Knee Pain

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Overview

Knee pain is a common compliant that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage, or wear over time resulting in a knee replacement. Medical conditions – including arthritis, gout and infections – also can cause knee pain. 


Many types of knee pain respond well to conservative measures. like physical therapy, although some require surgical intervention. 

Anatomy

The knee is one of the largest joints in the human body, and one of the most easily injured subsequently causing knee pain, requiring physical therapy and sports rehab. The knee joint is made up of four main things: bone, ligaments, tendons and cartilage.   

Bones: Your femur (thighbone), tibia (shinbone) and patella (knee cap) meet to form your knee joint.

Articular cartilage: The ends of the femur and tibia, and the back of the patella are covered with articular cartilage. This slippery substance helps your knee bones glide smoothly across each other as you bend and straighten your leg.

Meniscus: This tough and rubbery structure helps to cushion and stabilize the joint, acting as “shock absorbers” between your femur and tibia. You have a medial meniscus on the inside on your knee and a lateral meniscus on the outside of your knee. When people talk about torn cartilage in the knee, they are usually referring to the meniscus.

Ligaments: Bones are connected to other bones by ligaments. The four ligaments in your knee act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments: These are found on both sides of your knee. The medial collateral ligament is on the inside of your knee, and the lateral collateral ligament is on the outside. They control the sideways motion of your knee.

Cruciate Ligaments: These are found inside your knee joint, and cross each other like an “X”. The anterior cruciate ligament (ACL) crosses in the front and the posterior cruciate ligament (PCL) in the back. The cruciate ligaments control the back and forth motion of your knee.

Tendons: Muscle are connected to bones by tendons. The quadriceps tendon connects your quadriceps (thigh muscles) to your patella (knee cap). You also have a patella tendon that connects the patella (knee cap) to the tibia (shinbone).

Numerous muscles that help with movement and stabilization also surround the knee joint. Some of these muscles include the quadriceps, hamstrings, iliotibial band, and calf muscles. The muscles of your hip also play a critical role in knee function.


Symptoms

The location and severity of knee pain can widely vary depending on the cause.  Knee pain can be localized to a specific area of the knee or diffused throughout the knee, and is often accompanied by physical restriction. Knee pain can be divided into three major categories:

  • Acute injury: such as a broken bone, torn ligament or meniscal tear
  • Medical conditions: such as arthritis or infections
  • Chronic or overuse conditions: osteoarthritis, patellar syndromes, tendonitis, bursitis 

Common Injuries

  • ACL injury: An ACL injury involves the potential tearing or sprain/strain of the anterior cruciate ligament (ACL). This is one of the four ligaments that connect your tibia (shinbone) to your femur (thighbone). An ACL injury is common in sports that involve sudden stops, jumps or changes in direction such as basketball, soccer, football, tennis, downhill skiing, volleyball and gymnastics.
  • Fractures: The bones of the knee, including the kneecap (patella), can be broken during motor vehicle accidents or falls. 
  • Torn meniscus: The meniscus is a piece of tough, rubbery cartilage that acts as a shock absorber in your knee between your femur (thigh bone) and tibia (shin bone). Sudden meniscus tears often happen during sports where players squat and twist the knee, or are involved in direct contact like a tackle. Older people are more likely to have degenerative meniscus tears since cartilage weakens over time, with an awkward twist getting up from a chair being enough to cause a tear. 
  • Knee bursitis: Some knee pain is caused by inflammation of a bursa, a small fluid filled sac that cushions the outside of the knee joint for tendons and ligaments to glide smoothly over. You have numerous bursa in/around your knee, but knee bursitis most commonly occurs over the kneecap or on the inner side of your knee below the joint.
  • Patella tendonitis: Tendonitis is the irritation and inflammation of one or more tendons (thick, fibrous tissues that attach muscles to bones). Runners, skiers, cyclists, and those involved in jumping sports/activities are prone to develop inflammation in the patellar tendon due to repetitive stress, which connects the quadriceps muscle to the tibia (shinbone).  The patella tendon works with the muscles at the front of your thigh to extend your knee so you can kick, run and jump.
  • Patellofemoral pain/Runners knee: This is a general tern that refers to pain between your patella (kneecap) and femur (thighbone). It’s common in athletes that participate in activities such as running or cycling with a constant repetitive movement, and young adults with a mal-tracking kneecap. The pain and stiffness it causes can make it difficult to climb stairs, kneel down and perform other activities of daily life.
  • Iliotibial band syndrome: The iliotibial band is the tough band of tissue that extends from the outside of your hip to the outside of your knee. When the muscle it attaches to at the hip (tensor fascia lata) becomes tight, it puts increased tension on the iliotibial band, causing it to rub against the outer portion of your femur.  Symptoms include pain over the outside of the knee which will come on gradually over time getting progressively worse. Distance runners are especially prone to experiencing iliotibial band syndrome.
  • Osteoarthritis: This is the most common type of arthritis, sometimes called degenerative arthritis. It’s a wear-and-tear condition that occurs when the cartilage in our knee deteriorates with use and age. This causes the bones of the joint to rub more closely against one another with less of the shock-absorbing benefits of cartilage. The rubbing may result in pain, swelling, stiffness and decreased ability to move. Osteoarthritis symptoms can usually be effectively managed with conservative treatment such as physical therapy, although the underlying process cannot be reversed. 

Treatment

A thorough physical examination will usually establish the diagnosis of knee pain. The underlying cause of knee pain will help direct the treatment and plan of care.  Most instances of knee pain can be successfully treated conservatively (physical therapy, chiropractic, massage, etc.) although some injuries may require surgical intervention.


Source:https://orthoinfo.aaos.org

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