Knee Pain

Dr Healthism
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  • 6 May, 2019 4:27 pm
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Knee pain is pain in or around the knee.

The knee joint consists of an articulation between four bones: the femur, tibia, fibula and patella. There are four compartments to the knee. These are the medial and lateral tibiofemoral compartments, the patellofemoral compartment and the superior tibiofibular joint. The components of each of these compartments can suffer from repetitive strain, injury or disease.

Running long distance can cause pain to the knee joint, as it is high-impact exercise.

Causes
Injuries

Some common injuries include:

Sprain (Ligament sprain)
Medial collateral ligament
Lateral collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament
Tear of meniscus
Medial meniscus
Lateral meniscus
Strain (Muscle strain)
Quadriceps muscles
Hamstring muscles
Popliteal muscle
Patellar tendon
Hamstring tendon
Popliteal tendon
Hemarthrosis – Hemarthrosis tends to develop over a relatively short period after injury, from several minutes to a few hours.
Fractures
Femoral fracture
Tibial fracture
Patella fracture
Diseases
Some of the diseases of cause of knee pain include the following:

Knee osteoarthritis
Chondromalacia patella
Baker’s cyst
Meniscal cyst
Discoid meniscus
Osgood-Schlatter disease
Larsen-Johansson disease
Knee rheumatoid arthritis
Osteochondritis dissecans disease
Synovial chondromatosis disease
Tumors
Ankylosing spondylitis
Reactive arthritis
Tuberculosis arthritis
Septic arthritis (Pyogenic arthritis)
Osteomyelitis
Hemophilic arthritis
Gout (Gouty arthritis)
Neuroma
Inflammations
Bursitis of the knee
Prepatellar bursitis – Housemaid’s knee (most common)
Infrapatellar bursitis – Clergyman’s knee (Superficial infrapatellar bursitis and Deep infrapatellar bursitis)
Semimembranosus bursitis
Tendinitis
Patellar tendinitis (Jumper’s knee)
Hamstring tendinitis
Popliteal tendinitis
Synovitis of the knee
Deformities
Common deformities of the knee include:

Bipartite patella (two-part kneecap)
Genu varum (bow legs)
Genu valgum (knock-knees)
Genu recurvatum (Knee hyperextension)
Knee flexion deformity
Syndromes
Patellofemoral pain syndrome
Plica syndrome
Iliotibial band syndrome
Hoffa’s syndrome
Dislocations
Patella dislocation
Knee joint dislocation (Tibiofemoral joint dislocation)
Cold-induced
A Chinese study concluded that knee pain is significantly more prevalent in people working in cold stores than in those in normal temperature.

One study came to the conclusion that 17% of adolescents with anterior knee pain (a common but benign self-limiting condition) report that their pain is associated with cold weather. The same study indicated that the main activities associated with anterior knee pain are sporting, stair climbing and walking, but also sitting. Some people with anterior knee pain tend to have generally colder knees, and such people also trend towards having to wear extra tights/long johns in the winter.

Cold-induced knee pain may also be due to tenosynovitis of the tendons around the knee, in which cold exposure has a specific role, either as a causative or a contributing factor. Frank arthritis has been reported in children due to frostbite from extreme cold causing direct chondrocyte injury.

There is also a hereditary disease, familial cold autoinflammatory syndrome (FCAS), which often features knee pain, in addition to hives, fever and pain in other joints, following general exposure to cold.

Cold weather also aggravates knee pain in patients already having osteoarthritis, rheumatoid arthritis and fibromyalgia.

Knee pain due to less physical movement
A lower level of physical activity and a work environment where one is required to sit in a chair during the work day is one reason for developing knee joint pain, as the lower degree of physical movement tends to weaken the knee muscles. Blood vessels also can be affected, leading to development of painful conditions.

As age progresses the movement of the knee joint involves higher friction with adjacent tissue and cartilages.

Other causes
Ligamentous laxity
Fat pad impingement
Knee effusion
Deep vein thrombosis
Peripheral vascular disease
Exostosis
Referred knee pain
Referred pain is that pain perceived at a site different from its point of origin but innervated by the same spinal segment. Sometimes knee pain may be related to another area from body. For example, knee pain can come from ankle, foot, hip joints or lumbar spine.

Diagnosis
Knee MRIs should be avoided for knee pain without symptoms or effusion, unless there are non-successful results from a functional rehabilitation program.

In some diagnosis, such as in knee osteoarthritis, magnetic resonance imaging does not prove to be clear for its determination

Management
Although surgery has a role in repairing traumatic injuries and broken bones, surgeries such as arthroscopic lavage do not provide significant or lasting improvements to either pain or function to people with knee pain, and therefore should almost never be performed. Knee pain is pain caused by wear and tear, such as osteoarthritis or a meniscal tear. Effective treatments for knee pain include physical therapy exercises, pain-reducing drugs such as ibuprofen, knee replacement surgery, and weight loss in people who are overweight.

Acupuncture has also been found to be a potential treatment for those with knee pain. There is evidence that acupuncture can be useful in reducing acute pain after a total knee arthroplasty, reducing the need for certain prescription drugs such as opioids. For those suffering from chronic knee pain, defined as pain lasting more than 3 months, acupuncture was found to be effective in reducing pain up to 12 weeks after acupuncture treatment.

Overall, a combination of interventions seems to be the best choice when treating knee pain. Interventions such as exercises that target both the knee and the hip, foot bracing, and patellar taping are all recommended for use with patients suffering from knee pain.

Current evidence suggests that psychological factors are elevated in individuals with patellofemoral pain. Non-physical factors such as anxiety, depression, fear of movement, and catastrophizing are thought to have a linear correlation with increased pain experience and decreased physical function. Catastrophizing is defined as imagining the worst possible outcome of an action or event. Furthermore, psychosocial factors may have either a positive or negative impact on adherence to rehabilitation programs for managing knee pain.

Epidemiology
About 25% of people over the age of 50 experience knee pain from degenerative knee diseases.

Society and culture
In the United States, more than US $3 billion is spent each year on arthroscopic knee surgeries that are known to be ineffective in people with degenerative knee pain.

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