Knee Pain

What are the common causes of knee pain?
Chronic knee pain affects up to 25% of all adults and can be debilitating. The knee has the largest surface area in the body, and is able to support up to five times a person’s body weight.
Causes of knee pain after trauma include:
  • Knee cap tendon tear or dislocation
  • Ligament tear
  • Meniscus tear
  • Fracture
  • Cartilage injury
  • Knee dislocation
  • Bone bruising
Causes of knee pain with swelling and not related to trauma:
Worse with movement
  • Osteoarthritis
  • Osteochondral defect
Not worse with movement
  • Infection in the joint
  • Gout or pseudogout
  • Rheumatoid arthritis
Causes of knee pain without swelling and not related to trauma:
Anterior (front) of knee:
  • Quadriceps and patellar tendon injury
  • Inflammation of the bursa
  • Plica syndrome
  • Osgood-Schlatter disease
  • Hoffa’s fat pad syndrome
  • Patellofemoral pain
  • Chronic patella subluxation
  • Patellar stress fracture
  • Medial (inner aspect) of the knee
  • Pes anserine bursitis
  • Medial meniscus tear
  • Saphenous nerve entrapment
Lateral (outer aspect) of the knee
  • Iliotibial band syndrome
  • Lateral meniscus tear
  • Posterior (back) of the knee
  • Baker’s cyst
  • Popliteus tendinopathy
  • Popliteal artery aneurysm
Treatment of knee pain will depend on the underlying cause. But because most neck pain is due to muscle strain, rest and physiotherapy may be a good starting point.
Initial options include
  • Rest
  • Physiotherapy
  • Acupuncture
  • Wearing a knee brace
  • Paracetamol
  • COX-II inhibitors like arcoxia
  • Walk instead of running down slopes
  • Cycle or use a stepmaster instead of run
  • Don’t exercise as vigorously
  • Non-steroidal anti-inflammatories like ibuprofen
  • Get proper running shoes with adequate cushioning
  • Do proper warm up prior to exercise or taking long walks
  • Run on a proper track instead of on pavement or on uneven ground
  • See a podiatrist and get proper orthotics especially if you are flat-footed
  • Maintain a healthy weight, as every 0.5kg of extra weight means 2.25kg more load on your knee caps going up and down stairs
Treatment of severe or chronic knee pain include:
  • Steroid injections
  • Hyaluronic acid injections
  • Plasma rich platelet injections
  • Autologous protein solution injections
  • Geniculate nerve radiofrequency ablation
  • Knee arthroscopy
  • Meniscus repair or resurfacing
  • Cartilage repair
  • High tibial osteotomy
  • Total knee replacement
When should you see a doctor?
  • You cannot put any weight on your knee
  • You have severe pain, even at rest
  • Your knee locks or feels unstable
  • You cannot flex or extend your knee fully as before
  • You have pain, swelling and fever.
  • You still have pain after 3 days of rest.
What tests are there to investigate my knee pain?
After the medical interview and physical examination, the doctor may ask for one of the following:
  • X-ray
  • CT Scan: good for looking at bone and deep structures
  • MRI Scan: gold standard for looking at nerves, muscles, soft tissue
  • Blood test: to exclude various autoimmune conditions
  • Knee joint aspiration: fluid from the knee joint may be sent for testing

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