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KNEE PAIN

Overview

Knee pain is a common condition that occurs due to various factors. Four of your bones are involved in making the knee joint. It is one of the major joints of the body, and any structural abnormality or disease can limit the movement of this joint. Problems with your knee joint can restrict the overall movement of one or both legs and can be a debilitating factor for day-to-day routine work. The majority of the cases of knee pain can be treated with symptomatic care, physiotherapy, and medications. In severe cases, surgical options may be the last resort. 

Causes

There are multiple causative factors for knee pain that may occur individually or simultaneously. These factors include trauma, fractures, mechanical injury, infections, inflammation, dislocation, structural deformity, pathologic diseases, etc. Trauma or injury of muscles and ligaments associated with knee joints is one of the most common causes of knee pain. This can occur by direct collision with an object such as a car, football, etc., or indirectly by running long distances, heavy weight lifting, or other types of athletic activity. 

Fracture of any bones involved in making the knee joint can also cause immense knee pain. In some cases, the knee joint may get dislocated due to traumatic injury or other factors. Various diseases affect the knee joint. These include infectious diseases, inflammatory conditions, and systemic diseases. Examples of such diseases include baker’s cyst, meniscal cyst, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, osteomyelitis, bursitis, tendinitis, synovitis, etc. Some of these conditions involve the knees directly, whereas other conditions such as rheumatoid arthritis and osteomyelitis can involve other bones and joints apart from the knee joint. 

Structural abnormalities of the knee joint such as genu varum, genu valgum, etc., or syndromes such as plica syndrome, joint hypermobility syndrome, etc., can also lead to long-term knee pain. Age, weight, physical mobility, external weather, and certain other factors can affect the development of chronic knee pain. 

Risk Factors And Epidemiology

Age is a significant risk factor for the development of knee pain. Aging leads to reduced strength of the involved ligaments, muscles, and bones, reducing joint efficiency and mobility. The occurrence of gout and other degenerative diseases also increases with aging. The risk of indirect traumatic injury occurs if you start a strenuous workout without stretching your muscles first. If your knees are not used to running or bearing heavyweight, they may become injured right away. Obesity also affects knees as they become incapable of bearing extra weight with time. Being in athletics or physical sports also increases the risk of knee injury or knee pain. Other factors include a sedentary lifestyle, decreased mobility, systemic diseases, etc. 

Knee pain can occur at any age, but it frequently develops in older adults over 50. It affects both genders, although the risk of certain degenerative diseases such as osteoporosis, rheumatoid arthritis may be higher in women. 

Signs And Symptoms

Knee pain is itself a symptom of multiple underlying diseases. Pain in the knee joint area is often accompanied by swelling around the joint, tenderness, redness, reduced mobility, and inability to stretch leg muscles. Some cases may also present with popping sounds from the knee joint. The joint becomes stiff in certain cases, and its movement becomes limited. Long-term knee pain can also lead to loss of muscle volume in the affected leg or legs. 

Diagnosis

Since knee pain is a presenting symptom, diagnosis of the cause of knee pain is made by taking a detailed history, physical examination, lab tests, and radiographic imaging techniques. History involves the onset of symptoms, duration, severity, and other questions regarding occupation, physical activity etc. Physical examination checks for swelling, stiffness, tenderness, and knee joint mobility. If he suspects an underlying infection, inflammation, or tumor, your doctor may ask for specific lab tests such as CBC, ESR, CRP levels, etc. Imaging techniques include x-rays, ultrasound, CT scan, and MRI. Your doctor will require one or more of these radiographic images to make an accurate diagnosis if deemed necessary. 

Differential Diagnosis

Knee pain can occur due to a multitude of internal or external factors. Therefore, it is important to differentiate it from other causative factors based on symptoms, history, lab tests, and radiological tests. 

Treatment

Treatment of knee pain depends on the underlying cause. Mild to moderate knee pain that occurs due to a previous history of fracture, reduced mobility, or strenuous physical activity can be lessened by the use of analgesic medications along with physiotherapy. Placement of ice packs can be helpful in some cases to reduce pain and swelling. Pain due to systemic diseases requires medications for the particular cause to minimize symptoms. In some cases, corticosteroid injections may be given to relieve pain. Surgical treatment is needed in case of fractures, meniscal tears, or rupture of associated ligaments or muscles. It is not opted for all patients, but severe cases that cannot be corrected by limiting joint movement or medications need surgical intervention.

Medication

Medications are prescribed after diagnosing an underlying condition such as arthritis, osteomyelitis, etc. Analgesics such as acetaminophen, aspirin, diclofenac sodium, etc., may relieve pain for a certain duration, but the cause will still have to be treated. 

Prognosis

Knee pain can be a long-term debilitating condition if it is not managed well with lifestyle modifications and medical therapy. Certain cases recover completely after adequate treatment, although it may persist in many cases due to internal or external factors. 

Prevention

Knee pain can be prevented to some extent by maintaining a healthy weight and an active lifestyle. Stretching exercises are helpful to prevent knee pain, especially if you are preparing to do heavy physical activity. If you have a sedentary lifestyle like long office work hours, take a few breaks in between to stretch your legs and facilitate joint movement. Diet and nutrition are also necessary factors to avoid other associated complications. It is better to wear knee caps before participating in any athletic or sports activity that may have a risk of damaging your knees.