What Are Diseases And Conditions That Can Cause Knee Pain And How Are They Treated
Pain can occur in the knee from diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area. The knee joint is commonly affected by rheumatic diseases, immune diseases that affect various tissues of the body including the joints.
Arthritis is associated with pain and swelling of a joint. The causes of knee joint pain and swelling range from noninflammatory types of arthritis such as osteoarthritis, which is a degeneration of the cartilage of the knee, to inflammatory types of arthritis . Treatment of the arthritis is directed according to the nature of the specific type of arthritis.
Infections of the bone or joint can rarely be a serious cause of knee pain and have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee.
Tumors involving the joint are extremely rare. They can cause problems with local pain.
The collateral ligament on the inside of the knee joint can become calcified and is referred to as Pellegrini-Stieda syndrome. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilization, and rest. Infrequently, it requires a local injection of corticosteroids.
Why Do Joints Make Popping And Cracking Noises
Joints can make different noises–some are serious and some are not.
Some people learn how to “pop their knuckles.” By pushing or pulling a joint in a certain way an air bubble can suddenly appear in the joint with a “pop.” Once the bubble is there the joint cannot be popped again until the air has been reabsorbed.
Some joints crack as the ligaments and tendons that pass over them slide past bumps on the bones. Individuals who “crack their neck” make noise in this way.
Other joints lock up intermittently–often with a loud pop–because something gets caught in between the joint surfaces. A torn cartilage in the knee or a loose piece of bone or cartilage in the joint can do this. Once a joint is stuck in this way, it may need to be wiggled around to unlock it. This may also cause a pop.
Finally joints that are arthritic may crack and grind. These noises usually occur each time the joint is moved. This noise is due to the roughness of the joint surface due to loss of the smooth cartilage.
Meniscus Tears Of The Knee
The meniscus can be torn with the shearing forces of rotation that are applied to the knee during sharp, rapid motions. This is especially common in sports requiring reaction body movements. There is a higher incidence with aging and degeneration of the underlying cartilage. More than one tear can be present in an individual meniscus. The patient with a meniscal tear may have a rapid onset of a popping sensation with a certain activity or movement of the knee. Occasionally, it is associated with swelling and warmth in the knee. It is often associated with locking or and unstable sensation in the knee joint. The doctor can perform certain maneuvers while examining the knee which might provide further clues to the presence of a meniscal tear.
Routine X-rays, while they do not reveal a meniscal tear, can be used to exclude other problems of the knee joint. The meniscal tear can be diagnosed in one of three ways: arthroscopy , arthrography, or an MRI. Arthroscopy is a surgical technique by which a small diameter video camera is inserted through tiny incisions on the sides of the knee for the purposes of examining and repairing internal knee joint problems. Tiny instruments can be used during arthroscopy to repair the torn meniscus.
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How Will It Affect Me
If you have osteoarthritis of the knee, you will probably feel your knee is painful and stiff at times. It may only affect one knee, especially if youve injured it in the past, or you could have it in both. The pain may feel worse at the end of the day, or when you move your knee, and it may improve when you rest. You might have some stiffness in the morning, but this wont usually last more than half an hour.
The pain can be felt all around your knee, or just in a certain place such as the front and sides. It might feel worse after moving your knee in a particular way, such as going up or down stairs.
Sometimes, people have pain that wakes them up in the night. Youll probably find that the pain varies and that you have good and bad days.
You might find you cant move your knee as easily or as far as normal, or it might creak or crunch as you move it.
Sometimes your knee might look swollen. This can be caused by two things:
- Hard swelling: when the bone at the edge of the joint grows outwards, forming bony spurs, called osteophytes .
- Soft swelling: when your joint becomes inflamed and produces extra fluid, sometimes called an effusion or water on the knee.
Sometimes osteoarthritis of the knee can cause the muscles in the thighs to weaken, so your leg may look thinner. This weakness can make the joint feel unstable and could cause the knee to give way when you put weight on it.
How Is Arthritis Diagnosed
It’s important to find out if you have arthritis and what type it is because treatments vary for each type. Early diagnosis and treatment are important to help slow or prevent joint damage that can occur during the first few years for several types.
Only a doctor can tell if you have arthritis and what type it is. When you see your doctor for the first time about arthritis, expect at least three things to happen. Your doctor will ask questions about your symptoms examine you and take some tests or X-rays.
You can help your doctor by writing down information about your symptoms before your appointment. Bring your answers when you see your doctor.
Arthritis may limit how far or how easily you can move a joint. Your doctor may move the joint that hurts or ask you to move it. This is to see how far the joint moves through its normal range of motion. Your doctor may also check for swelling, tender points, skin rashes or problems with other parts of your body.
Finally your doctor may conduct some laboratory tests. These may include tests of your blood, muscles, urine or joint fluid. They also may include X-rays or scans of your body. The tests will depend on what type of arthritis your doctor suspects. They help confirm what type of arthritis your doctor suspects based on your medical history and physical exam and help rule out other diseases that cause similar symptoms.
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What Causes Arthritis
There are more than 100 different types of arthritis. What causes most types is unknown. Because there are so many different types there are likely to be many different causes.
Scientists are currently researching what roles three major factors play in certain types of arthritis. These include the genetic factors you inherit from your parents, what happens to you during your life and how you live. The importance of these factors varies for every type of arthritis.
What The Knee Needs
Your bones and cartilage need regular movement to keep them healthy, and also to strengthen the knee’s surrounding muscles, which protects the joint from excess stress, says Dr. Tenforde.
Not only can being active keep knee osteoarthritis from becoming worse, it also may reduce the risk of getting the disease in the first place. A study in the June 2017 Journal of Orthopaedic& Sports Physical Therapy reviewed 17 studies that involved almost 115,000 people and looked for a connection between running and osteoarthritis in the hip, knee, or both.
Researchers found that only 3.5% of recreational runners people who run for exercise and also compete in races like 5Ks, 10Ks, and half marathons got knee or hip osteoarthritis, compared with 10% of people who were not active.
Also, a 2015 study found among people who had mild knee osteoarthritis or were at risk for the disease, those who walked an average of almost 7,000 steps per day about 3.5 miles did not experience any additional cartilage loss over a two-year period.
If you have a high level of knee pain that makes movement difficult, Dr. Tenforde recommends you begin with lower-impact activities that place less stress on your knees. For instance, swimming and other forms of water aerobics offer buoyancy, so there is less impact on your knees. Elliptical trainers and stationary bikes are also good low-impact activities.
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Gradual Increase In Pain
Arthritis pain usually starts slowly, although it can appear suddenly in some cases.
At first, you may notice pain in the morning or after youve been inactive for a while.
Your knees may hurt when you:
- climb stairs
- stand up from a sitting position
- walk on a flat surface
- sit down for a while
Knee pain that wakes you up from sleep can be a symptom of OA.
For people with RA, the symptoms often start in the smaller joints. They are also more likely to be symmetrical, affecting both sides of the body. The joint may be warm and red.
With OA, symptoms may progress rapidly or they may develop over several years, depending on the individual. Symptoms can worsen and then remain stable for a long time, and they can vary day to day.
Factors that may cause worsening of symptoms include:
- cold weather
- excessive activity
With RA, symptoms usually appear over several weeks, but they can develop or worsen in a few days. A flare can happen when disease activity increases. Triggers vary and can include changes in medication.
How Is Knee Arthritis Diagnosed
Your doctor may use some of the following diagnostic tests and procedures to determine if you have knee arthritis:
- Medical history and physical examination
- Blood tests for genetic markers or RA antibodies
- X-rays to determine cartilage loss in the knee
- Joint aspiration: drawing out and testing the synovial fluid inside the knee joint
Cartilage cannot be seen on X-ray, but narrowing of the joint space between the bones indicates lost cartilage. X-rays show bone spurs and cysts, which can be caused by osteoarthritis. Other tests such as MRI or CT scans are rarely needed for diagnosis.
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How Is Arthritis Of The Knee Treated
Healthcare providers can’t cure knee arthritis. But they have some tips that might reduce the severity of your symptoms and possibly stop the arthritis from getting worse, including:
- Maintain a healthy weight.
- Exercise using low-impact activities instead of high-impact activities . Aim for about 150 minutes of exercise per week.
- Wear shock-absorbing inserts in your shoes.
- Apply heat or ice to the area.
- Wear a knee sleeve or brace.
- Physical therapy exercises that help with flexibility, strength and motion.
- Use a cane.
Most people have stage 4 arthritis when they get surgery.
Deformities Of The Knee
The appearance of the knee can change during a flare and as damage progresses.
In RA, swelling and redness are common during a flare. In the long term, persistent inflammation can result in permanent damage to the cartilage and the tendons. This can affect the shape and appearance of the knee.
With OA, the muscles around the knee can weaken, resulting in a sunken appearance. The knees can start to point toward each other or bend outward.
Knee deformities range from barely noticeable to severe and debilitating.
Treatment will depend on the type of arthritis a person has.
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What Are The Symptoms Of Knee Osteoarthritis
Symptoms of osteoarthritis of the knee may include:
- pain that increases when you are active, but gets a little better with rest
- feeling of warmth in the joint
- stiffness in the knee, especially in the morning or when you have been sitting for a while
- creaking, crackly sound that is heard when the knee moves
Stop Fearing Medications That May Help
Arthritis patients sometimes avoid painkillers because they’re afraid they’ll become addicted to them, or they choose not to use biologic drugs because they fear potential serious side effects. Remember that your healthcare provider would never prescribe something that might hurt you or that you could become dependent on as long as you take it as directed.
Make sure you understand when and how much of your medication you should take, and how you should take it and your arthritis meds should do nothing more than make it easier for you to live comfortably.
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What Kinds Of Arthritis Can Occur In The Knee
In the case of knee pain, one of the most common culprits is arthritis. There are three types of arthritis that can occur in the knee, and it is not unheard for patients to have multiple arthritic conditions present at the same time. The three kinds of arthritis that often develop in the knees include:
- Osteoarthritis : A slow-acting, progressive wear-and-tear process that deteriorates joint cartilage. Middle-aged and older patients are the most likely group to develop OA.
- Rheumatoid arthritis : RA can occur at any age. This inflammatory process can be marked by painful swelling in the joints.
- Post-traumatic arthritis: Patients who have a significant knee injury, such as a fracture, torn ligament, or torn meniscus, may develop post-traumatic arthritis. This can occur many years after the injury itself.
Knee Pain At A Glance
- The knee joint has three compartments.
- Causes of knee pain include injury, degeneration, arthritis, infrequently infection, and rarely bone tumors.
- Ligaments within the knee and on the inner and outer sides of the knee stabilize the joint.
- Surgical repair of ligament injury can involve suturing, grafting, and synthetic graft repair.
- Routine X-rays do not reveal meniscus tears, but can be used to exclude other problems of the bones and other tissues.
- The knee joint is commonly involved in rheumatic diseases, immune diseases that affect various tissues of the body including the joints.
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What Are The Risk Factors For Oa
- Joint injury or overuseInjury or overuse, such as knee bending and repetitive stress on a joint, can damage a joint and increase the risk of OA in that joint.
- AgeThe risk of developing OA increases with age.
- GenderWomen are more likely to develop OA than men, especially after age 50.
- ObesityExtra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees. This stress increases the risk of OA in that joint. Obesity may also have metabolic effects that increase the risk of OA.
- GeneticsPeople who have family members with OA are more likely to develop OA. People who have hand OA are more likely to develop knee OA.
- Race Some Asian populations have lower risk for OA.
What Injuries Can Cause Knee Pain
Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci , and bones forming the joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.
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Make The Right Move: See A Physical Therapist
Your knee pain also may stem from a biomechanical issue that can wear down the joint at a faster rate. A physical therapist can analyze how you move to see if you have an alignment issue or if the way your foot lands places extra stress on your knee. “Changing how you move can help ease existing pain as well as reduce your risk of a knee injury,” says Dr. Adam Tenforde, a Harvard sports medicine physician.
Knowing If You Have Arthritis Of The Knee
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Cracking Or Popping Sounds
When you bend or straighten your knee, you may feel a grinding sensation or hear cracking or popping sounds. Doctors call this crepitus.
These symptoms can occur when youve lost some of the cartilage that helps with smooth range of motion. Both OA and RA can result in cartilage damage.
When cartilage is damaged, rough surfaces and bone spurs develop. As you move your joints, these irregular areas rub against each other.