painful knee

                                     Painful knee &its treatment 

Knee pain 

Knee pain is a very common disease, especially in overweight people and age. The largest joint in our body is the knee joint and is sensitive to injury from infection, inflammation, trauma, and degenerative changes. The first step in knee pain is to look at the type of pain.

Knee pain can sometimes be caused by sitting with too much-bending legs or walking to fast. This type of pain usually heals quickly after taking a pain killer.  Our knee joints a soft surface, as we call cartilage. In fact, cartilage is present in every joint. This cartilage needs to be normal for normal movement.

 Cartilage weakens with age. Separating and protecting these bony surfaces is the lateral and medial meniscal cartilage, which works as a shock absorber throughout weight-bearing, protecting the articular cartilage. 

The patella is a large sesamoid bone anterior to the joint. It is placed in the quadriceps tendon, and it articulates with the trochlear channel of the femur Poor patellar following in the trochlear groove is a common source of knee pain especially when the cause is atraumatic in nature.

 The knee is supported by the collateral ligaments against varus (lateral collateral ligament) and valgus (medial collateral ligament) stresses. 

The tibia is limited in its anterior movement by the anterior cruciate ligament (ACL) and in its posterior movement by the posterior cruciate ligament (PCL). The bursae of the knee are detected between the skin and bony importance. 

They are sac-like structures with a synovial lining. They work to decrease the friction of tendons and muscles as they move over adjacent bony structures. To much external pressure or friction can lead to swelling and pain of the bursae. 

The prepatellar bursae located between the skin and patella, and the pes anserine bursa (which is medial and inferior to the patella, just below the tibial plateau) are most commonly affected. 

Other structures that susceptible to overuse injury and may cause knee pain following mind-numbing activity include the patellofemoral joint and the iliotibial band. 

Osteoarthritis of the knees is common after 50 years of age and can develop due to earlier trauma, ageing, activities, alignment issues, and genetic predisposition.

Signs and symptoms of knee pain 

Assessment of knee pain should begin with general questions concerning period and immediacy of symptom inception and the mechanism of injury or irritating symptoms. Overworked or degenerative problems can arise with stress or compression from sports, hobbies, or occupation.

 Symptoms of infection (fever, recent bacterial infections, risk factors for Sexually transmitted infections [such as gonorrhoea] or other bacterial infections (such as staphylococcal infection) should always be elicited.

Some of common symptoms and  complaints are :

1. Existence of clicking, grinding or cracking with bending, may be indicative of osteoarthritis of the patellofemoral syndrome.

2. Jamming " or "catching" when walking suggests an internal derangement, such as meniscal injury or a loose body in the knee.

3. Pain that occurs when rising after prolonged sitting suggests a problem with tracking of the patella.

Causes of knee pain

The knee is so much exposed, therefore easily injured. The knee is weight-bearing and for his reason is at a higher risk when the patient is obese.

 Not all knee pain is the same, each has a different cause. There are many reasons for knee pain, like torn ligaments or torn cartilage, dislocated and arthritis. Common causes include,

* Mechanical dysfunction or disruption:

1. Internal derangement of the knee: injury to the menisci or ligaments. 

2. Degenerative changes caused by osteoarthritis.

 3. Dynamic dysfunction or misalignment of the patella Fracture as a result of trauma. 

* Intra-articular inflammation or increased pressure :

1. Internal derangement of the knee: injury to the menisci or ligaments. 

2. Inflammation or infection of the knee joint. 

3.Ruptured popliteal (Baker) cyst. 

* Periarticular inflammation :

1. Internal derangement of the knee: injury to the menisci or ligaments

2. Prepatellar or anserine bursitis

3. Ligamentous sprain.

*  Common causes of knee pain and locations  :

* Medial knee pain :

1.Medial compartment osteoarthritis. 

2. Medial collateral ligament strain. 

3. Medial meniscal injury. 

4. Anserine bursitis (pain over the proximal medial tibial plateau)

*  Anterior knee pain :

1. Patellofemoral syndrome (often bilateral) Osteoarthritis. 

2. Prepatellar bursitis (associated with swelling anterior to the

patella). 

 3. Gout (buildup uric acid ) or other inflammatory disorder. 

* Lateral knee pain :

1.Lateral meniscal injury.

2. Iliotibial band syndrome (pain superficially along with the distal

iliotibial band near lateral femoral condyle or lateral tibial

insertion). 

3. Lateral collateral ligament sprain (rare). 

* Posterior knee pain :

1. Popliteal cyst. 

2. Osteoarthritis. 

3. Meniscal tears. 

4. Hamstring or calf tendinopathy.

Investigations for knee pain  

Laboratory  investigations :

Laboratory testing of aspirated joint fluid leads to a definitive diagnosis in most patients. 

Imagings:

Knee pain is evaluated with plain (weight-bearing) radiographs and MRI most commonly. Plain radiographs are usually negative in anterior cruciate ligament injury tears but are useful to rule out fractures.

 If a plain X-ray doesn't accurately diagnose a patient's knee pain, then MRI is the best choice.MRI is used to diagnose PCL and other related injuries.

MRI of the knee is the best diagnostic option for meniscal injuries. In osteoarthritis, MRI is most likely unneeded unless another pathology is suspected, like ischemic osteonecrosis.

Treatment of knee pain 

The treatment of painful knee depends on what the underlying diagnosis is, The most important thing to do is find the cause, especially if activities such as walking fast or jogging have just begun to run. Many people who exercise with sideways movements have symptoms of knee pain. 

But after these activities are stopped for approximately 2-6 weeks, the symptoms of knee pain will disappear slowly.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help deal with inflammation (swelling or redness) and pain. 

These drugs can cause stomach problems and are recommended to take after eating. People who suffer from ulcer disease or gastric inflammation are advised to see a doctor before using these drugs.

Pain in the kneecap can usually be treated with physical therapy to strengthen the quadriceps muscle (quadriceps) and stretch the hamstring muscles (hamstrings) and calf muscles (lower legs). Sprained ligaments often heal on their own as time passes and adequate rest. 

Ligaments that are torn around the knee sometimes require immobilization and are followed by active physical therapy. If the pain in the knee does not decrease or worsen as the treatment progresses, a surgeon will recommend an operation (arthroscopy) to repair the damage.

After the symptoms have been successfully cured, previous activities can be carried out slowly, as usual, starting with activities such as walking or cycling.

Anterior Cruciate Ligament Injury treatment 

Most young and active patients will require surgical reconstruction of the ACL. Common surgical techniques use the patient's own tissues, usually the patellar or hamstring ten-dons (autograft) or a cadaver graft (allograft) to arthroscopically reconstruct the torn ACL.

Collateral Ligament Injury treatment 

The majority of MCL injuries can be treated with protected weight-bearing and physical therapy. For grade 1 and 2 injuries, the patient can usually bear weight as tolerated with a full range of motion. A hinged knee brace can be given to patients with grade 2 MCL tears to provide stability.

Posterior Cruciate Ligament Injury treatment 

PCL injuries can be treated nonoperatively. Acute injuries are usually immobilized using a knee brace with the knee extension; the patient uses crutches tor ambulation.

 Meniscus Injuries treatment 

Conservative treatment can be used for degenerative tears in older patients. The treatment is similar for patients with mild knee osteoarthritis, including analgesics and physical therapy for strengthening and core stability. Acute tears in young and active patients can be best treated arthroscopically with meniscus repair or debridement.

Patellofemoral Pain treatment 

For symptomatic relief, use of local modalities such as ice and anti-inflammatory medications can be beneficial. If the patient has signs of patellar hypermobility, physical therapy exercises are useful to strengthen the quadriceps to help stabilize the patella and improve tracking. Support for the patellofemoral joint can be provided by the use of a patellar stabilizer brace or special taping techniques.

*Osteoarthritis treatment 

Knee braces provide Some improvement in subjective pain symptoms most likely due to improvements in neuromuscular function. 

The initial drugs of choice for the treatment of pain in knee osteoarthritis are oral acetaminophen and topical capsaicin. Knee joint corticosteroid injections are options to help reduce pain and inflammation and can provide short-term pain relief, usually lasting about 5-10 weeks.

*Surgical treatment 

Joint replacement surgeries are effective and cost-effective for patients with significant symptoms or functional limitations, providing improvements in pain, function, and quality of life. 

Knee realignment surgery, such as high tibial osteotomy or partial knee replacement surgery, is indicated in patients younger than age 60 with unicompartmental osteoarthritis, who would benefit from delaying total knee replacement. 

Knee joint replacement surgery has been very successful in improving outcomes for a patient with end-stage osteoarthritis.

A physical therapist or certified trainer can always help you with proper knee movements and make you know your limits.

Many people are afraid of knee replacement surgery, while surgery is definitely the last option it is also the best way to get rid of knee pain. A knee replacement patient can lead a normal life after 3 to 4 weeks of treatment.