Knee Pain: Causes, Signs, Symptoms, Diagnosis and Treatment, When To See Your Doctor? - Page 6 of 8

Knee pain is one of the commonest complaints that humans experience. This, along with headaches, anal canal conditions, difficult labor and neck pain are the side effects of us standing on two limbs. Our knees carry the entire weight of our bodies and are, therefore, subject to immense stress and risk of injury. Although knee pain is usually easily manageable, the pain itself can be disabling, and patients may stay in bed or seated to avoid the pain that walking brings. Taking good care of our knees will ensure that we keep our mobility for the longest time possible. In this article, we will discuss knee pain, its symptoms, possible causes, diagnosis, treatment including some home remedies, and when you should see your doctor regarding your knee pain.

Understanding our knees – Thelifetoday.com

Our knees are synovial joints, which means that they are junctions between two bones with the space in between filled with a certain fluid for lubrication and surrounded by a capsule. The knee joint is the junction between three bones, an upper long bone called the femur (thigh bone) and a lower bone called the tibia (shin) with a thinner lower one called the fibula. The front of our knee is formed of a special bone called the patella. This bone helps make bending our knees more efficient by acting as a lever. Our knees also contain two crescent-shaped cartilages called menisci -the singular is meniscus-. They act as shock absorbers for our weight during activities like running or jumping to avoid damaging the cartilage lining the joint.

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Several muscles help move our knees including the main extensor muscle, the quadriceps femoris, which means the four-headed muscle, and the flexor muscles which are collectively known as the hamstrings. They are the largest muscles in our bodies and are incredibly strong.

What causes knee pain?

The commonest causes of knee pain are aging, and stress related to injury or increased weight. The cartilage lining our joint can become injured or the muscles and tendons surrounding it can be injured.

Osteoarthritis

Osteoarthritis is one of the commonest causes of knee pain. It usually occurs in the elderly and overweight individuals. The cartilage lining our knee joint becomes eroded either as a result of aging or constant stress. Overweight individuals tend to have worn-out cartilage at a younger age because of the constant stress that weight puts on the knees. Osteoarthritis is a chronic condition, but it is treatable.
Sprained ligaments: Our knees are surrounded by ligaments for support, some of the ligaments are located within the knee joint cavity and are called the cruciate ligaments. Others surround the knee from the outside and are called the collateral ligaments. Ligaments can be strained by sudden extreme movements of the leg. They are usually mild and resolve rapidly.
Torn ligaments: Torn ligaments can occur if a more severe stress is applied to ligaments. The most common ligaments to be torn in the knee are the cruciate ligaments. This can occur when you overextend your knee or fall with your knee fully extended. It is one of the commonest injuries in football.
Tendonitis: The muscles moving our knee joint are very sturdy, yet over exertion can cause inflammation in their tendons, a condition known as tendonitis. It is a self-limited condition.
Bursitis: Bursa are small fluid-filled sacs surrounding our tendons and joints. They act as shock absorbers and cushions for muscles to slide over and reduce friction. Yet they can get inflamed and cause severe pain. It is also a self-limited condition that gets better with rest.
Torn cartilage (menisci): The crescent-shaped menisci can be torn if severe stress is exerted on them, mostly in excessive sports or in direct trauma to the knee. This is usually a treatable condition, but if the stress persists or if adequate treatment is not given, the condition can become chronic.

Autoimmune arthritis

Several autoimmune diseases including rheumatoid arthritis, systemic lupus and ankylosing spondylitis can involve the knee joint, causing pain and immobility. These conditions commonly affect other joints and may affect other body systems as well such as the cardiovascular, respiratory or urinary systems.
Joint infection: Joint infection is rare, since the knee joint is separated from the surroundings by tough tissue and capsule, but if these natural defenses are breached, as in case of penetrating trauma, severe infection can occur. Joint infection needs rapid identification and treatment, or rapid joint destruction can occur.
Bone fracture: Bones forming the knee joint are the thigh bone (femur) and the shin bone (tibia). Both of those bones are strong, but they are subject to injury and fractures can occur. Tibial plateau fractures are more common and can cause severe pain and bruising of the knee joint.
Gout: Gout is the accumulation of uric acid crystals -which originate from the metabolism of proteins- in the capsule of a joint. This condition is known as gouty arthritis, and commonly affects smaller joints like those of the toes and fingers. However, the knee joint can be affected in severe cases. It commonly occurs in the form of recurrent attacks of incapacitating pain following meals that contain red meat or in heavy coffee and tea drinkers.
Bone cancer: Bone cancer is a rare cause of joint pain. It commonly affects children and young adults and is very rare after 30 years old. Classical symptoms include bone pain around the knee joint with the presence of a hard swelling and overlying redness and tenderness.

Symptoms of knee pain

Symptoms of knee pain include:

Inability to fully flex or extend the knees without considerable discomfort or pain.
Pain that increases on movement and improves on rest.
Swelling and redness of the knee.
In some autoimmune conditions such as rheumatoid arthritis, knee pain is maximal on rest and improves with movement. It is also associated with incapacitating morning stiffness.
Locking: Locking is a common symptom of meniscal tears. It means that your knee can get stuck in a flexed or extended position for some time with you not being able to move it. If you try to force it using your arms or knee thigh muscles, severe pain will result.
Giving way: Giving way is a symptom of ligament tears especially cruciate ligaments. It means that your leg can suddenly flex from under you while standing or walking, affecting you balance and potentially causing falls.
Popping sounds while moving your knee: They usually occur in osteoarthritis when the rough, worn out cartilage rubs against each other. It is worth noting here, though, that many cases of popping sounds while using your knees is not a result of osteoarthritis and can be normal.

Treatment of knee pain

Knee pain has different causes as mentioned before, and a single treatment for all conditions is not practical. Most cases, however, are mild and can be treated at home using the following home remedies:

Rest: This can’t be stressed enough. Our bodies heal by themselves in most cases, and in cases of ligament sprains, tendonitis, bursitis and any inflammation from overexertion, the main treatment is to allow your body to rest and heal.
Ice packs: Ice packs can help reduce the swelling and inflammation especially in cases of injuries and acute inflammation, thus relieving pain.
Elevating your leg: Gravity helps increase swelling, and counteracting it reduces swelling and inflammation. This is especially true during sleep. Elevating your leg on one or two pillows while sleeping can sometimes do miracles since swelling can also hinder the body’s ability to control the inflammation which is maximal at night while sleeping.
Compression: Sometimes, applying moderate compression on the swelling can help reduce the pain and improve healing. Do not over compress your joint, though, lest you should cut off the circulation to your foot if you occlude your arteries.

The above regimen is called the RICE regimen and is the optimal treatment of all inflammatory joint pain.

Gradual exercise: Once the pain starts diminishing, gradual exercising is a must to return to optimal joint health, just remember not to overstress it while it is healing.
Topical anti-inflammatory ointments: Many ointments are available for pain relief. They are applied directly over the inflamed joint and can cause rapid pain relief. They commonly contain salicylates.
Oral pain relievers: In some cases, some systemic pain relief is a must. The best pain reliever is Paracetamol for use at home. Other over-the-counter medications like Aspirin, Diclofenac and Ketoprofen are not safe for prolonged use and should only be used as prescribed by your doctor. One of the commonest mistakes that people with joint pains do is using these pain killers on their own, exposing themselves to stomach and kidney damage.

When to see your doctor?

Although most cases of knee pain are benign and can heal on their own, there are some red flags that you should look for and they include:

Knee pain that is associated with a mass: Although most masses associated with knee pain are those of the surrounding inflamed bursae -plural of bursa-, a mass associated with knee pain or tenderness should alert you to visit your physician.
Knee pain that is associated with an open wound: If you injured yourself and an open wound is present, visiting your doctor is a must to receive adequate wound care and avoid the complications of joint infection.
If it lasts for a long time: Usual inflammatory joint pain should resolve within a week or two. If it lasts for more, then it is unlikely to resolve on its own and a doctor’s consultation is a must.
If multiple joints are affected: This is especially true if you are a female in your twenties to forties since it is the age of autoimmune diseases. Visiting a doctor when you feel pain in multiple joints, particularly the small joints of your hands and feet can help diagnose and manage the condition as early as possible.
If your knee is giving way or locking: Those symptoms are of ligament or meniscal tears, and adequate medical treatment is a must in these cases to avoid chronic injury which is much harder to treat.
If you develop fever: Fever is a sign of systemic inflammation, and if you develop a fever with your knee pain, it can be a sign of infective arthritis. The other possibility is that it might be a part of an autoimmune condition. Both cases need professional medical care.
If you have severe bruising: Bruising is a common finding in knee pain. It is usually due to the trauma that caused knee pain in the first place. However, severe bruising can mean that a more severe injury has occurred and bleeding within the joint or bone fracture is likely.

Treatment options for osteoarthritis

Osteoarthritis management is essential knowledge for all physicians. The prevalence of the condition and its chronic nature necessitates a gradual approach in its management to avoid using unnecessary medications or intervention. Currently the used regimens include:

Exercise programs: Exercise is essential to strengthen the muscles of the knee joint. Strong muscles mean less stress on the joint and less pain. Patients are instructed to walk at least half an hour 5 times a week.
Analgesics: Analgesics are used cautiously and in a gradual manner to avoid their side effects on the kidney and stomach. Patients who have to take high doses of analgesics for a long time should get their kidney functions checked and should receive protection against stomach ulcers.
Joint injections: Joint injections with steroids or hyaluronic acid are other options in these patients. Pain relief can last for up to 6 months.
Joint wash: Joint wash is a procedure done to clean the joint from debris and inflammatory chemicals. This procedure helps reduce pain considerably.
Joint replacement surgery: It is the last resort in osteoarthritis cases

Do all patients with arthritis need to replace their knees?

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Knee replacement surgery involves removing the diseased cartilage and replacing it with an artificial joint material. Knee joint replacement is the final solution to osteoarthritis and is only resorted to in cases where analgesics, joint injections and all other medical therapies fail to control the condition. Many patients suffering from osteoarthritis go through life without needing to replace their joints. Even those who need to replace the joint can only replace half of it if the other half is relatively healthy. People who replace their joints immediately feel great pain relief especially after suffering for years from intolerable pain.