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Knee pain#Inflammations

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| field = Orthopedics

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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 experience repetitive strain, injury or disease.{{Cite web |title=Knee pain - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/knee-pain/symptoms-causes/syc-20350849 |access-date=2024-09-22 |website=Mayo Clinic |language=en}}

Running long distance can cause pain to the knee joint, as it is a high-impact exercise.{{Cite web |last= |first= |date= |title=Knee Injuries from Long Distance Running |url=https://castleortho.co.uk/knee-injuries-long-distance-marathon-running/ |access-date=2024-09-23 |website=Castle Orthopaedics |language=en-GB}}

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully straighten the knee

Causes

= Injuries=

Some common injuries based on the location include:{{cite web |last1=Green |first1=Shelby |title=Knee Pain Location Chart |url=https://www.feelgoodlife.com/knee-pain-location-chart/ |website=Feel Good Life |date=24 November 2022 |publisher=feelgoodlife |access-date=17 December 2022}}

= Fractures =

=Diseases=

Some of the diseases of cause of knee pain include the following:

|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}{{cite web|url=http://www.medterms.com/script/main/art.asp?articlekey=11789|title=Definition of Osteochondritis dissecans|access-date=20 February 2009 | vauthors = Shiel Jr WC |publisher=MedicineNet, Inc.}}

  • Synovial chondromatosis disease{{cite book|title=Soft Tissue and Bone Tumours: WHO Classification of Tumours|url=https://books.google.com/books?id=kaR9zQEACAAJ|year=2020|publisher=International Agency for Research on Cancer|isbn=978-92-832-4502-5|chapter=Synovial chondromatosis|pages=368–369}}
  • Tumors{{cite web|url = https://www.lexico.com/en/definition/neoplasm|archive-url = https://web.archive.org/web/20190926221344/https://www.lexico.com/en/definition/neoplasm|url-status = dead|archive-date = September 26, 2019|title = Neoplasm|work = Lexico|publisher = Oxford University Press}}
  • Ankylosing spondylitis{{cite web |url= https://www.lecturio.com/concepts/ankylosing-spondylitis/| title= Ankylosing Spondylitis

|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}

  • Reactive arthritis{{cite web |url= https://www.lecturio.com/concepts/reactive-arthritis/| title= Reactive Arthritis

|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}

  • Tuberculosis arthritis{{Cite web|title=Tuberculosis (TB)|url=https://www.who.int/news-room/fact-sheets/detail/tuberculosis|website=www.who.int|language=en|access-date=2020-05-08}}
  • Septic arthritis (Pyogenic arthritis){{cite web |url= https://www.lecturio.com/concepts/septic-arthritis/| title= Septic Arthritis

|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}

  • Osteomyelitis{{cite web |url= https://www.lecturio.com/concepts/osteomyelitis/| title= Osteomyelitis

|website=The Lecturio Medical Concept Library |access-date= 22 August 2021}}

  • Hemophilic arthritis{{cite web |title=What Is Hemophilia? |url=https://www.cdc.gov/ncbddd/hemophilia/facts.html |website=cdc.gov |date=12 May 2020 |publisher=U.S. Centers for Disease Control |access-date=3 April 2021}}
  • Gout (Gouty arthritis){{cite web |url= https://www.lecturio.com/concepts/gout/| title= Gout|website=The Lecturio Medical Concept Library | date= 9 September 2020|access-date= 22 August 2021}}
  • Neuroma

=Inflammations=

=Deformities=

Common deformities of the knee include:

=Syndromes=

  • Patellofemoral pain syndrome
  • Plica syndrome
  • Iliotibial band syndrome
  • Hoffa's syndrome{{Citation |last=DuBose |first=Matthew |title=Hoffa Pad Impingement Syndrome |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK589637/ |access-date=2024-09-23 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=36943955 |last2=Taqi |first2=Muhammad}}
  • Joint hypermobility syndrome{{Citation |last=Miklovic |first=Tyler |title=Ehlers-Danlos Syndrome |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK549814/ |access-date=2024-09-23 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31747221 |last2=Sieg |first2=Vanessa C.}}

=Dislocations=

  • Patella dislocation{{Citation |last=Hayat |first=Zara |title=Patella Dislocation |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK538288/ |access-date=2024-09-23 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30855872 |last2=El Bitar |first2=Youssef |last3=Case |first3=Justin L.}}
  • Knee joint dislocation (Tibiofemoral joint dislocation){{Citation |last=Mohseni |first=Michael |title=Knee Dislocation |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK470595/ |access-date=2024-09-23 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262122 |last2=Mabrouk |first2=Ahmed |last3=Simon |first3=Leslie V.}}

= Cold temperature =

Knee pain is more common among people working in the cold than in those in normal temperature. Cold-induced [https://www.leefordortho.in/products/premium-knee-cap 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.{{cite journal | vauthors = Pienimäki T | title = Cold exposure and musculoskeletal disorders and diseases. A review | journal = International Journal of Circumpolar Health | volume = 61 | issue = 2 | pages = 173–82 | date = May 2002 | pmid = 12078965 | doi = 10.3402/ijch.v61i2.17450 | doi-access = free }} Frank arthritis has been reported in children due to frostbite from extreme cold causing direct chondrocyte injury.{{cite journal | vauthors = Carrera GF, Kozin F, McCarty DJ | title = Arthritis after frostbite injury in children | journal = Arthritis and Rheumatism | volume = 22 | issue = 10 | pages = 1082–7 | date = October 1979 | pmid = 486219 | doi = 10.1002/art.1780221006 | doi-access = free }}

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.{{ClinicalTrialsGov|NCT00887939|Pathogenesis of Physical Induced Urticarial Syndromes}}

= 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. Working on building strength through a full range of motion is crucial for rebuilding strength and getting rid of knee pain. {{citation needed|date=February 2023}}

As age progresses the movement of the knee joint involves higher friction with adjacent tissue and cartilages.{{citation needed|date=February 2023}}

=Other causes=

= 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.{{cite book | last=Porth | first=Carol | title=Essentials of Pathophysiology: Concepts of Altered Health States | publisher=Lippincott Williams & Wilkins | date=2011 | isbn=978-1-58255-724-3 | page=853}} 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.{{Citation|title=Five Things Physicians and Patients Should Question|date=24 April 2014|url=http://www.choosingwisely.org/doctor-patient-lists/american-medical-society-for-sports-medicine/|author1=American Medical Society for Sports Medicine |work=Choosing Wisely: an initiative of the ABIM Foundation|publisher=American Medical Society for Sports Medicine|access-date=29 July 2014}}

  • {{cite journal | vauthors = Dixit S, DiFiori JP, Burton M, Mines B | title = Management of patellofemoral pain syndrome | journal = American Family Physician | volume = 75 | issue = 2 | pages = 194–202 | date = January 2007 | pmid = 17263214 }}
  • {{cite journal | vauthors = Atanda A, Ruiz D, Dodson CC, Frederick RW | title = Approach to the active patient with chronic anterior knee pain | journal = The Physician and Sportsmedicine | volume = 40 | issue = 1 | pages = 41–50 | date = February 2012 | pmid = 22508250 | doi = 10.3810/psm.2012.02.1950 | s2cid = 25791476 }}
  • {{cite journal | vauthors = Pappas E, Wong-Tom WM | title = Prospective Predictors of Patellofemoral Pain Syndrome: A Systematic Review With Meta-analysis | journal = Sports Health | volume = 4 | issue = 2 | pages = 115–20 | date = March 2012 | pmid = 23016077 | pmc = 3435911 | doi = 10.1177/1941738111432097 }}
  • {{cite journal | vauthors = Rixe JA, Glick JE, Brady J, Olympia RP | title = A review of the management of patellofemoral pain syndrome | journal = The Physician and Sportsmedicine | volume = 41 | issue = 3 | pages = 19–28 | date = September 2013 | pmid = 24113699 | doi = 10.3810/psm.2013.09.2023 | s2cid = 24177847 }}
  • {{cite journal | vauthors = Roush MB, Sevier TL, Wilson JK, Jenkinson DM, Helfst RH, Gehlsen GM, Basey AL | title = Anterior knee pain: a clinical comparison of rehabilitation methods | journal = Clinical Journal of Sport Medicine | volume = 10 | issue = 1 | pages = 22–8 | date = January 2000 | pmid = 10695846 | doi = 10.1097/00042752-200001000-00005 | s2cid = 25418309 }}

In some diagnosis, such as in knee osteoarthritis, magnetic resonance imaging does not prove to be clear for its determination.{{cite journal | vauthors = Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM | title = Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis | journal = British Journal of Sports Medicine | volume = 53 | issue = 20 | pages = bjsports–2018–099257 | date = June 2018 | pmid = 29886437 | pmc = 6837253 | doi = 10.1136/bjsports-2018-099257 }}

Management

Although surgery has a role in repairing traumatic injuries and broken bones, arthroscopic surgeries do not provide significant or lasting improvements to either pain or function to people with knee pain, and therefore should almost never be performed.{{cite journal | vauthors = Siemieniuk RA, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, Buchbinder R, Englund M, Lytvyn L, Quinlan C, Helsingen L, Knutsen G, Olsen NR, Macdonald H, Hailey L, Wilson HM, Lydiatt A, Kristiansen A | title = Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline | journal = BMJ | volume = 357 | pages = j1982 | date = May 2017 | pmid = 28490431 | pmc = 5426368 | doi = 10.1136/bmj.j1982 }} 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,{{cite journal | vauthors = Lack S, Neal B, De Oliveira Silva D, Barton C | title = How to manage patellofemoral pain - Understanding the multifactorial nature and treatment options | journal = Physical Therapy in Sport | volume = 32 | pages = 155–166 | date = July 2018 | pmid = 29793124 | doi = 10.1016/j.ptsp.2018.04.010 | hdl = 11449/171014 | s2cid = 46921956 | hdl-access = free }} pain-reducing drugs such as ibuprofen, joint stretching,{{cite web | title=Knee Reviver, innovatief product voor gewrichtsparende behandeling bij knieartrose | website=NWO | date=2024-01-01 | url=https://www.nwo.nl/onderzoek-en-resultaten/onderzoeksprojecten/i/22/28022.html | archive-url=https://web.archive.org/web/20190705112326/https://www.nwo.nl/onderzoek-en-resultaten/onderzoeksprojecten/i/22/28022.html | archive-date=2019-07-05 | url-status=dead | access-date=2024-09-22}}{{Cite web | url = https://www.umcutrecht.nl/nl/behandeling/kniedistractie | title = Kniedistractie - UMC Utrecht | website = www.umcutrecht.nl | archiveurl = https://web.archive.org/web/20240418134327/https://www.umcutrecht.nl/nl/behandeling/kniedistractie | archivedate = 2024-04-18 | url-status = live}} knee replacement surgery, and weight loss in people who are overweight.

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 who have knee pain.{{cite journal | vauthors = Crossley KM, van Middelkoop M, Callaghan MJ, Collins NJ, Rathleff MS, Barton CJ | title = 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) | journal = British Journal of Sports Medicine | volume = 50 | issue = 14 | pages = 844–52 | date = July 2016 | pmid = 27247098 | pmc = 4975825 | doi = 10.1136/bjsports-2016-096268 }}

Current evidence suggests that psychological factors are elevated in individuals with patellofemoral pain.{{cite journal | vauthors = Maclachlan LR, Collins NJ, Matthews ML, Hodges PW, Vicenzino B | title = The psychological features of patellofemoral pain: a systematic review | journal = British Journal of Sports Medicine | volume = 51 | issue = 9 | pages = 732–742 | date = May 2017 | pmid = 28320733 | doi = 10.1136/bjsports-2016-096705 | doi-access = free }} 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.{{Cite web|url=https://www.merriam-webster.com/dictionary/catastrophize|title=Definition of CATASTROPHIZE|website=www.merriam-webster.com |access-date=2019-03-12}} The psychosocial factors may have either a positive or negative impact on adherence to rehabilitation programs for managing knee pain. Furthermore, studies have found knee pain to be negatively associated with health-related quality of life, and an increase in knee pain to be associated with a reduction in patient-reported quality of life, as compared to those with no or stable knee pain, even in the relatively younger middle-aged population.{{Cite journal |last1=Singh |first1=Ambrish |last2=Campbell |first2=Julie A. |last3=Venn |first3=Alison |last4=Jones |first4=Graeme |last5=Blizzard |first5=Leigh |last6=Palmer |first6=Andrew J. |last7=Dwyer |first7=Terence |last8=Cicuttini |first8=Flavia |last9=Ding |first9=Changhai |last10=Antony |first10=Benny |date=September 2021 |title=Association between knee symptoms, change in knee symptoms over 6-9 years, and SF-6D health state utility among middle-aged Australians |url=https://pubmed.ncbi.nlm.nih.gov/33942204 |journal=Quality of Life Research |volume=30 |issue=9 |pages=2601–2613 |doi=10.1007/s11136-021-02859-5 |pmid=33942204|s2cid=233487528 }}

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.

References

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External links

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Category:Musculoskeletal disorders

Category:Rheumatology

Category:Orthopedic problems

Pain