Common Causes Of Knee Pain

From WebHealth

Common causes of knee pain Introduction
Underlying diagnosis:	Comments:
Septic arthritis	red, hot, swollen knee; mostly Staph. aureus, also streptococcal and gonococcal
Inflammatory arthritis	gout, osteoarthritis, RA, AS, psoriatic
Knee trauma	strain/sprain, meniscal tear, ACL tear, ligamentous tear, bone/cartilage injury
Bursitis	carpenter's knee, Baker's cyst, prepatellar bursitis, Anserine bursitis
Growing pains	in children during growth spurts
Osgood-Schlatter disease	in athletically minded adolescents
Avascular necrosis	at medial compartment of knee in elderly females
Congenital knee problems	hypermobility, congenital plicae
Alignment problems	Bowlegs, Knock knees
Malignant bone tumors	osteosarcoma and others

[edit] Common Causes Of Knee Pain

Introduction:

The knee is very exposed and therefore easily injured. It is weight bearing and for his reason is at a higher risk when the patient is overweight.The knee is a complex structure with a medial (inside) and lateral (outside) compartment as well as a patellofemoral joint.

All of these strucutures are held together with ligaments, a joint capsule and muscle tendons that are providing significant support to the knee. Knee pain can develop when any of these structures get injured. When there is pain in the knee, the patient usually starts limping as weight bearing may be painful and the range of motion is reduced. With inflammation the synovial pouches, called bursae, can contain fluid (called an "effusion") as does the knee joint. This makes the knee cap disappear and the normal contours of the knee are blunted. Knee pain can also be referred from the lower back, the hip, pelvis and in an adolescent even from a slip in the femoral growth plate ("slipped femoral epiphysis").

In the following I will describe each of these conditions in more detail, how to diagnose and how to treat it.

Home page

Arthritis

Knee pain

[edit] Inflammatory arthritis

These traditional forms of arthritis tend to lead to synovitis, which is swelling of the synovial lining of the knee joint. Tests to diagnose and treatments to deal with these conditions vary according to the underlying diagnosis. The following links can be used to get more details regarding each of these forms of arthritis:

Gout and pseudogout

Osteoarthritis (=degenerative arthritis)

Rheumatoid arthritis(=RA)

Ankylosing spondylitis(=AS)

Home page

Arthritis

Knee pain

[edit] Growing pains

These are harmless, but can be very hard on the parent's mind: they occur in the middle of the night in children who are in the middle of a growth spurt. The legs (and also the arms) are very painful, but this disappears very quickly upon treatment with massage. In the morning there is absolutely no pain and no loss of function. Excamination a the doctor's office is normal. Usually within a few weeks even the nightly aches and pains are disappeared (Ref. 2).

Home page

Arthritis

Knee pain

[edit] Avascular necrosis (also called "osteochondritis dissecans")

This condition tends to happen suddely and occurs on one side, usually the medial aspect of a knee.

There are predisposing risk factors such as prior treatment with systemic corticosteroids, a history of lupus, alcohol abuse, history of sickle cell anemia or the hormone changes of pregnancy. Also, a history of deep sea diving with exposure to increased barometric pressure can often be found. Part of the bone and hyaline cartilage of the medial femoral condyle is cut off the circultaion and dies off, but then gets regenerated. Technetium-99 bone scan or MRI scan can help in the diagnosis. Treatment consists of high tibial osteotomy or total knee arthroplasty (knee replacement), both of which would require a referral to an orthopedic surgeon (Ref. 4).

Home page

Arthritis

Knee pain

[edit] Alignment problems

The two major alignment problems are the bowleg (genu varus) and the knock-knee (genu valgus). For more details and how this may affect the knees and gait, see this link: Alignment problems.

Home page

Arthritis

Knee pain

[edit] Bowleg (genu varus)

For a period of time it is normal for a toddler to have bowlegedness. However, by about 18 months this normalizes on its own. If it persists, rickets (Vit. D deficiency) has to be ruled out. An orthopedic surgeon should be consulted. Bracing usually helps to normalize it, if not, correctve surgery might be needed in order to prevent premature osteoarthritis.

Home page

Arthritis

Knee pain

[edit] Knock-knee (genu valgus)

This is not as common and usually peaks at age 3, then outgrows itself by age 9. It is more common in girls. If it persists, a referral to an orthopedic surgeon should be made as uncorrected genu valgus leads to premature osteoarthritis and the need for total knee replacement later in life, which can be prevented by intervening at a young age. There is a surgical stapling method available that can straighten out the malalignment (Ref. 3,p.2404).

Home page

Arthritis

Knee pain

[edit] Malignant bone tumors

There are a number of malignant bone tumors, the most common around the knee are osteosarcomas and malignant giant cell tumors. These are dealt with under this link: bone cancer, where diagnostic tests and treatment are also discussed.

Home page

Arthritis

Knee pain

References:

1. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157.

2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 4.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

4. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

6. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier