About Knee Pain

Knee pain is one of the most common musculoskeletal complaints when making visits to the doctor. The pain can originate either from within the knee joint or outside the knee joint.  Within the knee joint, any of the bony structures compromising the joint (femur, tibia, fibula), the kneecap (patella) or the ligaments, tendons and cartilage (meniscus) of the knee, can be injured, causing inflammation and pain. Physical activity can aggravate the pain, and it can also be triggered by other problems such as back conditions or foot injury. This condition can affect people of all ages, and many-a-times, home remedies can be helpful unless it becomes severe.

The number of knee problems has been on the rise as the factors contributing to knee pain increase. The causes of such localised pain are varied: it can be from a sudden injury due to a torn cartilage or a ruptured ligament, an overuse injury, or by an underlying condition, such as arthritis gout and infections. Treatment administered is dependent on the cause.

Knee Pain Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and others.
Injuries
Some of the more common knee injuries include:

ACL injury

This happens when the anterior cruciate ligament (ACL- one of four ligaments that connect your shinbone to your thighbone) suffers from a tear. People who frequently play basketball, soccer or other sports that require sudden acceleration-deceleration and changes in direction may commonly experience this.

Depending on the severity of the injury, it can range from a simple sprain to a complex tear.  In an ACL tear, the painful knee will often have swelling of the knee as well as instability of the knee whenever walking, running or climbing stairs.

  • Fractures

Falls and motor accidents may cause bones of the knee, including the kneecap (patella), to be broken. Osteoporosis, which weakens the bones, adds increased risks as one can sustain a fracture just by making a wrong step.

Knee fracture can happen innocuously without any significant trauma in severe osteoarthritis of knee.  This type of pain is constant throughout, making weight-bearing very difficult on the painful knee.

  • Torn meniscus

The meniscus is a tough, rubbery cartilage which acts as a shock absorber between your shinbone and thighbone. When carrying heavy objects, the meniscus can tear through sudden twists or movements.

Meniscus pain can present similar tofracture pain.  It is difficult to initiate standing and walking.  It can present as locking of knee when standing after being seated for some time.

  • Knee bursitis

The bursae containssmall fluid-filled sacs that provides cushioning to the knee joint. They also allow tendons and ligaments to glide over the joint smoothly. Knee injuries can cause inflammation in the bursae, leading to pain and discomfort.

The knee becomes progressively more painful if patient walks or stands more.  The pain is usually on the inner or middle part of the knee.

 

  • Patellar tendinitis

Sports enthusiasts who run, ski, cycle or frequently take part in jumping sports are prone to developing inflammation in the patellar tendon. This tendon is a connection for the quadriceps muscle that lies on the front of the thigh to your shinbone. When tendinitis occurs, one or more of your tendons gets irritated and inflamed.

Mechanical problems
Mechanical problems can also cause pain, they include:

  • Loose body

A piece of bone or cartilage may end up breaking off and floating in the joint space after injury or degeneration. Although this phenomenon is in itself harmless, it will cause pain when the loose body interferes with knee joint movement. It can present as a locking knee which has jammed up the movement of the knee. Depending on where the loose body is located, it can have pain-free intervals interspersed with sudden pain.

 

  • Iliotibial band syndrome

When the tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your femur, this syndrome occurs. Those who run long or cycle for long distances tend to be especially susceptible.

This type of pain can be mistaken as radicular pain from buttock to lateral part of the affected knee. It is the pulling and tightness of left lateral thigh.

  • Dislocated kneecap

A kneecap dislocates when the triangular bone (patella) that covers the front of your knee slips out of place, frequently to the outside of your knee. Sometimes you can see the dislocation under the skin.

  • Hip or foot pain

When you have hip or foot pain, you may change the way you walk to avoid pain. However, this in turn places stress on other areas, such as your knee joint. Over time, the knee will degenerate with the increased unequal loading pressures on the knee, resulting in meniscal or cartilage injury.

Types of arthritis

There are numerous types of arthritisbut these are the more common varieties:

  • Osteoarthritis

Also known as degenerative arthritis, this is the most common type of arthritis. Especially common with old age, this happens after the cartilage in your knee deteriorates with use and wear-and-tear.

As one ages, the synovial fluid (lubricant) dries up.  This increases friction between the articulating cartilage surfaces of the knee joint.  The friction will cause accelerated wearing off of the cartilage, resulting in cartilage thinning and loss. Once the protective layer of cartilage is breeched, the underlying bone will swell and inflame with any seemingly harmless weight bearing activities on the knee.

 

If untreated, the ongoing degeneration of the knee will result in destruction of the knee joint, resulting in pain, swelling and deformity of the knee.  This will restrict the normal function of the knee, making it difficult to stand, walk or climb stairs.

  • Rheumatoid arthritis

This is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.This is part of the systemic condition affecting many body organs/joints.

Similar to osteoarthritis, the inflammation and end-result of joint destruction is the same. The major difference is that this is immune-mediated and not due to age degeneration.

  • Gout

Uric acid crystals build up in the joint to form gout. Most people experience it in the big toe, but it can also occur in the knee.The excessive uric acid build-up in the body accumulates in the knee joint causing an severe inflammatory reaction.

The knee is often red and swollen. It is painful even to non-weight bearing activities such as bending or extending the knee joint while lying in bed.

  • Pseudogout

Pseudogout is often mistaken for gout but it is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.  It has similar inflammatory signs to gout but the uric acid levels are not elevated.

  • Septic arthritis

The symptoms of this condition is when your knee joint can become infected, leading to swelling, pain and redness. It often occurs with a fever, and there’s usually no trauma before the onset of pain. Septic arthritis can quickly cause extensive damage to the knee cartilage. If you have knee pain with any of these symptoms, see your doctor right away.

This infective cause of painful knee is potentially dangerous and it can progress to systemic sepsis (generalised infection of the body), causing harm to other body organs.  In severe localized septic arthritis, it can even result in loss of limb such as amputation of the leg to save the patient.

Other problems

Patellofemoral pain syndrome is generally used to refer to pain arising between the kneecap (patella) and the underlying thighbone (femur). It’s common in athletes; in young adults, and in those who have a slight maltracking of the kneecap; Older adults experience this condition too, as a result of arthritis of the kneecap.

Symptoms of Knee Pain

Due to the varied causes of knee pain, the location and severity of the pain may vary. However, you can watch out also for accompanying signs and symptoms that include:

  • Swelling and stiffness
  • Popping or crunching noises
  • Inability to fully straighten the knee
  • Redness and warmth to the touch
  • Weakness or instability
  • Pain when putting weight on the knee
  • Pain when walking, standing or squatting

Important Take-home Message

Knee pain may or may not be serious. However some conditions such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. Knee injuries, even minor ones, will predispose you to similar injuries in the future.

Diagnosing Knee Pain

Your doctor will first perform these tests on you:

  • Inspect for swelling, pain, tenderness, warmth and visible bruising on your knee
  • Evaluate how far you can move your lower leg in different directions
  • Push on or pull the joint to check the integrity of the structures in your knee

Your doctor may further evaluate through these tests:

  • X-ray

An X-raycan help detect bone fractures and degenerative joint disease.

  • Computerised tomography (CT) scan

CT scans can help diagnose bone problems and subtle fractures. A special kind of CT scan can accurately identify gout even when the joint is not inflamed.

  • Ultrasound

Sound waves are used to produce real-time images of the soft tissue structures within and around your knee. During the ultrasound, your doctor may move your knee into different positions to check for specific problems.

  • Magnetic resonance imaging (MRI)

This test, uses radio waves and a powerful magnet to create 3D images of the inside of your knee, is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.

  • Joint Aspiration/Blood tests

Infection or inflammation can be detected through blood tests and/or sometimes a procedure called arthrocentesis. A needle is inserted into the swollen knee, a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis.

When Should You Seek Medical Care?

You should seek medical help when:

  • You can’t bear weight on your knee or feel as if your knee is unstable (gives out)
  • Have marked knee swelling
  • Are not able to fully extend or flex your knee
  • Have affected sleep due to painful knee
  • Notice an obvious deformity in your leg or knee
  • Experience a fever, in addition to redness, pain and swelling in your knee
  • Experience severe knee pain that is associated with an injury

General Treatment of Knee Pain

After proper diagnosis, the doctor will be able to effectively treat the problem. However, there are some common methods of knee pain treatment.
The non-surgical treatment for knee pain can include:

Physical therapy
Strengthening exercises will help build up the muscles around your knee to make it more stable. A physiotherapist will be able to advise on the specific types of exercise that will be based on the condition causing your pain. If you are physically active or practice a sport, the therapist will guide you to use exercises to correct movement patterns that may be affecting your knees and to establish good technique during your sport or activity. They may sometimes include exercises to improve your flexibility and balance.

 

The therapist will recruit and strengthen weakened muscles to compensate the specific painful area of the knee, offloading the pressure on the injured area of the knee.

Using support

It is recommended to use supports and braces toshiftpressure away from the knees, which is most affected by osteoarthritis. Sometimes, different types of braces may be used to help protect and support the knee joint.

Injections
Getting knee injection in Singapore is generally more common now. Medications or other substances may be injected directly into your joint for treatment. Such instances include:

  • Corticosteroids

A corticosteroid drug may be injected into your knee joint to help reduce the symptoms of an arthritis flare, while providing pain relief that may last a few weeks.

  • Hyaluronic acid

In order to lubricate your joints, hyaluronic acid can be injected into your knee to improve mobility and ease pain. Effectiveness may vary across individuals but relief from one to a series of shots have been said to last as long as six months to 3 years.

Depending on the severity of the arthritis of knee, the outcome of the visco supplement injections may be as follows:

  1. Early arthritis: 5 years sustained outcomes
  2. Moderate arthritis: 2 – 5 years
  3. Late arthritis: 6 months or less

 

  • Platelet-rich plasma (PRP)

This plasma can enhance healing  through its concentrated growth factors.These types of injections are more effective for those whose knee pain is caused by tendon tears, sprains or injury.
Surgery
It is important to consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction before deciding to go under the knife. If you choose to have surgery, your options may include:

  • Arthroscopic surgery

Afiber-optic camera and long, narrow tools are inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage (especially if it is causing your knee to lock) and reconstruct torn ligaments.It also cleans up the inflamed area and hence alleviates the pain. However, this does not reverse the degeneration.

  • Partial knee replacement surgery

Here, only the most damaged portion of your knee are replaced with parts made of metal and plastic. The surgery can usually be performed through small incisions, so you're likely to heal more quickly than you are with surgery to replace your entire knee.

  • Total knee replacement

Your damaged bone and cartilage from your thighbone, shinbone and kneecap are replaced with an artificial joint made of metal alloys, high-grade plastics and polymers.  These implants last from 8 years to 12 years.  Afterwards, the degeneration will cause implant fatigue and wear.  Another new implant may be needed to replace the old one in selected patients.

Lifestyle and home remedies
You can get over-the-counter anti-inflammatory medications such as paracetamol andibuprofen to help relief knee pain. Many OTC pain relief creams contain methanol to cool the skin and surrounding tissue, giving limited relief.

Other specificprescriptive paincreams contain a numbing agent or analgesic, such as lidocaine, salicylate or capsaicin might be more effective andmore targeted at reducing pain and swelling.

Some home remedies include:

  • Rest

Cut down on activities that will cause repetitive strain on your knee and give it time to heal and prevent further damage. A day or two of rest may be all you need for a minor injury. More severe damage is likely to need a longer recovery time.

  • Ice

Ice is helpful in reducing both pain and inflammation. You can try using a bag of frozen peas because it covers your whole knee. Alternatively, you also can use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don't use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin.

  • Heat

A heat pack or hot water bottle can give you temporary pain relief when applied to the painful area on your knee.

  • Compression

Look for a compression bandage that's lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation. This helps prevent fluid build-up in damaged tissues and maintains knee alignment and stability.

  • Elevation

To help reduce swelling, try propping your injured leg on pillows or sitting in a recliner.  Keeping the knee slightly bent at rest is more effective than keeping the knee straight.

Alternative medicine

  • Glucosamine and chondroitin

These supplements are usually taken to relieve osteoarthritis pain. The clinical data has been non-conclusive regarding its use. Different papers have shown differing outcomes.

  • Acupuncture

This traditional Chinese method involves the placement of hair-thin needles into your skin at specific places on your body. Research suggests that acupuncture may help relieve knee pain caused by osteoarthritis.

Prevention

It may be difficult to prevent knee pain but some careful measures can be taken to forestall injuries and joint deterioration:

  • Maintain a healthy weight

Making sure that your knees doesn’t experience a strain in supporting your weight is the best thing you can do to keep them healthy.  Weight reduction has been shown to be the single more important variable in the outcome of knee arthritis management.  Every kilogramme above the target BMI for the individual increases 4% loading stress on the degenerated knee.  One should aim to work towardsthe target BMI for each individual.

 

  • Condition yourself for your sport

Work with a coach or trainer to prepare your muscles for the demands of sports participation, thus ensuring that your technique and movement are the best they can be.  Before you develop arthritis of the knee, knee-strengtheningexercises such as climbing steps, stairs and jumps are helpful in building strength and integrity of the knee. These sports would not be applicable for those who have developed arthritis and degeneration of the knee.

  • Get strong, stay flexible

Weak muscles are a leading cause of knee injuries. That said, build up your quadriceps and hamstringswhich support your knees. Work on your balance and stability to help the muscles around your knees work together more effectively. Include flexibility exercises and stretching in your workouts because tight muscles also can contribute to injury.

  • Choose your exercises

If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you work out. Consider swimming, water aerobics or other low-impact activities. Simply limiting high-impact activities will sometimes provide relief.

Ask a Question

Singapore Paincare Center
Paragon Medical Centre
290 Orchard Road #18-03
Singapore 238859


Tel
+65 6235 6697


Fax
+65 6235 6846


Email Address
enquiries@paincarecenter.com.sg


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Singapore Paincare Center @ Novena
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #07-33
Singapore 329563


Tel
+65 6734 4500


Fax
+65 6684 0773


Email Address
enquiriesnovena@paincarecenter.com.sg


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