Knee is the largest joint in your body. It is a complex joint made of bone, cartilage and ligaments. The cartilage in the knee acts as a cushion and gliding surface. When healthy, the cartilage keeps the bones in the joint from rubbing together. However, when the joint is affected by arthritis, the bones make contact and cause pain. Injuries, aging and degenerative conditions such as arthritis can cause the cartilage to break down
Common Causes of Knee Pain
Osteoarthritis: Arthritis is a chronic condition that causes joint inflammation. Symptoms include redness, warmth, swelling, tenderness and pain.
Up to 40 percent of the population may have knee osteoarthritis, or “wear and tear” arthritis. This is the gradual breakdown of the cartilage in the knee. Also called degenerative joint disease, osteoarthritis usually develops over years and often is found in patients who have had a knee infection or injury and those who are overweight/
As cartilage wears away, the bones around it can grow thicker and develop bony spurs. This can lead to increased friction between the bones and disrupted movement in your knee. This also can lead to problems with the synovium, a membrane in your knee that produces a liquid to keep your cartilage slippery. This membrane can become inflamed and make too much fluid. This results in swelling, or “water on the knee.” In the most severe cases, the knee can become deformed as the continued friction wears away the bone. Common symptoms of osteoarthritis include pain, stiffness, tenderness, a limited range of motion and a grating sensation when you bend your knee. The pain is usually worse after activity.
Rheumatoid arthritis: Rheumatoid arthritis can affect joints on both sides of the body (both knees, both hands and/or both wrists). In rheumatoid arthritis, your body’s cells attack your own tissues. Rheumatoid arthritis affects three to five times more women than men and often presents between the ages of 20 and 50.
Over time, rheumatoid arthritis can cause cartilage to wear away, swelling in the synovium, and excess fluid in the knee. In later stages, bones can rub against each other.
Bursitis: Bursitis is the inflammation of any of the fluid-filled sacs (bursae) protecting the body’s joints. This is usually caused by repetitive motions or by a stress such as kneeling. Sometimes, a sudden injury can cause bursitis.
Tendonitis: The tendons – rope-like tissues connecting muscles to bone at the knee and other joints – can become painfully inflamed by repetitive and strenuous movement. Tendonitis is a common sports injury, caused by overuse of the same parts of the body. Patellar tendinitis, or “jumper’s knee,” is an inflammation or irritation of the tendon between the knee cap and the shin bone.
Patellofemoral pain syndrome (PFPS): Knee pain or discomfort while walking up and down stairs, jumping or squatting may be symptoms of patellofemoral pain syndrome. This common knee problem is felt toward the front of the knee. It can cause a grinding sensation when bending or straightening your leg, and can cause the knee to occasionally buckle. Sometimes called “runner’s knee,” patellofemoral pain syndrome may be caused by a kneecap that is not aligned properly, overuse, injury, excess weight or when the cartilage in the knee cap is worn significantly.
Injuries: Knee injuries can be the result of sports, falls or trauma. They typically involve the ligaments that hold two of the bones of the knee – the femur and tibia – together eg-ACL,MCL,& Meniscal injuries
How is Knee Pain detected?
A careful medical history which includes
• A description of knee pain (aching, tenderness, burning or swelling)
• Where the pain is located and when it occurs?
• When did the pain start(and if it is the result of an injury or accident )?
• Anything that makes the pain worse or better
Investigations Conducted for Knee Pain
X-rays, MRI, CT Scan
Knee Pain Treatment
Conservative care: Many types of knee pain can be relieved and/ or resolved with conservative treatments such as:
Rest: When the knee is injured or is inflamed, as in bursitis, tendonitis or arthritis, it’s important to rest the joint and avoid overuse. That may mean keeping the knee straight (extended) or in positions that limit bending.
Ice/heat: Applying ice or cold packs to the knee can reduce inflammation and swelling, especially after an injury. Once swelling is gone, heat may be used to help relax and loosen tissues – although ice is the primary treatment.
Pain relievers: Over-the-counter anti-inflammatory medicines can help relieve knee pain, including ibuprofen and naproxen
Weight loss: Lose weight to reduce pressure on the knees.
Braces: In general, knee braces wrap around the knee and leg and help limit unwanted movement while supporting the knee. They are commonly used when knee ligaments are weak, and help to keep the knee from “buckling.”
Injections in the Knee Joint: Potent anti-inflammatory agents can be injected inside the knee to reduce pain and inflammation. Ozone Gas can also be injected into the knee to reduce pain and inflammation. Another nonsurgical injection technique that can provide relief from knee pain is viscosupplementation. This treatment involves injecting a lubricant into the knee. The filler lubricates and adds cushioning to the joint, allowing bones to move more easily and reducing friction. It is a viable solution for mild to moderate OA.
Stem Cell/Platelet Rich Plasma (PRP) therapy: PRP therapy involves injecting platelets from the patient’s own blood to rebuild a damaged tendon or cartilage. It has been successful in not only relieving the pain, but also in jumpstarting the healing process. The patient’s blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage.
Physical therapy: Physical therapies can help you recover from the injury and decrease the pain you are experiencing. They may also include low-impact stretches and exercises that can strengthen muscles in your knee, improve stability and flexibility, and reduce pressure on the joint.
Surgical options: These includes partial and total knee replacements in case of OA or RA knee . In cases of injuries, we can go for arthroscopic or open repair.
Knee Pain Treatment Options available at DPMC
- Oral/Physical therapies
- Synvisc-One injections
- Platelet Rich Plasma/Stem Cell therapy
- Intra-articular Ozone Injections
- Radiofrequency lesioning knee joint