The knee is a
hinge joint formed by two bones (femur and tibia) and is held together by four
ligaments (medial collateral ligament, lateral collateral ligament, anterior
cruciate ligament, posterior cruciate ligament).The patella, or
knee cap, also is part of the normal knee anatomy. The ends of the femur and
tibia and underside of the patella are covered by articular cartilage, a
slippery surface which allows friction-free, painfree movement.
The normal knee joint is surrounded by a
membrane (the synovium) which produces a small amount of thick fluid (synovial
fluid). The synovial fluid helps to nourish the cartilage and keep it slippery.
The synovium also has a tough outer layer (the joint capsule) which protects
and supports the joint.The normal knee joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid). The synovial fluid helps to nourish the cartilage and keep it slippery. The synovium also has a tough outer layer (the joint capsule) which protects and supports the joint.
The surface
layer of cartilage breaks down and wears away in osteoarthritis (sometimes called wear-and-tear arthritis). The
breakdown of cartilage causes the bones under the cartilage to rub together
(bone-on-bone).
Pain, swelling,
and loss of motion result. The joint may lose its normal shape over time and
become deformed. Bone spurs can develop along the edges of the joint. Bits of
bone or cartilage can break off and float inside the joint space, causing even
more pain and damage.
The location of
the knee pain can be useful information when trying to obtain an accurate
diagnosis. Pain on the front of the knee can be caused by bursitis,
arthritis, or softening of the patella cartilage as in chrodomalacia of patella.
Pain on the
sides of the knee is usually related to injuries to the collateral ligaments,
arthritis, or tears to the meniscuses. Pain in the back of the knee can be
caused by arthritis or an accumulation
of synovial fluid behind the knee. Infection can be another possible cause of
knee pain.
Knee
Pain:
Understanding
what is causing your knee pain may be a simple task, but sometimes could be
complicated. A physician can use clues to determine the cause of your knee
pain. Some of these clues have to do with you; how old are you? What types of
activities do you do? But others with your symptoms (has your knee pain been
ongoing? Was there a recent injury?).Common knee joint symptoms include:
Location of Pain:
·
Inside of Knee: Pain on
the inside, or medial side, of the knee is commonly caused by meniscus tears, MCL injuries , and arthritis.
· Outside of Knee: Pain on the outside of the
knee, or lateral side, is commonly caused by lateral meniscus tears, LCL
injuries, band tendonitis, and arthritis.
·
Back of Knee: Pain in the back of the knee
can be due to the collection of fluid.
·
Front of Knee: Pain over the front of the
knee is most commonly related to the knee cap whose causes could be by several different problems.
Timing of Pain:
·
Morning pain: Pain after first waking in
the morning that quickly resolves with gentle activity is typical of early arthritis
·
While going down stairs: Pain while walking down steps
is very commonly associated with kneecap problems.
Swelling:
Swelling of the knee is common with several
different knee problems. When there is an effusion immediately after a knee
injury, a possible cause is severe injury to an internal joint structure, like
the anterior cruciate ligament or a fracture of the top of the shin bone.
When swelling develops
gradually over hours to days after an injury, it is likely to be something less
severe, like a tear of the meniscus or a ligament sprain.
Swelling that occurs without the presence of a
known injury can be due to osteoarthritis (common), gout (less common), inflammatory
arthritis, or a joint infection (uncommon).
Mobility:
Mobility
of the knee can be affected by a number of common conditions. If mobility is
chronically limited, often the cause is arthritis. When the
surface of the joint becomes irregular as a result of the arthritis, the
mobility of the joint may become limited.
If the mobility is limited after an acute injury, there is
likely swelling limiting the motion, or a torn structure that is limiting the
mobility.
Instability/Giving Way:
The stability of the kneeis
provided by the ligaments that connect the shin bone to the thigh bone. When the ligaments are stretched or torn, the knee may feel as though
it is giving way beneath the
patient. A sensation that the knee may give out from beneath you is a common symptom of ligament injury.
Popping/Clicking/Crunching/Grinding:
Popping
and snapping within the knee is common, and often not a symptom of any
particular problem. When the pops are painless, there is usually no problems but
painful pops and snaps should be evaluated by your doctor. A pop is often heard
or felt during an injury when a ligament, such as the ACL, is torn.
Grinding or crunching is a common symptom of
cartilage problems. If the cartilage is damaged -- a condition called chondromalacia -- a
crunching sensation is often felt by placing the hand over the kneecap and
bending the knee. A similar grinding sensation may be felt with knee arthritis.
Locking:
Locking
is a symptom that occurs when a patient cannot bend or straighten their knee.
The locking can either be due to something physically blocking motion of the
knee, or by pain preventing normal knee motion.
One way to determine if there is something
physically blocking knee motion is to inject the knee with a numbing medication.
After the medication has taken effect, you can attempt to bend the knee to
determine if pain was blocking the motion or if there is a structure, such as a
torn meniscus, that is
blocking normal motion.
Treatment:
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