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