A Comprehensive Guide to Understanding, Diagnosing, and Treating Knee PainThere are numerous ways to alleviate knee joint pain, ranging from non-medical remedies to medications and medical procedures.
Knee Pain Location Chart
The knee is a synovial joint that bridges your thigh bone (femur) and shin bone (tibia). Alongside the tibia runs the fibula, which extends from the knee to the ankle. The kneecap (patella) is a triangular bone that rests in front of the knee, moving in response to knee bending.
The knee has two kinds of cartilage. The meniscus, a crescent-shaped disc, acts as a shock absorber, preventing bones from rubbing against each other during movement. The articular cartilage, a thick layer, sits behind the patella.
Ligaments are robust fibrous tissues that connect the bones to other bones, providing strength and stability to the knee joints. The knee relies on the following primary ligaments:
- Anterior Cruciate Ligament (ACL): Restrains forward motion and some rotation of the shin bone relative to the thigh bone.
- Posterior Cruciate Ligament (PCL): Connects the thigh bone and shin bone.
- Medial Collateral Ligament (MCL): Restrains sideways movement of your thigh bone.
- Lateral Collateral Ligament (LCL): Also inhibits sideways movement of your thigh bone.
TENDONS, JOINT CAPSULE, BURSA, AND MUSCLES
Tendons are elastic tissues composed of collagen, connecting your bones to the muscles and providing joint stability. The joint capsule is a membrane that encases the knee joint, filled with synovial fluid that nourishes and lubricates the joints. Bursa are fluid-filled sacs that cushion the knee joint to minimise friction between muscles, bones, tendons, and ligaments. The knee is powered by the quadriceps, hamstrings, and calf muscles, which together enable flexing, extending, and stabilising the knee joint.
Identifying Causes of Knee Joint PainKnee pain origins are usually classified under three categories: acute injuries, underlying conditions, and overuse.
ACUTE INJURIESAcute injuries result from sudden trauma, often incurred during sports activities. These injuries might stem from a twist, fall, excessive force, or a direct blow from a solid object. These include:
- Muscle Strain: Typically caused by forceful activities, presenting with a popping noise, joint swelling, pain, and instability while walking.
- Meniscus Tears: Occur due to direct impact or gradual degeneration. Symptoms include pain inside the knee, a sensation of knee locking, swelling, and tenderness.
- Patellar Dislocation: The patella slips out of alignment, causing knee pain, difficulty straightening the knee, and a deformed knee cap appearance.
- Patellar Tendon Rupture: A tear in the tendon connecting the kneecap to the shin bone, often resulting in tenderness, cramping, bruising, and walking difficulty due to knee instability.
- Knee Fracture: Resulting from a direct blow or a fall, this injury causes severe pain, tenderness, swelling, and a deformed knee appearance.
- Unhappy Triad of the Knee: A severe injury involving multiple knee components, presenting with a popping sound, intense pain, swelling, and an unstable knee.
- Ligament Tears: Common in sports, these injuries limit movement and vary in symptoms depending on the specific ligament damaged.
UNDERLYING CONDITIONSSome knee pain is associated with a pre-existing disease or a predisposition to the condition such as genetics or lifestyle practices, etc. Proper diagnosis and treatment is essential to help alleviate knee pain and other accompanying symptoms that make it worse. The goal of treatment is to reduce inflammation and restore joint function. Some examples are:
- Knee Arthritis: Inflammatory condition limiting motion range, with swelling, increasing pain, and noticeable knee deformity.
- Knee Tumour: Abnormal cell growth causing dull, aching pain, joint swelling, stiffness, and limping.
- Infection (Septic Arthritis): Bacterial contamination of joint lubricant causing pain, limited motion, redness, and fatigue.
- Systemic Lupus Erythematosus (SLE): An autoimmune disease attacking healthy tissues, causing pain, stiffness, swelling, and warmth in the knee.
- Lyme Disease: Tick-borne infection causing fatigue, fever, rashes, and inflamed, painful knee joints.
- Obesity: Extra weight exerting pressure on knees, leading to pain, swelling, stiffness, and instability when walking.
- Sexually Transmitted Disease: Certain STDs can lead to gonococcal or reactive arthritis causing pain, stiffness, swelling, and chills.
- Hip Joint Pathology: Hip issues can lead to referred knee pain, causing painful, tender knee joints and limited movement.
OVERUSE INJURIESOveruse injuries are the most common cause of knee pain, typically occurring due to repetitive motions or activities that put consistent strain on the knee joint, such as long-distance running, excessive jumping, or heavy lifting. Over time, the constant wear and tear can damage the knee’s cartilage, ligaments, and tendons. The most common being:
- Patellar Tendinopathy (Jumper’s Knee): Common in athletes, influenced by multiple factors, causing mild to severe knee pain and swelling.
- Chondromalacia: Softening of kneecap cartilage, common among active individuals and the overweight, causing a grinding sensation and dull, aching pain around the kneecap.
- IT (Iliotibial) Band Syndrome: Condition due to muscular imbalances, leading to sharp or burning pain and swelling on the outer knee area.
- Knee Bursitis: Inflammation of knee’s fluid-filled sacs, causing localised swelling, warmth, tenderness, and increased pain when kneeling.
Alleviating Knee Pain: Non-Medical Remedies, Medications, and ProceduresThere are numerous ways to alleviate knee joint pain, ranging from non-medical remedies to medications and medical procedures.
NON-MEDICAL REMEDIESSeveral lifestyle adjustments can aid in alleviating knee pain, including:
- Regular Exercise: Exercise strengthens the muscles around the knee, improves posture, and helps in weight reduction.
- Warm and Cold Therapy: Heat relaxes muscles and joint stiffness, while cold reduces inflammation and swelling.
- Diet Adjustments: Certain dietary choices can either ease or trigger knee joint pain.
- Weight Reduction: Losing weight reduces the load on your knees, leading to less wear and tear.
- P.R.I.C.E Protocol: Protect, Rest, Ice, Compression, Elevation can reduce pain and swelling after a knee injury.
- Massage: Can relieve short-term knee pain and improve stiffness.
- Acupuncture: Traditional Chinese medicine that can help reduce pain and improve knee function.
- TENS: Transcutaneous Electrical Nerve Stimulation for arthritic pain, triggering the release of endorphins, your body’s natural painkillers.
MEDICATIONSMedications for alleviating knee pain may include corticosteroids, NSAIDs, disease-modifying anti-rheumatic drugs, and injections (e.g., corticosteroids, hyaluronic acid, and platelet-rich plasma).
PROCEDURESMedical procedures for severe cases of knee pain can include cartilage regeneration, arthrocentesis, arthroscopic surgery, and partial or total knee replacement surgery. Get detailed insights about these treatments here.
Diagnostic Tests For Knee PainDiagnosing knee pain starts with a physical examination, during which a healthcare professional will evaluate objective anatomical findings by observing, feeling, and listening. Further tests may include:
- McMurray Test: To check for meniscal tears.
- Apley Grind Test: Used to detect meniscal tears.
- Valgus Stress Test: To check damage to the medial collateral ligament.
- Lachman Test: To diagnose ACL injuries.
- Imaging Tests: X-rays, CT Scans, MRIs to visualise the internal structures of the knee.
- Knee Arthroscopy: A surgical technique for diagnosing and treating knee problems.
- Joint Aspiration: To remove fluid from the joint space.
When to Seek Medical Help
If knee pain persists or intensifies, making spontaneous movement difficult, seek professional help as soon as possible. A medical consultation can provide a proper assessment and diagnosis to initiate suitable treatment, improving the chances of relieving knee pain and preventing further deterioration.
Singapore is known for its top-notch healthcare system, especially in orthopaedics. With so many skilled specialists, it can be tricky to decide who to see for your specific needs. We’ve put this blog together to make things easier and quicker — a useful resource for understanding knee pain, with all the key info to help you choose the right orthopaedic doctor for your condition. However, always consult with a healthcare professional for personalised advice and treatment options.