Knee Pain

The knee is one of the most easily injured parts of the body. The largest and most complicated joint, the knee is used for everything from standing up and sitting down, to walking, running, etc. It is a weight-bearing joint that straightens, bends, twists and rotates. All this motion increases your risk of acute or chronic knee pain.

Types of knee pain

Knee pain can be categorised as either:

• immediate (acute) pain or
• long-term (chronic) pain.

Acute knee pain
This may be the result of fractures, knee dislocation and ligament tears. Fractures cause sudden pain, swelling and an inability to bear weight on the limb that is affected. Acute dislocation of the knee is a severe injury which requires immediate medical attention. Sprained and torn collateral ligaments can also cause acute knee pain and is often a result of accident while playing contact sports. You may also notice knee instability and swelling and even feel pain strong enough to make you feel like vomiting.

If the acute knee pain is caused by a complete tendon rupture, which causes severe pain, you will be unable to extend your knee. This can lead to permanent disability if the tendon rupture is left untreated. If your patella (kneecap) is out of place, facing either upward or downward, it may be dislocated, particularly if you are suffering severe pain and your knee appears to be deformed. If your knee locks in a particular position and swells badly, there is a chance you may have a meniscal injury, which can also cause acute pain.

Chronic knee pain
This may be caused by Osteoarthritis, and activity will aggravate the pain. In addition to the knee pain, in Rheumatoid arthritis, morning stiffness or pain in other joints may be experienced. Crystalline arthritis (gout and pseudogout) may also be the cause of your chronic knee pain.

Other causes of chronic knee pain include Bursitis, common in overweight women and people who work on their knees. It also affects athletes. Other sports-related knee conditions include Iliotibial band syndrome and Jumper's knee. Iliotibial band syndrome is an external knee pain, often a complaint of distance runners. Jumper's knee, which is a localised pain, hurts more when you jump and land.

If the pain is due to an infection, then you will experience painful knee swelling and possibly even fever and chills. Some diseases cause knee pain. In Osgood-Schlatter disease, children complain of pain a few inches below the knee and their knees are tender to touch. Patellofemoral syndrome and chondromalacia patella are conditions that are likely to occur in young women, athletes and the elderly where pain is caused more with activity or prolonged sitting.

Diagnosis

Medical background
When diagnosing the pain in your knee, the doctor will want to know the exact nature of the pain. So, he might ask where exactly in the knee your pain is, what it feels like, if it's happened before and if anything makes the pain worse or better. He will also need to know about any medical problems, your lifestyle and medication you might be taking. The doctor may confirm the diagnosis by performing examination and/or by taking X-rays.

Examination

The doctor will do a physical examination of your knee after obtaining your health background by pressing around the knee to search for tender spots. He may perform manoeuvres to stress the ligaments, tendons and menisci of the knee to evaluate the severity of the pain.

Medical Imaging
Depending on your background and the examination, the doctor may suggest one of the following medical imaging of your knee:

X-ray
This will show bones fractures and dislocations as well as arthritic changes and abnormally large or small joint spaces.

CT Scan
Your doctor may order a CT scan (a 3-dimensional x-ray) of the knee to accurately define a fracture or deformity.

MRI Scan
While both X-rays and CT scans are excellent at diagnosing fractures, they are poor at evaluating soft tissue structures of the knee such as ligaments, tendons, and the menisci. This is why, when evaluating tendons and ligaments, a magnetic resonance imaging (MRI) is used.

Fluid Removal
Your doctor may have to remove fluid from your knee for analysis to diagnose infection and some kinds of arthritis. Crystals, which suggest crystalline arthritis, can often be seen under the microscope, and infection can be detected this way, too. The doctor may perform certain blood tests for diagnosing rheumatoid arthritis and diabetes.

Arthroscopy
This is a surgical procedure where the surgeon places a fibre optic camera within the knee joint itself to look more closely at damaged menisci or cartilage. The surgeon can see possible small particles in the knee and is able to repair damage by shaving down torn cartilage or removing particles from the knee during the procedure.

Treatment

Although treatment of knee pain depends entirely on the cause of the problem, stretching the muscles and performing low-impact exercises and using electrical stimulation can strengthen the muscles. Physical therapy is also an advisable treatment as therapists use different exercises to increase strength, regain mobility and help patients recover from their injury.

Other common treatments can range from simply applying ice and heat over the affected area to taking anti-inflammatory medications or cortisone injections. Nonsteroidal anti-inflammatory medications (NSAIDs) are prescribed commonly for arthritis, bursitis and tendonitis. Cortisone is a powerful medication that treats inflammation, which is a common problem with patients with knee pain.

Prevention

Knee injuries are difficult to prevent, but you can take some precautionary measures to limit your risk of knee pain.

• Stay slim - excess weight puts a strain on your knees
• Maintain flexibility
• Exercise wisely - stretch muscles as a warm up and cool down to exercise and maintain the correct body posture during sports, especially when lifting weights
• Use knee supports if you feel knee discomfort
• Seek early medical intervention to get your knee pain accurately diagnosed and treated before the problem becomes serious