affecting athletic teens and preteens, this overuse syndrome causes:

• Pain, usually worse with activity, especially running and jumping
• Swelling
• Tenderness at the bony prominence (tibial tuberosity) just below the kneecap

The discomfort can last a few months and may continue to recur until your teen or preteen stops growing.

Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome, which generally causes:

• A sharp, burning pain on the outer side of the knee that usually begins after longer distance runs
• Pain that initially goes away with rest from running, but in time may persist when you walk or go up and down stairs

With this type of knee injury, there usually isn’t swelling and you’ll likely have normal range of motion.

Hyperextended knee. In this injury, your knee extends beyond its normally straightened position so that it bends back on itself. Sometimes the damage is relatively minor, with pain and swelling when you try to extend your knee. But a hyperextended knee may also lead to a partial or complete ligament tear, especially in your ACL.

Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Rheumatoid arthritis. The most debilitating of the more than 100 types of arthritis, rheumatoid arthritis can affect almost any joint in your body, including your knees. Common signs and symptoms of rheumatoid arthritis include:

• Pain
• Swelling
• Aching and stiffness, especially when you get up in the morning or after periods of inactivity
• Loss of motion in your knees and eventually deformity of the knee joints
• Sometimes, a low-grade fever and a general sense of not feeling well (malaise)

Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — often alternate with periods of remission.

Osteoarthritis. Sometimes called degenerative arthritis, this is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age. Osteoarthritis usually develops gradually and tends to cause:

• Varying degrees of pain, especially when you stand or walk
• Swelling
• Stiffness, especially in the morning and after you’ve been active
• Creaking or popping sounds
• A loss of flexibility in your knee joints

Gout and pseudogout. Gout, a type of arthritis, is likely to cause:

• Redness.
• Swelling.
• Intense knee pain that comes on suddenly — often at night — and without warning. The pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving your knee joints apparently normal and pain-free.

Another condition, pseudogout (chondrocalcinosis), which mainly occurs in older adults, can cause:

• Severe inflammation
• Intermittent attacks of sudden pain and swelling in large joints, especially the knees

Chondromalacia of the patella, or patellofemoral pain. This is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in young adults, especially those who have a slight misalignment of the kneecap; in athletes; and in older adults, who usually develop the condition as a result of arthritis of the kneecap. Chondromalacia of the patella causes:

• Pain and tenderness in the front of your knee that’s worse when you sit for long periods, when you get up from a chair, and when you climb or descend stairs.
• A grating or grinding sensation may be present when you extend your knee.

When to see a doctor
If you have new knee pain that isn’t severe or disabling, a good rule of thumb is to try treating it yourself first. This includes resting, icing and elevating the affected knee, and sometimes using nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. If you don’t notice any improvement in three to seven days, see your doctor or a specialist in sports medicine or orthopedics.

Some types of knee pain require more immediate medical care. Call your doctor if you:

• Can’t bear weight on your knee
• Have marked knee swelling
• See an obvious deformity in your leg or knee
• Have worrisome pain
• Have a fever, in addition to redness, pain and swelling in your knee, which may indicate an infection

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