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Knee Pain Overview (cont.)

Causes, Symptoms, Signs, Treatment, Prognosis, and Types of Chronic Knee Pain

  • Arthritis: Arthritis of the knee is an inflammatory disorder of the knee joint that is often painful. Arthritis has many causes.
    • Osteoarthritis
      • Description: Osteoarthritis is caused by degeneration of cartilage in the knee. In its extreme form, the menisci (cartilage) will be completely eroded, and the femur will rub on the tibia, bone on bone.
      • Symptoms and signs: Osteoarthritis (OA) causes a chronically painful knee that is often more painful with activity. It can be stiff with prolonged sitting and may become enlarged from new bone formation at the edge of the degenerated cartilage.
      • Treatment: Treatment is aimed at pain control with over-the-counter pain relievers. Anti-inflammatory medications, either over the counter, or by your doctor's prescription, are also quite helpful. Knee bracing can be beneficial for more mobile patients. Injections of hyaluronic acid (viscosupplementation; Synvisc-One) can be helpful in relieving chronic pain
      • from OA. More severe OA can be treated with narcotic pain medicines or a knee joint replacement with a synthetic joint.
    • Rheumatoid arthritis
      • Description: Rheumatoid arthritis (RA) is a disease of the whole body that affects many joints, often including the knee. People who have this disease often have family members who suffer from it as well.
      • Symptoms and signs: In addition to knee pain, rheumatoid arthritis may produce morning stiffness and pain in other joints. The knee can be warm to the touch and swollen.
      • Treatment: Treatment includes pain medications, anti-inflammatory medications, and prescription drugs. (These drugs either try to slow the progression of the disease or try to suppress the immune system or decrease inflammation.) Newer medications, called biologics, are proteins that specifically target the substances that stimulation rheumatoid inflammation. Your health care professional will need to evaluate which one of these medications is best suited for you.
      • Prognosis: It is essential that patients with rheumatoid arthritis be evaluated and treated aggressively early for best outcomes. This generally will include a thorough evaluation by a rheumatologist.
    • Crystalline arthritis (gout
    • and pseudogout)
      • Description: These severely painful forms of arthritis are caused by crystals that form in the knee and other joints. These crystals can form as a result of defects in the absorption or metabolism of various natural substances such as uric acid (which produces gout) and calcium pyrophosphate (pseudogout).
      • Symptoms and signs: Gout and pseudogout cause a rapid-onset, markedly inflamed knee joint. The knee can be exquisitely painful, swollen, and warm with loss of range of motion.
      • Treatment: Treatment is aimed at controlling inflammation with anti-inflammatory medications and at aiding the metabolism of the various chemicals that may lead to crystal formation. Alcohol should be avoided and gout-specific dietary changes can be successful in avoiding flare-ups.
  • Bursitis
    • Description: As a result of trauma, infection, or crystalline deposits, the various bursae of the knee may become inflamed.
    • Symptoms and signs: Acute or chronic trauma causes a painful and often swollen knee from the inflammation of the bursae. A particularly common bursitis is prepatellar bursitis. This type of bursitis occurs in people who work on their knees. It is often referred to as housemaid's knee or carpet layer's knee. Another type of bursitis is anserine bursitis. The anserine bursa is located about 2 inches below the knee along the medial side of the knee. Though it occurs more commonly in the overweight and in women, it also affects athletes and others. Anserine bursitis often causes pain in the region of the bursa and is often worse with bending the knee or at night with sleep.
    • Treatment: Treatment will usually include home care with PRICE therapy and NSAIDs. Severe forms, however, can be treated with periodic steroid injections to the bursae.
    • Prognosis: With optimal treatment and management, patients generally do very well.
  • Infection (or infectious arthritis)
    • Description: Many organisms can infect the knee. Gonorrhea
    • , a common sexually transmitted disease, can infect the knee, as can common organisms residing on normal skin, especially when the immune system is suppressed by underlying diseases or certain medications.
    • Symptoms and signs: Infection of the knee causes painful knee swelling. In addition, people who develop such an infection typically complain of fevers and chills. Less severe infections may not have associated fevers.
    • Treatment: New swelling and pain in the knee must be evaluated for infection based on your doctor's opinion. Treatment usually includes intensive antibiotic therapy and may include aspiration of the joint or surgical drainage of the infection.
    • Prognosis: The outlook depends on how early the appropriate antibiotic therapy is begun. Infection in a knee joint can lead to permanent cartilage damage.
  • Patellofemoral syndrome and chondromalacia patella
    • Description: These two conditions represent a spectrum of disease caused by patellar mistracking.
    • Symptoms and signs: The condition typically occurs in young women and also in athletes of both sexes and elderly people. In patellofemoral syndrome, the patella rubs against the inner or outer femur rather than tracking straight down the middle. As a result, the patellofemoral joint on either the inner or outer side may become inflamed, causing pain that is worse with activity or prolonged sitting. As the condition progresses, softening and decay of the articular cartilage on the underside of the patella occurs, and the syndrome is referred to as chondromalacia patella.
    • Treatment: Home care with PRICE therapy, NSAIDs, and exercises (such as straight leg raises) that balance the muscles around the patella work for most people. Others may benefit from commercial arch supports (for the arch of the foot) or orthotic supports that correct foot mechanics and may reduce abnormal forces on the knee. Severe cases of patellofemoral syndrome or chondromalacia may be treated surgically through a variety of procedures.
  • Jumper's knee
    • Description: Tendonitis (inflammation of the tendon) of the quadriceps tendon at the upper point of the patella, where it inserts, or tendonitis of the patellar tendon either at the lower point of the patella, or at the place where it inserts on the tibia (called the tibial tuberosity, about 2 inches below the knee on the front side), is termed jumper's knee. Jumper's knee is so named because it is typically seen in basketball players, volleyball players, and people doing other jumping sports.
    • Symptoms and signs: Jumper's knee causes localized pain that is worse with activity. It usually hurts more as you jump up than when you land because jumping puts more stress on tendons of the knee.
    • Treatment: Home therapy with the PRICE regimen together with anti-inflammatory drugs is the basis of treatment. Particularly important are rest, ice, and NSAID drugs, which will help stop the pain and break the cycle of inflammation. After controlling the pain, you should slowly start an exercise regimen to strengthen the quadriceps and hamstring muscles and resume your sport of choice a few weeks down the line.
  • Osgood-Schlatter disease
    • Description: Osgood-Schlatter disease occurs most commonly in adolescents participating in sports where repetitive extension of the knee causes inflammation and injury of the tibial tubercle (of the bone itself). It can occur in nonathletes as well and is usually linked to growth spurts during puberty
    • .
    • Symptoms and signs: Children suffering from this syndrome report pain at the tibial tubercle (the tibial tubercle is the protuberant knob on the front of the tibia, a couple of inches below the knee, where the patellar tendon attaches). This pain is typically worse when extending the leg. The tibial tubercle is tender to touch and over time begins to protrude more because the chronic inflammation stimulates the bone to grow.
    • Treatment: Osgood-Schlatter disease is a self-limited condition that usually resolves as the bone stops growing with the end of adolescence (at about 17 years of age in males and 15 years of age in females). Treatment includes PRICE and NSAID therapy. In severe cases, splinting the knee for a few weeks may help reduce the pain and halt the inflammation cycle.
  • Iliotibial band syndrome
    • Description: A fibrous ligament, called the iliotibial band, extends from the outside of the pelvic bone to the outside of the tibia. When this band is tight, it may rub against the bottom outer portion of the femur (the lateral femoral epicondyle).
    • Symptoms and signs: Distance runners typically suffer from this condition. These runners complain of outside knee pain usually at the lateral femoral epicondyle. Early on, the pain will typically come on 10-15 minutes into a run and improve with rest.
    • Treatment: The most important aspect of treating iliotibial band syndrome is to stretch the iliotibial band. One way to do this is to place the right leg behind the left while standing with your left side about 2-3 feet from a wall. Then, lean toward your left for 20-30 seconds using the wall to help you support yourself. In addition to stretching the iliotibial band, PRICE therapy and NSAIDs may be of some help.
Medically Reviewed by a Doctor on 2/19/2016

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