The knee is a complex and one of the most mobile and loaded joints of the human body, so it is not surprising that the knee mechanism breaks one day. The knee begins to give the first signals in the form of short-term arthralgia - quickly passing pain: such symptoms are familiar to many people from a young age. But in old age, knee pain ceases to be a small harmless nuisance: it becomes difficult to walk with it, go up and down stairs, the gait becomes like rearranging the legs of a compass. Surely everyone has seen such people.
Therefore, if the knee hurts, you need to think about it from a young age.
How exactly does the knee hurt - this is important
All pains in the knee can be conditionally divided according to their duration, intensity, nature and causes.
They can be divided into three categories based on duration:
- short-term, passing in a few days;
- long-term (can last three or more months);
- chronic (lasting constantly, with small shortening intervals of remission).
According to the intensity of pain are divided into weak, moderate, strong, intense.
The nature:
- pulling, aching;
- sharp sudden;
- shooting;
- pulsating, etc.
The intensity and color of pain is extremely important for diagnosis, since pain analysis allows us to suspect the presence of not only a certain pathology, but also to determine the areas affected by it and the stage of development.
short term pain
Who hasn't had knee pain at some point? Short-term pain may be due to:
- physical activity;
- sharp amplitude movements reaching critical points of joint limitation;
- prolonged immobility (sitting, squatting, kneeling);
- walking in high heels;
Such pain is the result of stretching of muscles or tendons, and usually goes away without treatment, or with the help of simple procedures: massage, kneading, gymnastics. Sometimes just lying down is enough to relieve the knee.
When it hurts really bad
- Acute sudden pain in the knee that does not go away for several hours is a signal for immediate medical attention, as it may be associated with an injury.
- Pain in the knee joint that does not go away for a long time, not associated with a previous injury, says: about ongoing degenerative-dystrophic or inflammatory (possibly infectious, autoimmune, reactive) processes in the joint or in its ligaments, tendons and bags; the formation of microtraumas in the meniscus or ligaments under the influence of fatigue stress, often occurring in athletes.
- Chronic, near-constant pain, usually combined with limited range of motion where the knee cannot be flexed to 90 degrees, is a sign of advanced arthropathy.
33 most important causes of knee pain
If your knees hurt, the reasons can be the most serious.
Pain may result from:
- traumatic or pre-traumatic condition of the knee;
- a consequence of hidden processes: gonarthrosis and periarthrosis;
- atritis and periarthritis;
- osteopathy and osteochondropathy.
Behind each name is a number of diseases with their own specifics. Consider the most common causes of knee pain.
Knee joint injuries
Injuries (dislocation, fracture, meniscus rupture, sprain/torn ligaments, etc.) are one of the most common problems in sports, as well as in childhood/adolescence.
meniscus tear
Meniscopathy at rupture manifests itself:
- sudden sharp pain;
- blockade of the joint;
- pain when pressing on the depression between the tibia and the patella;
- swelling, sometimes aggravated by hemarthrosis (bleeding into the joint bag).
The torn one must be removed, since its flap rubs against the cartilaginous tissue of the joint during movements and gradually destroys it. This process is called chondromalacia.
Rupture of ligaments is accompanied by:
- pain and swelling;
- a characteristic crack from a torn ligament;
- violations of the stability of the knee;
- with an injury to the anterior cruciate ligament, the lower leg moves forward;
- with an injury to the posterior cruciate ligament - back.
A triad injury is possible with simultaneous rupture of both ligaments and the medial meniscus with aggravated symptoms: pain, blockage, and instability.
Gonarthrosis
In second place in terms of prevalence is a degenerative-dystrophic disease (), which will gradually mutilate and deform the joint.
Initial symptoms:
- mild pain in the knees after exercise;
- after a long absence of movement, especially in a sitting position, the knee joints are stiff, they have to be “paced”;
- with the onset of periarthrosis, the first manifestations of synovitis are possible: the knee swells evenly due to the synovial fluid accumulating inside the joint bag.
In the future, with the progress of gonarthrosis, there is:
- increased pain, morning stiffness;
- when moving, a dull crunch appears;
- the knee is deformed with thickening of the subchondral bone;
- due to the narrowing of the interarticular gap, free movement of the knee, the angle of elevation is increasingly limited;
- synovitis becomes more frequent and more severe, may lead to a Baker's cyst, a collection of fluid in the posterior popliteal region
Late arthrosis of the knee can be determined:
- for unrelenting night pains; lameness
- axial deformity of the thigh and lower leg (X-shaped legs);
- bumpy surface of the knee due to the replacement of cartilage with calcium deposits;
- ossification of ligaments;
- myopathy.
Arthritis of the knee
Arthrosis is more often an age-related disease, but if knee joints hurt at a young and childhood age, then arthritis can be the cause.
Arthritis is a systemic disease that affects not only the joints, but the entire body.
The main differences between arthritis and arthrosis are:
- Pain attacks in the night/morning hours, passing with the beginning of movement (with arthrosis, on the contrary, the pain increases with movement).
- Breaking character of pain.
- Increasing the temperature to 38 - 40˚.
- The skin surface over the joint may be swollen, reddened, and hot to the touch.
General malaise is caused by intoxication with inflammatory infections that cause arthritis.
Rheumatoid arthritis
Rheumatoid arthritis is the most threatening form of arthritis, affecting the cardiovascular, nervous, urinary systems, blood-forming organs, vision, etc.
Destroys joints symmetrically and multiple times, turning into polyarthritis. The joints of the knees are affected less frequently than the small joints of the hands and feet, from which rheumatoid arthritis usually originates. More often suffer from rheumatoid arthritis in young and young years. The disease is accompanied by a number of syndromes (Still, Felty, pseudoseptic, allergoseptic), manifested in an increase in leukocytes, ESR, fever, rash, enlargement of the spleen, etc.
Reactive arthritis
Reactive arthritis causes a unilateral lesion, has a rapid character, quickly starting and ending in one joint and literally flying to another. Joint symptoms (pain, swelling, redness of the skin) appear late after recovery from an infectious disease (flu, chickenpox, rubella, etc.).
infectious arthritis
It is distinguished by a rapid onset, fever and deterioration of health caused by general intoxication. It is provoked by staphylococcal and streptococcal infections, as well as gonococci, meningococci, gram-negative intestinal bacteria. Pain in the joints is acute, accompanied by high fever, gives to other areas. In children, an infectious-allergic form is most often observed with skin rashes, conjunctivitis, Quincke's edema.
Gout
Gout rarely selects the knee, usually centering in the feet. It starts suddenly with very intense pain, usually at night. The skin over the joint turns red, soon tophi forms on it - protruding formations consisting of urate salts. The cause of gout lies in the increased content of uric acid in the blood - this is due to impaired metabolism.
Psoriatic arthritis
Psoriatic arthritis presents with severely swollen joints, thickening of the bone, and characteristic white, itchy, scaly patches on the skin of the body and scalp. It is less common in the knee joints than in the joints of the hands.
Osteoarthritis
Osteoarthritis is an inflammatory process caused by arthrosis, so it combines the symptoms of both diseases: pain during movement and rest, swelling and redness, deformities, crunching, periarthritis, etc. It develops slowly, joining the already existing arthrosis.
Traumatic arthritis
Traumatic arthritis is characterized by a latent course: sometimes it manifests itself years after the injury. The main symptom of post-traumatic injuries: constant aching pain at the site of injury; crackling, swelling of the joint.
Inflammation of the periarticular tissues of the knee joint
The knees hurt not so much because of the deformity of the joint, but because of the inflammation of its soft tissues (muscles, membranes, ligaments, tendons). It is periarthritis that causes swelling.
Synovitis
The most common cause of swelling in the knee joints is synovitis.
Signs of synovitis:
- uniform smooth swelling of the knee;
- pain on palpation of the knee and movements;
- in acute purulent or purulent-hemorrhagic form (septic synovitis), fever, nausea, and weakness are possible.
Septic synovitis requires urgent puncture with the evacuation of fluid contents from the joint cavity.
Baker's cyst
In some cases, synovial fluid collects in the posterior folds of the joint capsule, forming a Baker's cyst in the form of a ball in the popliteal fossa. At the same time, the knee area swells at the back, and when you try to bend it, there is posterior surface pain. If the pain radiates to neighboring areas, is accompanied by tingling or numbness, this indicates compression of the peripheral nerve by the cyst.
The rupture of the cyst is accompanied by a sharp intense pain, an increase in swelling, redness of the skin and high fever. This requires urgent aspiration (puncture).
Tendinitis
Tendinitis is inflammation of the tendons. If your knees hurt after constant training or hard work, then it is quite possible that the tendons have become inflamed. Most often, tendinitis affects the own ligament of the kneecap. This disease is not only sports: in a good half of people, the knees hurt not so much from osteoarthropathy, but from tendon-ligamentous inflammation, that is, periarthritis. And the reasons for this are simple:
- age-related tissue fibrosis with the appearance of pseudocysts;
- flat feet;
- dislocation of the knee joint;
- violations of the stability of the knee;
- myofascial syndrome of the muscles of the back of the thigh, in which there is a forced change in the anatomical position of the patella.
Tendonitis of the knee occurs almost always with any injury and often accompanies arthrosis of the knee.
Signs that the knee hurts due to tendonitis:
- Tendinitis in the initial stages manifests itself as a dull pain under the patella and near the condylar tubercle of the tibia.
- Initially, pain occurs only after movements or exertion, but then it begins to accompany all movements and becomes more and more intense.
- Tension and stiffness arise in the knee, it becomes more difficult to unbend it.
Knee Tendinitis Test
The following test allows you to diagnose a partial or complete rupture of the ligament:
- In a sitting or lying position with a bent knee, clasp it with your hands.
- Try to straighten your knee, resisting with your hands according to the PIRM method.
If, when trying to straighten the knee, pain occurs under the patella or near the tubercle on the outside of the knee, then this indicates a possible inflammation of the tendon.
knee bursitis
Bursitis is an inflammation of the tendon bags that attach the muscles to the bones of the articular joints.
In contrast to synovitis of the knee, which always manifests itself as an evenly distributed swelling around the knee (the exception is a Baker's cyst), it gives localized swelling (one or more) in the near-knee region. The position of the edema corresponds to the topography of the tendon bags, which are very numerous in the knee joint: there are ten main ones. With a deep position of the bag, edema may not be visualized.
Symptoms depend on which bag is affected.
Osteopathy and osteochondropathy
If degenerative processes affect the patella itself, we are talking about chondropathy.
Chondropathy of the patella occurs with constant physical exertion, and can also be a consequence of a knee fracture. It is diagnosed by severe pain, a crunch in the knee, and the inability to lean on the affected leg.
Osteopathies (osteoporosis, osteomyelitis) are systemic, intractable pathologies.
Osteoporosis mainly affects the elderly, especially women. Accompanied by aching chronic pain and a continuous decrease in bone density, which can lead to a traumatic knee fracture - this injury is the second most common osteoporotic fracture in old age after a hip fracture.
is a rare infectious disease of the bones that affects the bone marrow.
It begins acutely with severe pain in the joint area, its swelling, redness of the skin, and temperatures up to 40. Then the disease becomes latent and can proceed almost asymptomatically in the initial stages. In the later stages, purulent abscesses begin with penetration into the surrounding tissues.
Joint pain can also be due to so many diseases, it is impossible to talk about all of them in one article. It presents the most common causes of pain in the knee joints.
How to treat knee pain
The causes and treatment of knee joint are closely related. It is impossible to give the same scheme for all pathologies.
What to do if your knee suddenly hurts
Do not try to diagnose a sudden onset of acute knee pain. Even if it subsides, you must definitely visit an orthopedist and make a diagnosis. First of all, it concerns a knee injury. How to treat a knee joint, only a doctor can decide.
In case of a traumatic lesion, first aid is provided in the form of immobilization of the knee with a tight bandage or orthosis. You can apply a bandage on your own at home before visiting a doctor and remove any load from the knee.
In case of dislocation, the orthopedist will simply adjust the knee. A fracture of the patella, a torn meniscus, or may require surgery, after which the doctor will also immobilize the knee with an orthopedic segment and prescribe a rehabilitation regimen.
If a sharp pain arose for no reason, and is accompanied by general incomprehensible symptoms, the orthopedist should redirect the patient to a rheumatologist.
What to do if your knee hurts all the time
You need to see a rheumatologist:
- with constant pain of any nature that does not go away for two months or more;
- arising motor dysfunctions;
- the appearance of swelling and redness in the knee area;
- the appearance of non-articular symptoms (fever, nausea, rash, diseases of the eyes and other organs), accompanying pain in the knees or appearing after it.
Diagnosis of knee pain
First of all, an x-ray is taken.
According to the results, the doctor may prescribe the following types of research:
- CT or MRI.
- Densimetry;
- Arthroscopy (with synovitis, Baker's cyst, damage to the meniscus and ligaments).
Laboratory diagnostics is carried out:
- general and biochemical blood test with a study on rheumatic factor;
- bacterial analysis (if infectious arthritis is suspected), etc.
Relief of knee pain
Pain during exacerbation of arthropathy (degenerative-inflammatory process in the knees) is stopped:
- NSAIDs (diclofenac, nimesil, ketonal, etc.).
- Post-traumatic pain is treated with novocaine/lidocaine blockade.
- To reduce spasm of the femoral and tibial muscles, antispasmodics (mydocalm, sirlalud) are prescribed.
Removal of edema in the knee
- The formation of effusion in the joint area with synovitis is reduced by injection of glucocorticosteroids (hydrocortisone / dexamethasone).
- In an emergency, fluid is evacuated from the joint (aspiration).
- Chronic synovitis is treatable with proteolytics (trypsin/lysozyme).
Treatment of infectious and inflammatory processes
In infectious arthritis, differentiated antibiotic therapy is performed taking into account the identified pathogen and the selection of the desired antibiotic.
Rheumatoid arthritis requires long-term complex treatment with the help of basic drugs (methotrexate/sulfasalazine), immunosuppressants (cyclophosphamide/cyclosporine) and modern means of genetically engineered biology.
It is difficult to cure due to the autoimmune nature of the process.
Non-drug treatment for knee pain
In 50% of cases, knee pain is not associated with serious illness (see above: Short-term pain). For example, tendon sprains or mild tendinitis can be treated with knee strengthening exercises.
Failure of any part of the locomotor organs, especially the knees, leads to a violation of the movement and balance of the body. Pain during movement of the knee joint (during flexion, extension, turning inside plus laterally, rotation, lifting and lowering) can occur under different circumstances and under the influence of various factors. The strength of the pain syndrome, as well as its duration, differs depending on the depth of the lesion, the etiology and pathogenesis of the pathology.
Painful sensations and a specific crunch most often occur after physical exertion, injuries or against the background of chronic somatic pathologies. After carrying out medical therapy and eliminating the main cause, which is the source of the pathology, pain and movement restrictions disappear. Otherwise, the prognosis is not encouraging: complete or partial paralysis of the organ of movement can lead to lifelong disability. .
The anatomical design of the knee joint has its own characteristics, which, with any change, respond with pain. The knee joint consists of a bony structure of the femur and tibia plus the patella. The marginal shape of each bone is equipped with condyles, their thickened shape and a certain relief create conditions for ideal biomechanics, stable balance of the body in a horizontal position, as well as safe movement with joint cushioning. The bones are reinforced with each other by a special plexus of soft tissues.
The muscles, their tendons, which fasten the knee joint, are directed both from the side of the thigh and from the side of the lower leg. From the side of the thigh goes a thin muscle plus a large adductor, as well as the biceps femoris, semitendinosus and semimembranosus. The most powerful muscle of the articular knee structure is the quadriceps, in turn, it is divided into 4 muscle heads: rectus, lateral wide, medial wide + intermediate wide muscle. The tailor, thin, adductor, biceps femoral, semitendinosus + semimembranosus, as well as the triceps muscle of the lower leg and popliteal are also involved in the creation of the knee joint. Their combined plexus creates stability, mobility and mobility of the lower extremities.
Attention! Forced violation of the integrity of the articulation genus as a rupture, impact, inflammation, destruction or infection leads to the development of pain syndrome with limitation of motor function.
Inside the articulatio genus, that is, the internal space of the joint consists of periosteal cartilage, cruciate ligament, menisci, synovial bag. The blood supply and innervation of the knee joint is carried out through many complex plexuses. The sciatic, peroneal, tibial plus peroneal nerves provide sensation to the anterior and medial portion of the knee. The posterior part is provided with sensitivity by the tibial nerve with its branches.
To the menisci, along its peripheral part of the cartilaginous plate and inside it, plexuses from nerves and blood vessels (pulp and non-pulp nerve fibers) enter. When the menisci are traumatized, an acute pain syndrome develops, because the menisci are quite sensitive. With the development of dystrophic processes in the articulation genus, the pain increases and becomes permanent, and the organ itself loses its functionality plus the ability to move.
Risk factors and warning signs
Pain in the knee joints develop as a result of certain risk factors involving special conditions associated with the general condition of the body, lifestyle plus harmful environmental factors. The risk group for articulatio genus pathologies accompanied by pain is made up of people with:
- genetic abnormalities;
- anomalies in the development of cartilage and connective tissue;
- patients with pathologies of the central nervous system and peripheral nervous system;
- neurodysfunctions;
- obesity II, III - IV degree;
- diseases of the endocrine glands (thyrotoxicosis, hypothyroidism, diabetes mellitus, acromegaly, dysfunction of the adrenal glands);
- pathologies of the kidneys and liver (pyelonephritis, renal failure, urolithiasis, hepatitis B + C);
- allergic reactions to various agents;
- bronchial asthma;
- reactive pathologies of the immune system.
An alarming symptom of the pathology of the knee joint structure is a crackling sound during biomechanical actions such as flexion, extension or rotation. This symptom indicates the destruction of the joint, that is, a violation of metabolic processes, abrasion of the periosteal cartilage plate from the distal parts of the bones, plus thickening of the joint capsules with poor production of synovial fluid. Excessive weight with excessive load on the knee joints or constant motor use of the lower extremities gradually destroy the depreciation structure of the locomotor organs, leading to destructive processes.
The causes leading to gonarthrosis or pain in the knee joints can be divided into three large groups, namely:
- Infectious-inflammatory type.
- traumatic origin.
- Degenerative-dystrophic causes.
Gonarthrosis (inflammatory-destructive arthrosis) affects 65-70% of patients, of the total number of patients suffering from joint pathologies. Rheumatoid arthritis ranks second after arthrosis and arthritis. The mechanism of pain development starts from the moment of damage to the cartilaginous periosteal tissue, ligamentous plexus, accumulation of fluid in the intraarticular space with leakage into the area of neighboring tissues, as well as due to a decrease in synovial lubrication, the ingress between the articular bones of pieces of bone, cartilage tissue, meniscus or other post-traumatic body. Acute pain appears after infringement of the nerve plexus as a consequence of injury or disproportionate physical activity.
Causes of an inflammatory nature
Most often, inflammation of the articulatio genus (unilateral or bilateral) begins as a result of heavy physical exertion, as well as against the background of other pathologies, leading to the deposition of salts in the joints or washing out Ca + cartilage. The latter is a trigger for the inflammatory process in the joints of the lower extremities.
Inflammatory diseases, symptoms:
| Inflammation of the ligament plexus and muscles of the knee joint (tendinitis) | Pathology occurs at a young age (16-28 years), as well as in physically active patients at the age of 30-45 years. Athletes often get sick. The pain is acute, with variable exacerbations. With the decline of inflammation becomes aching. At rest, the leg does not hurt, the slightest movement generates a sharp pain that grows rapidly. Motor function is partially or completely limited, it all depends on the degree of inflammation. |
| Arthritis of the knee | Inflammation of the articuldtio genus occurs suddenly after injury, intoxication. The joint increases in volume, the skin is hyperemic and edematous. The pain syndrome is strong. There is motor paralysis. Microbial infection may be involved in the process. After the cause is eliminated, the pain disappears and the functionality of the knee is restored. |
| Bursitis articulatio genus | The list of causes is identical to arthritis. The clinical picture is completely similar to inflammation of the knee joint. Method of treatment: medical + surgical (puncture of the bag, stress during suppuration/destruction). |
| Inflammation of certain muscle groups articuldtio genus or myositis | Intense exercise or long hikes lead to inflammation of the muscles. A large accumulation of lactic acid in muscle tissue causes an inflammatory reaction in the muscles of the limbs and especially the knee joints. Visually, the volume of the motor organ is increased. On palpation, muscle tightening is felt, the patient reacts to acute pain, trying to remove the doctor's hand. The general condition of the patient is satisfactory, in some cases the temperature rises locally over the affected tissues and the general temperature throughout the body (up to 38-39 degrees). After drug therapy, the pain disappears, the joint acquires its former shape + functionality. |
By eliminating the source of pathology through medical or surgical treatment, the functional ability of the knee joint is restored, and acute or aching pain disappears completely. If the inflammatory process has attracted more extensive areas and the depth of the lesion is quite large, then the motor function can be partially restored. In some cases, surgical restoration of the joint is performed.
Traumatic causes
Any mechanical injury can lead to gonarthrosis. Bruises, compressions, fractures of the knee bones, open or closed injuries, as well as meniscus rupture plus bursitis, ligament ruptures, soft tissue contusion are included in the list of traumatic causes. Chemical and physical effects can also lead to knee pain. This group of causes includes burns, intoxication with toxic substances.
Causes of degenerative-dystrophic nature
There are several factors that can trigger the mechanism of degenerative-dystrophic destruction with partial or irreversible processes in the knees, namely: constant physical activity with weight lifting, excessive sports, injuries of any etiology. As well as a sedentary lifestyle with improper nutrition, stressful situations. And the last: the aging of the human body with a violation of the normal functioning of all systems and organs.
Pathologies causing degeneration and destruction of the knee joint:
- Arthritis.
- Arthrosis articulatio genus.
- Sclerosis of muscles, ligaments, ligaments, synovial bags.
- Many osteophytes replacing the cartilage plate.
- Meniscopathies.
- Metabolic disease.
- Dysfunction of the hormonal system.
- Intoxication of the body with heavy metals.
In place of the abraded cartilage, bare zones appear, that is, bare bone, which, when the joint moves, creates unbearable pain in the knee. After a certain period of time, pointed osteophytes develop in this zone. The gradual deformation of the joint in gonarthrosis leads to a change in the anatomical configuration of the articular structure and to partial or complete paralysis of the motor function of the knee (or knees). Symptoms of destructive gonarthrosis are acute pain and constant crunching of the knee with swelling of the soft tissues.
Advice! Gonarthrosis of the degenerative-destructive type is not treated with folk remedies or a drug regimen invented individually, but only in a hospital under the strict guidance of doctors. Self-treatment will lead to lifelong disability!
Diagnosis of pathology and first aid
The final diagnosis of pathology is carried out in stationary conditions. Through laboratory and instrumental studies, the causes that cause pain and limit the biomechanics of the knees are clarified. Diagnosis is approached individually, because each case of morbidity has its own source + development mechanism, therefore, the same studies are not suitable for all patients.
List of diagnostic measures:
- Taking general and biochemical blood tests.
- Urinalysis (if pyelonephritis and urolithiasis are suspected, an analysis according to Zemnitsky + Nichiporenko is recommended).
- Performing tests to detect rheumatoid factor.
- X-rays of the knee in three projections
- CT plus MRI articuldtio genus to identify the degree of damage to the bones, cartilage, ligamentous-muscular apparatus.
Patients with gonarthrosis of unknown etiology are advised to consult with the following doctors: traumatologist, arthrologist, rheumatologist and endocrinologist. If there is a suspicion of a malignant process in the joints, the patient is referred to an oncologist.
First aid for acute pain in the knee joints is provided at home or when injured. Before the ambulance arrives, the joint must be immobilized, that is, fixed with a splint. Further, an intramuscular injection with an analgesic drug is recommended, plus one of the non-steroidal anti-inflammatory drugs (Movalis or Dicloberl). On the inflamed joint, you need to put a cold compress and in no case warming or vasodilating. If the injury is open bleeding, apply a tourniquet above the knee to stop the bleeding.
Diseases of other organs, as the cause of pain in the knee
Pain and impaired functional movements of the knee joints are not only the result of inflammation, arthrosis / arthritis or injuries, but a complication of concomitant pathologies. After a full course of medical therapy, pain may subside or disappear altogether, it all depends on the remission of somatic diseases.
The list of diseases of organs and systems that lead to pain in the knee joint structures:
- Hepatitis B, C
- Thyrotoxicosis
- Hypothyroidism
- Diabetes
- Urolithiasis disease
- Bronchial asthma
- Crohn's disease
- blood disease
- Strokes
An anamnesis, laboratory plus instrumental studies help determine the cause. Each pathology has its own treatment regimen. It is prescribed by a doctor after receiving the results of the research.
Varieties of pain
Pain in the defeat of the knee joints is completely different, it depends on the cause, location, involvement of soft tissues and microbial infection, as well as on the degree of destruction of the joint. The nature of the pain can be: sharp, stabbing, aching. By localization: from the internal, external, in front, behind the knee joint, as well as above and below the patella. According to the type of distribution: the pain is strictly localized or radiating to the thigh or lower leg. By duration: temporary, permanent, variable.
How to get rid of knee pain
Before the start of medical therapy, the exact cause of the pathology is clarified, having found out the source, proceeds to eliminate it and stabilize the general condition. The therapy consists of a complex of drug treatment, physiotherapy (for medical reasons), exercise therapy, massage plus time-tested folk remedies.
Medicines
All the forces of treatment are aimed at eliminating the cause of pain, then at treating the underlying disease. In parallel, you can use medicines in the form of ointments, gels, local compresses. In the first days of acute pain, it is recommended to administer the drugs intravenously or intramuscularly. After subsidence, you can switch to oral administration.
The complex of therapeutic measures consists of:
- Pain relief of affected joints.
- Relieve knee inflammation.
- Restorative measures of a biomechanical nature, that is, the motor function of the articulatio genus.
- Treatment of pathology leading to pain in the knees (the treatment regimen is prescribed by the attending physician or highly specialized specialists such as an endocrinologist, hepatologist, allergist, rheumatologist, arthrologist, oncologist).
- Increasing the body's resistance.
- Normalization of metabolism.
- Hepatoprotectors.
- Restoration of the cartilaginous periosteal layer and normalization of the production of synovial fluid (the use of the latest generation of chondroprotectors, vitamins B and C, Calcemid D).
Therapeutic gymnastics and massage
Constant passive movements of the diseased joint and massage of the inflamed organs of movement will restore the function of the lower extremities in 1-1.5 months. A set of exercises is chosen by a doctor for exercise therapy. Massage is done locally only on the joints of the legs or general. The use of warming, anti-inflammatory or analgesic ointments will improve blood circulation and metabolism. The course of massage procedures depends on the speed of recovery of organs. Plus, a special diet is applied to these events, excluding fried, fatty, sweet, sour. The nutritionist adjusts the menu by adding dishes rich in gelatin in the form of fractional meals. All procedures in the complex in one course of treatment will eradicate pain and paralysis of the knee joints.
Folk remedies
Grandma's methods in the form of folk recipes can be used in parallel with drug therapy. All funds are negotiated with the attending physician and applied locally directly on the affected joint. The effect of folk remedies is aimed at eliminating pain + swelling, as well as warming, which in turn improves blood circulation, innervation, intensively nourishing the sore knee.
Popular folk remedies:
- Herbal baths: celandine, chamomile, mint, wormwood + ginseng root. The ingredients are taken on a spoon, poured with boiling water in the amount of 1 liter, then brewed for 2-3 minutes. At a tolerable temperature, a foot bath is performed.
- Baking soda compress: a spoonful of soda to 1 liter of boiling water. After abundant lubrication of the knee with a fortified cream, a compress is applied for the whole night.
- A compress of moonshine and grated potatoes: half a kilogram of grated potatoes + 0.5 moonshine. It is recommended to keep an hour. Repeated 3-4 times a week until the pain and swelling disappear.
- Honey rubbing: honey 200g + 100ml vodka + 200g grated horseradish. It insists for a day. Sore joints are rubbed 2-5 times a day.
Patients with an increased reaction to certain herbs or substances should refrain from traditional medicine.
Prevention
For preventive purposes, in order for the lower limbs to be healthy until old age, it is recommended to adjust the nutritious diet, be careful when moving, excluding injuries, constantly go in for sports, swimming, and walk more often in the fresh air. People over the age of 45 are advised to adjust the hormonal background of sex hormones, plus eat foods rich in gelatin in food. Spa treatment is recommended for all patients with problems of the musculoskeletal system. Once every six months, undergo an examination by the attending physician.
The knee joints are among the largest and most complex joints in the human body. They account for more than 80% of body weight, and in some situations, the load on them can increase significantly. For example, when running or jumping, the articular cartilage and menisci are deformed 5 to 10 times more than when walking. In connection with this fact, the knee joints are considered the most susceptible to various types of damage. Almost all elements of this joint are well innervated, so their damage causes pain, as well as a range of other associated discomfort. The inflammatory reaction that develops in response to damage leads to increased pain due to soft tissue edema and increased pressure of the synovial fluid in the joint cavity.
However, not only damage to the knee joint can lead to pain in this area. Often the reason lies in the pathology of the structures surrounding the knee joint - blood vessels, nerve trunks, lymph nodes and muscles. A more rare cause of pain is a volumetric formation that forms in the popliteal fossa - a cyst, a benign and malignant tumor, aneurysm, etc. In medical practice, psychogenic pains in the knees occur periodically, without any real substrate ( basics).
Each disease has a number of external signs that are detected during examination and palpation of the knee area and the rest of the limb. Together with the patient's feelings ( the nature of the pain, the frequency and duration of its occurrence, etc.) it is often possible to accurately establish a preliminary diagnosis and start appropriate treatment. With an unclear clinical picture, they resort to the use of additional instrumental and laboratory studies, the most used of which are radiography, ultrasound and arthroscopy.
Treatment should always be focused on eliminating the cause of the pain. If it is ineffective, then you should think about the reliability of the initial diagnosis. The range of drugs for the relief of pain in the knee area is huge, since the causes of pain can be extremely diverse. The most commonly used anti-inflammatory, analgesic and anti-allergic drugs in the form of ointments, compresses, injections, tablets, suppositories, etc.
Anatomy of the knee area
Knowledge of the anatomical structure of the knee joint and its surrounding structures is of paramount importance in understanding the causes and mechanisms of the development of a particular disease, manifested by pain in this area. Anatomy of the knee joint
The knee joint is formed by the distal ( remote) end of the femur, proximal ( near) the end of the tibia and the patella.The knee joint in shape belongs to the complex condylar ( blocky) joints, so it can move around three axes, and not around one or two, as in the classic block joint. The widest range of motion is recorded in the sagittal plane ( flexion and extension) and in healthy people reaches more than 140 degrees. Movements in the lateral plane and around its axis can only be carried out in a bent position of the joint. Lateral abduction and adduction of the lower leg is carried out within only 5 - 7 degrees. Rotary movements ( around its axis) are carried out within 20 - 25 degrees.
Upon closer examination of the articular surfaces of this articulation, it becomes obvious that they are not congruent. In other words, the articular surfaces do not touch tightly and there are gaps between them. With such an architectonics, the stability of the joint would be in question, however, instead, the knee joint is one of the most reliable joints of the human body. The explanation lies in the menisci - paired triangular layers of cartilage that fill the above gaps, playing the role of a gasket or sealant.
Both the menisci and the surfaces of the adjacent bones are lined with hyaline cartilage, which provides a multiple reduction in the friction force in the joint. In addition, the friction force is reduced due to the synovial fluid that fills all the free space in the joint.
The capsule of the knee joint is tightly attached to all the bones that make up it. Like all joint capsules, it is two-layered. The outer layer is called fibrous and consists of densely formed connective tissue - one of the most durable types of tissue present in the body. In addition, numerous external ligaments of the knee are involved in strengthening the articular capsule of the knee joint. The greatest contribution to strengthening the capsule of the knee joint is made by the tendon of the quadriceps femoris, which is intertwined with the fibers of the capsule and forms the tendon of the patella upon exiting it. The inner layer of the capsule of the knee joint is called synovial, because it consists of stratified columnar epithelium. Due to its structural features, this epithelium provides a constant circulation of synovial fluid, which is extremely important for cartilage nutrition and joint performance.
Anatomy of muscles and ligaments in the knee joint
The muscles in the area of the knee joint are located in such a way that they are absent in front of the knee, and behind it they form a diamond-shaped recess in which the neurovascular bundle passes. From the sides, the knee joint is protected by a small muscle mass.When feeling the knee joint from behind, the popliteal fossa, which has the shape of a rhombus, is clearly defined. The upper inner border of this rhombus is the biceps femoris muscle. The upper outer border is the semimembranosus muscle. The lower internal border is the internal head of the gastrocnemius muscle and a small part of the plantar muscle. The lower outer border of the popliteal fossa is the outer head of the gastrocnemius muscle. Deeper, under both heads of the gastrocnemius muscles, the popliteal muscle passes along the back surface of the capsule of the knee joint.
On the inside, the capsule of the knee joint is in contact with the rudimentary plantar muscle. The sartorius muscle is located more superficially. Some muscles are not in the projection of the knee joint, but their tendons are thrown over it and attached to the tuberosities and condyles of the tibia, fibula and femur. Among these tendons is the tendon of the gracilis muscle of the thigh, the semitendinosus muscle, and the semimembranosus muscle.
The most important role in the functioning of the knee joint is played by the ligamentous apparatus. Its main task is to limit the range of motion in the knee joint in such a way that dislocations do not occur. The ligaments of the knee joint are divided into internal ( located in the joint cavity) and external ( located outside the joint cavity). Part of the external ligaments is intertwined with the fibers of the knee joint capsule, significantly increasing its strength.
The most important intra-articular ligaments include:
- lateral ( internal and external);
- cruciform ( front and back);
- meniscofemoral ( front and back);
- transverse ligament of the knee.
With a lateral injury to the knee joint, the lateral ligaments are often affected. Damage to the transverse ligament of the knee is rare, since more often there is a rupture of one of the menisci, between which this ligament is located.
The most important extra-articular ligaments of the knee joint are:
- patellar ligament;
- collateral ligaments.
Collateral ligaments are located on the sides of the joint, preventing its excessive deviation from the axis of the leg in the frontal plane ( sideways). Injuries to these ligaments are extremely painful and rarely regenerate completely, so recurrent spontaneous dislocations are observed after sprain or rupture.
Anatomy of vessels and nerves in the knee joint
In the popliteal fossa passes the neurovascular bundle, including the popliteal artery, vein and sciatic nerve. Some people have one of the options for the blood supply to the knee joint, in which the femoral artery divides into two branches - the larger posterior tibial artery and the smaller anterior tibial artery. While in most people this branching is localized below the knee joint, in a small part it is at the level of the joint or above it. In this case, instead of the popliteal artery, the posterior tibial artery or even both will enter the neurovascular bundle ( anterior and posterior tibial arteries). In the same way, there are various variants of venous collaterals ( branches) in the area of the knee joint, and their number exceeds the number of variants of arterial collaterals. In addition to the above-mentioned largest blood vessels in the knee area, there is a developed vascular network designed to ensure the vital activity of the joint capsule and the pericapsular part of the menisci. In the formation of this network, not only the popliteal artery takes part, but also some branches of the femoral artery located above. In particular, we are talking about the superior and inferior medial arteries of the knee, the descending genicular artery, the superior and inferior lateral arteries of the knee, etc.
Among the nerves located in the area of the knee joint, it should be noted the sciatic nerve and its branches - the tibial and peroneal nerve, into which it divides above the level of the knee. Small sensory cutaneous nerves may also be present.
All elements of the neurovascular bundle are covered from above with fatty tissue in order to protect them in case of injury.
What structures can become inflamed in the knee?
Almost always, the cause of pain in the knees is an inflammatory process. Depending on which of the structures of the joint is inflamed, certain types of disturbances in its functioning and pain appear, which are also of a diverse nature. In the area of the knee joint, the following structures can become inflamed:
- articular cartilage;
- arteries;
- veins;
- nerves;
- lymph nodes and blood vessels;
- joint capsule ( fibrous and synovial layer);
- bones ( femoral, tibial, patella);
- muscles and tendons;
- synovial bags;
- subcutaneous adipose tissue;
Main causes of knee pain
Medical terminology for most people uninitiated in this field is complex and incomprehensible. However, its use is necessary due to its high functional capacity and accuracy. The table below is intended to improve patients' understanding of the essence of medical terms and mechanisms by which a particular disease develops.Causes of knee pain
| Inflamed structure | Name of inflammation | Mechanism of development of inflammation |
| articular cartilage | Chondrite | The most common cause of inflammation of the articular cartilage is its degenerative-dystrophic change in deforming arthrosis. With this disease, there is a gradual destruction of cartilage, accompanied by a progressive decrease in its elasticity. As a result, cartilage damage increases. In addition, there is a decrease in its ability to recover, which indirectly leads to an increase in inflammatory processes. |
| Popliteal artery | Arteritis | Inflammation of the popliteal artery mainly occurs due to local disorders of blood circulation. The most common reason for this is the deposition of microbes on an atherosclerotic plaque located in this segment of the bloodstream and the destruction of the inner layers of the artery wall by them. |
| Popliteal vein | Phlebitis | Inflammation of the saphenous vein occurs more often than inflammation of the saphenous artery, for the reason that the speed of blood flow in the vein is much lower than in the artery, and the likelihood of bacteria settling is therefore increased. In addition, the veins have a system of valves, in the area of \u200b\u200bwhich the blood flow swirls, which predisposes to the formation of a blood clot. Thrombotic masses are a favorable environment for the growth of bacteria, which cause inflammation of the wall of this vessel. |
| Sciatic or tibial nerve | Neuritis | The main cause of inflammation of the sciatic nerve is its mechanical compression and stretching due to injury or local cooling in a draft. More rare is damage to the nerve sheath by self-antibodies in certain autoimmune diseases. |
| Lymph node | Lymphadenitis | Inflammation of the regional lymph node can be localized in the popliteal fossa in response to any inflammation of the knee of the lower leg or foot ( osteomyelitis, abscess, gangrene, etc.). In this case, the lymph node acts as a barrier that traps bacteria that spread from the focus of inflammation to the rest of the body. At the same time, the size of the node increases due to the accumulation of lymphocytes in it ( immune system cells), its capsule stretches and causes pain. |
| lymphatic vessel | Lymphangitis | Often, in parallel with lymphadenitis, inflammation of the lymphatic vessel is also observed ( lymphangitis), usually located slightly below the node itself. This inflammation looks like a swollen red strip, painful to the touch. The cause of lymphangitis is an excessive amount of live bacteria or inflammatory mediators in the lymph. It is also possible the mechanism of retrograde ( reverse) inflammation of the wall of the lymphatic vessel from the inflamed lymph node. |
| Capsule of the knee joint | Synovitis | Inflammation of the synovial membrane of the joint capsule in young people is most often the result of mechanical trauma. In middle-aged and elderly people, inflammation can occur, among other things, due to rheumatism. In rheumatism, an aggressive factor is the body's own antibodies produced by the body against streptococcal infection, which, due to antigenic similarity, erroneously affect the synovial epithelium. |
| Bone marrow | Osteomyelitis | Primary osteomyelitis often develops in middle-aged and elderly people ( there are exceptions) due to bacteria entering the bone marrow along with the blood stream. Secondary osteomyelitis is traumatic, can develop in patients of any age and is always associated with the entry of microbes into the bone marrow from the environment during open fractures, surgical operations, etc. |
| Muscles and tendons | Myositis, tendonitis | Inflammation of the musculotendinous apparatus of the knee joint mainly occurs due to mechanical injuries, overworking and local hypothermia ( being in a draught). Stretching and rupture of the tendons happens in athletes who are rapidly gaining muscle mass and do not care about strengthening the tendons. |
| Synovial bursa | Bursitis | The knee joint contains from 3 to 5 synovial bags, most of which are located on the anterior surface of the capsule in the projection of the patella. They become inflamed quite rarely and for this reason their diagnosis is difficult. The main cause of their inflammation is trauma. Less often, inflammation can spread to them from neighboring structures. |
| Subcutaneous adipose tissue | Cellulite | Inflammation of the subcutaneous fat is a rather rare phenomenon and is most often caused by inflammation of neighboring structures ( osteomyelitis, purulent arthritis, etc.). |
| Leather | Dermatitis | Inflammation of the skin of the knee can develop due to a bacterial infection ( erysipelas), as well as allergic contact dermatitis. |
Diagnosis of causes of knee pain
Due to the fact that pain in the knee area can be the result of a large number of diseases, it is often necessary to use additional laboratory and instrumental studies to make a correct diagnosis. Of course, one should not underestimate the role of anamnesis ( collection of information about the development of the disease), examination and general examination of the patient, since the careful implementation of these standard methods of data collection allows in 70% of cases to establish a diagnosis. Which doctor to contact?
Due to the variety of causes of knee pain, the patient does not always know which doctor he should consult. Therefore, in order to make specifics, the patient is recommended, first of all, to contact a family doctor who will conduct the necessary primary studies to determine which area a particular disease belongs to.Approximately 80% of knee diseases can be treated by a family doctor. If there is a suspicion of a disease that is not within his competence or which he is not able to treat due to neglect, the family doctor refers the patient for a consultation with an appropriate specialist. If necessary, the family doctor or an appropriate specialist refers the patient for planned or urgent treatment to the appropriate department of the hospital.
Specialists involved in the treatment of diseases that cause pain in the knee area are:
- traumatologist;
- orthopedist;
- neuropathologist;
- surgeon;
- allergist/immunologist;
- rheumatologist;
- infectious disease specialist;
- gastrologist;
- oncologist;
- psychotherapist, etc.
Laboratory and instrumental research
To clarify the diagnosis, it is often necessary to base on the data of additional paraclinical studies specific to a particular area of medicine.Methods for diagnosing the causes of knee pain
| Medical field | Disease | Diagnostic methods |
| Traumatology/
orthopedics |
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| Neurology |
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| Surgery |
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| Allergology/ immunology |
|
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| Rheumatology |
|
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| infectious diseases |
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| gastrology |
|
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| Oncology |
|
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| Psychiatry |
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| Endocrinology |
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Radiography / fluoroscopy of the joint in two projections
Radiography is an instrumental research method in which an image of the bone structure of the knee joint is created using x-rays on a film. Cartilage is not displayed, so instead, a so-called joint space is formed between the distal end of the femur and the proximal end of the tibia.
Fluoroscopy is a similar instrumental method, but unlike radiography, it is performed in real time. In other words, the radiologist examines the skeleton of the knee joint in dynamics, turning the patient at different angles, and also asking him to make movements in the joint. As a rule, such a study is prescribed when the results of x-rays give questionable data for making a diagnosis.
With the help of radiography / fluoroscopy of the knee joint, it is possible to establish the cause of pain in its area. The most common of these are deforming arthrosis, intra-articular fracture, osteomyelitis and purulent arthritis.
X-ray of the chest in two projections
A chest x-ray may be prescribed by a doctor to exclude the development of tumor metastases in the lungs of cartilage, bone, synovial and other tissues. For their detection and localization, it is recommended to perform a chest x-ray in two projections ( posterior anterior and lateral).
ultrasound ( ultrasonography) joint and periarticular region
Ultrasound of the knee joint and periarticular space is modern, affordable, non-invasive ( not traumatic), a harmless and high-precision instrumental research method. The essence of the method is to register sound vibrations reflected from tissues of different density. Modern ultrasound devices provide a three-dimensional image of the structures of the joint, allow you to determine the thickness of the synovial membrane, cartilage, determine the state of the ligamentous-tendon apparatus, and register the presence of inflammatory changes in the synovial fluid. Also, with the help of this study, it becomes possible to study in detail the periarticular space and the structure of the popliteal fossa. In particular, with the help of ultrasound, it is possible to determine the presence of a cyst in the popliteal space, which restricts movement in it and is often the cause of pain.
With the help of ultrasound of the knee joint, most of the diseases associated with a change in its integrity, as well as the integrity of its auxiliary apparatus, are diagnosed. In addition, compared to CT and MRI, this study is much cheaper. However, unfortunately, this area has not yet been sufficiently studied and there are few specialists in this field, so ultrasound of the joints can be performed only in a few clinics.
Ultrasound of the pelvic organs
Ultrasound of the pelvic organs is carried out in two ways - transabdominally ( through the anterior abdominal wall) and intravaginally ( through the vagina). The most accurate is the study of the pelvic organs during intravaginal examination. This method is used if there is a suspicion of an endocrine cause of pain in the knees, with the so-called climacteric or post-castration ( after ovary removal) arthritis.
Dopplerography of the popliteal fossa
This study is focused on the study of blood flow. Dopplerography of the popliteal fossa determines the patency of the popliteal artery and vein, as well as the presence of wall defects in them ( aneurysm) that can cause pain in this localization. The advantages of this study are non-invasiveness, harmlessness and relative cheapness. To find out the causes of pain in the knee, a study of all large vessels of the lower extremities is performed, indicating the location and degree of blockage ( in percentages).
Arthroscopy with biopsy
Arthroscopy is an endoscopic examination method in which an LED conductor is inserted into the joint cavity, connected to a converting device and a monitor. The advantages of this method are that it can visualize the articular surfaces, menisci, intraarticular ligaments and the synovial membrane as they really are. Moreover, with the help of an arthroscope, it is possible to carry out low-traumatic operations to remove foreign bodies from the knee joint and to restore the integrity of the menisci. If a joint mass is suspected, a sample may be taken ( biopsy) and examine its histological structure for malignancy. The synovial fluid obtained from the joint cavity can also be examined cytologically for the presence of atypical cells, leukocytes, uric acid crystals, etc.
MRI
MRI is by far the second most image-clear examination after PET ( positron emission tomography). The essence of this method is to register photons emitted by the human body in a large variable magnetic field. A feature of MRI is a better visualization of structures rich in fluid ( in particular, hydrogen ions).
It should be noted that the use of this method for the diagnosis of diseases of the knee joint is extremely rare, due to the high cost of the study. However, sometimes, it is necessary to diagnose a systemic disease, one of the manifestations of which is arthritis.
A limitation to the use of MRI is the presence of metal implants in the patient's body ( dental crowns, spokes, pins, prostheses, etc.), as well as the weight of the patient more than 160 kg.
CT
CT is one of the most modern radiological research methods. Its essence is the circular performance of numerous X-ray images of a certain segment of the body with their subsequent comparison. As a result, a three-dimensional virtual reconstruction of the required body segment is created, which can be examined both in its entirety from any angle, and layer by layer in any required section. A feature of CT is better visualization of dense structures ( bones, metal, etc.). The limitation of this research method is the weight of the patient over 120 kg.
The use of CT to diagnose the cause of knee pain is also limited by high cost. As in the case of MRI, this method can be used if a systemic disease is suspected, one of the manifestations of which is inflammation of the knee joint.
When it comes to choosing between CT and MRI, several criteria are used. The most important criteria are the resolution of tomographs and their harmlessness ( exposure value). Also, one of the important factors is the competence of the doctor describing the results of the study.
Intravenous angiography
Intravenous angiography is one of the most specific radiological studies. Its essence is the introduction into a certain artery ( usually femoral or subclavian) a probe through which a radiopaque substance is introduced at a certain point in time and radioscopy is carried out in parallel ( visualization of the internal structures of the body in real time). Thus, the researcher can monitor the spread of the contrast agent along the vascular bed and mark the sites of stenoses ( constrictions) with aneurysms ( extensions) that can cause pain to the patient.
In particular, obstruction of the femoral or popliteal artery can cause acute vascular insufficiency of the lower leg ( thrombosis, atherosclerotic plaque, etc.). Clinical signs of acute arterial insufficiency are sudden pallor of the skin, absence of a pulse, and severe pain below the supposed site of narrowing.
Scintigraphy
Scintigraphy is also one of the specific radiological methods, a feature of which is the use of labeled radiopharmaceuticals administered intravenously. As they spread throughout the body, radiopharmaceuticals settle in tissues to which they exhibit tropism ( affinity). Thus, when performing an x-ray after intravenous administration of the necessary drug, the places of its accumulation are visualized on the monitor screen. The main field of application of scintigraphy is the detection of malignant processes, as well as tumor metastases, which are difficult to visualize by other methods. For most malignant tumors, specific radiopharmaceuticals already exist.
Malignant tumors of the articular structures and periarticular space can cause pain, but such cases are rare. Moreover, due to the fact that the knee joint is well visualized by simpler research methods, the use of scintigraphy to diagnose a tumor in the knee joint area is only of scientific interest and is practically not used.
Colonoscopy
Colonoscopy is an instrumental endoscopic method for diagnosing the pathology of the rectum, sigmoid and colon. Some colonoscopes are able to pass through the ileocecal valve and visualize the terminal ileum. In this study, air is forced into the rectum, after which a flexible fiber-optic conductor is introduced into it, gradually moving up the intestine. Through the fiber, a certain area of the intestine is illuminated in front of the end part of the apparatus, and an image of the inner wall of the large intestine is also transmitted to the screen.
Colonoscopy may be used to diagnose diseases such as Crohn's disease ( terminal ileitis) and ulcerative colitis. Usually, these diseases do not affect the musculoskeletal system in any way, however, in rare cases, arthritis develops, presumably through autoimmune mechanisms. Most often, such arthritis affects the hip, knee and ankle joints.
General blood analysis
A complete blood count is a screening method in any field of medicine. Without a doubt, this analysis will not indicate the exact cause of knee pain, but it can significantly narrow the search circle among a huge range of them. Some features of the shape, diameter, color index and number of red blood cells may lead the doctor to think about rare diseases in which arthritis can develop. Features of the leukogram ( percentage of different types of leukocytes in the blood) may indicate an autoimmune ( allergic), the viral or bacterial nature of inflammation of the joint.
Thymol test
Thymol test is one of the biochemical analyzes indicating the severity of the inflammatory process. This analysis is general, and its high rates may indicate an arbitrary localization of the inflammatory process.
C-reactive protein
C-reactive protein is also a common marker of the inflammatory process in the body, however, unlike the thymol test, an increase in its values may also indicate the rheumatic nature of inflammation of the knee joints.
Determination of the level of VIII and IX coagulation factors
One of the manifestations of hemophilia ( congenital disease characterized by a deficiency in blood clotting) is intra-articular bleeding. As a rule, it is abundant and difficult to stop, as a result of which a large amount of blood enters the joint cavity. Together with the blood, biologically active substances enter the joint cavity, causing inflammation and pain. Since the knee joint is one of the most massive human joints, and according to statistics, its injuries are the most frequent. Bleeding into this joint in patients with hemophilia is the most likely and, as a rule, the most pronounced.
Diagnosis of hemophilia is helped by a carefully collected family history, an appropriate clinical picture, and the determination of blood levels of VIII and IX clotting factors. The tests included in the coagulogram may also be useful ( prothrombin, thrombin time, fibrinogen, etc.).
CEC
CECs are complexes of an antigen circulating in the blood with an antibody that attacked it. CECs are found in type 3 allergic reactions according to Gell and Coombs ( immunocomplex reactions). When this complex is deposited on the vascular wall, an inflammatory reaction develops in it, externally manifested by local redness and pain of varying severity. As a rule, such reactions are systemic in nature and their manifestations are not limited to the defeat of only certain parts of the body. In other words, damage to the knee joints, usually symmetrical, develops as part of a systemic allergic process in the body.
Fractions of immunoglobulins
Determination of the fraction of immunoglobulins is used in the differential diagnosis of some allergic and autoimmune diseases that can manifest as pain in the knee area.
ASL-O
ASL-O ( antistreptolysin-O) is a type of antibody against streptolysin - a proteolytic ( destroying proteins) an enzyme from a bacterium called beta-hemolytic streptococcus. In a certain category of patients, these antibodies cross-infect the cartilaginous tissue of the joints. In connection with the foregoing, a high titer of ASL-O is a diagnostic criterion for rheumatism.
Rheumatoid factor
Rheumatoid factor is also one of the tests needed to make a diagnosis of acute rheumatic fever, which is known to cause severe knee pain.
Uric acid
An increase in the level of uric acid in the blood is a substrate for a disease such as gout, in which joints ( more often large) deposits of salts of this acid are formed. As a result, acute arthritis develops, accompanied by fever and severe pain in the knee, up to the lack of movement in this joint.
Antibodies to DNA
The detection of these antibodies is the most accurate criterion for the laboratory diagnosis of systemic lupus erythematosus, one of the manifestations of which is pain in the knee joints.
LE cells
LE cells are certain types of leukocytes that have absorbed the nuclei or fragments of the nuclei of other cells in the body. These cells are found in 70% of children with systemic lupus erythematosus, which can cause bouts of knee pain.
Wasserman reaction
This analysis is positive for such a well-known venereal disease as syphilis. One of the complications of this infection is syphilitic arthritis, which develops with a direct lesion of the synovial membrane or the end of the bone with pale treponema ( the causative agent of syphilis) or indirectly through autoimmune mechanisms.
ELISA/ELISA
With the help of ELISA ( linked immunosorbent assay) searches for certain types of antibodies in the blood. In particular, the diagnosis of antibodies to chlamydia and gonococcus, which causes Reiter's syndrome, may be useful. With this syndrome, there is a triad of lesions of the conjunctiva of the eye, urethra ( as well as the prostate) and the synovial membrane of the joints ( more often large). If antibodies to pale treponema and pain in the knees are detected, a diagnosis of syphilitic arthritis can be made with a high probability.
Microscopy and culture of urethral smear
Microscopy and culture of the urethral smear allows the identification of the causative agent of sexually transmitted infections, which, directly or through autoimmune mechanisms, can cause pain in the knees.
Microscopy and culture of a nasopharyngeal swab
Diseases such as measles, typhoid, diphtheria or pneumococcal pneumonia can cause knee pain mediated, as in the cases above, by immunological cross-aggression. For bacterial diseases typhus, diphtheria, pneumococcal pneumonia, whooping cough, etc.) it is often possible to diagnose the pathogen with simple microscopy with appropriate staining of smears. If necessary, resort to specific diagnostic tests and inoculation on simple and enriched nutrient media. For viral diseases ( measles, rubella, etc.) to identify the pathogen is much more difficult. For this purpose, virus inoculation on live nutrient media or PCR is used ( polymerase chain reaction) , which make it possible to identify regions of the genome characteristic of a particular virus.
ASCA
Antibodies to saccharomycetes are a diagnostic criterion for Crohn's disease. These bacteria belong to the permanent microflora of the human intestine, since they are involved in the process of food fermentation and even secrete a number of vitamins. However, some patients develop an enhanced immune response to these bacteria, due to which a specific inflammatory process develops in the intestine, which is a substrate ( basis) Crohn's disease.
In even rarer cases, the formed pathological antibodies affect not only the intestinal tissues, but also the synovial membrane of the joints, which is why patients develop reactive arthritis. Their most common localization is the large joints of the lower extremities ( hip, knee, ankle).
pANCA
Antibodies to the cytoplasm of neutrophils are detected in a number of diseases, one of which is ulcerative colitis. With this disease, as well as with Crohn's disease, autoimmune arthritis can develop, manifested by pain in large joints and, in particular, in the knee joint.
kidney tests ( creatinine, urea)
These tests are performed to assess the excretory function of the kidneys. Their deviations may indicate amyloidosis, systemic lupus erythematosus, primary tumor, metastases, etc. All of the above pathologies can affect the functional integrity of the knee joints through various mechanisms. Thus, the study of kidney function can complement the clinical picture of a certain disease, one of the manifestations of which is inflammation of the knee joint.
liver tests ( total bilirubin and its fractions, ALT, AST, alkaline phosphatase, GTP)
The study of liver function is carried out for the same purpose as the study of kidney function. Due to the fact that the liver is a filter for blood collected from the intestines and pelvic organs, it is in it that metastases of malignant tumors of these organs are most often found. Malignant tumors, in addition to the classical clinical picture, can provoke the development of paraneoplastic syndrome, in which antibodies produced by the body against the tumor cross-attack tissues that are similar in antigenic structure. As a result, the kidneys, liver, lungs, brain, synovium of the joints, etc. can become the target of antitumor antibodies. In particular, the development of paraneoplastic arthritis of the knee joint is manifested by its swelling, redness, pain, and is almost always bilateral.
Tumor markers ( tumor markers)
While in the body, tumors of various tissues almost always secrete certain substances into the blood that are not normally found. Such substances are called tumor markers. Their detection helps in the diagnosis of the primary focus of a malignant neoplasm. Unfortunately, not all tumor markers have been discovered to date, and their diagnostic value is not always absolute, since for most of them there is a certain percentage of error.
The negative impact of the tumor on the knee joint can be mediated by direct and indirect influence. Direct influence involves the growth of a tumor directly from the cartilage, bone or connective tissue of the joint itself, leading to a change in congruence ( compliance) of its surfaces and the development of inflammation. Indirect influence is more often mediated by the paraneoplastic syndrome described earlier.
The markers specific for synovial sarcoma are vimentin, epithelial membrane antigen, and pancytokeratin. The marker of malignant schwannoma is vimentin, S-100, CD99, proliferative activity index Ki-67. A marker of myosarcoma is a high titer of antibodies to desmin, myoglobin, specific actin HHF-35, and vimentin. The markers of other tumors are either poorly studied or not informative enough.
Determination of the level of estrogen and progesterone in peripheral blood
This study is relevant only for the fair sex, since it is they who normally experience a change in the level of ovarian hormones ( estrogen and progesterone) throughout the utero-ovarian cycle. Violations of this cycle or its absence may indicate certain somatic diseases or the onset of menopause. In addition to the classic signs of menopause in some women, it can be manifested by climacteric arthritis, the nature of which, unfortunately, has been little studied. It is believed that estrogens accelerate the regenerative properties of articular cartilage, so their absence leads to its accelerated destruction, accompanied by inflammation and pain. A similar condition can develop after surgery to remove both ovaries, and in this case it is called post-castration arthralgia.
What to do for knee pain?
Causes of knee pain are conditionally divided into urgent and non-urgent. Urgent conditions are those that pose a threat to life or can lead to significant impairment of the function of the knee joint and the entire lower limb. All other states are non-urgent. First aid for urgent conditions causing knee pain
Urgent conditions leading to knee/knee pain include:- hemarthrosis ( intra-articular hemorrhage);
- purulent arthritis;
- stretching of the ligament-tendon apparatus;
- joint jamming;
- dislocation / subluxation of the joint;
- intraarticular fracture.
Almost always, the patient finds it difficult to independently establish a diagnosis, since the external signs of damage to the knee joint are always the same ( pain, redness, swelling, local increase in skin temperature). Therefore, for all emergencies associated with knee pain, there are some general first aid measures.
For urgent conditions associated with knee pain, it is recommended:
- call an ambulance;
- give the leg a position in which pain would be minimal;
- put an ice pack or cold bandage on the swollen knee ( change every 3 - 5 minutes);
- take any available pain reliever or anti-inflammatory drug ( ketanov, analgin, ibuprofen, paracetamol, etc.) in the amount of one dose ( see instructions for the drug), if it was not previously allergic.
- knee massage;
- applying an elastic bandage.
Treatment of non-urgent conditions associated with knee pain
As mentioned earlier, all diseases that cause pain in the knee area are divided into groups according to the cause of their occurrence. Various diseases are treated by appropriate specialists. Each area of medicine has a certain set of the most commonly used methods and medicines.For the treatment of pain in the knee of a traumatic nature, it is used:
- surgical or non-surgical restoration of the integrity of the joint;
- temporary immobilization of the joint plaster splint, orthosis, Ilizarov apparatus, etc.);
- skeletal traction method;
- painkillers and anti-inflammatory drugs ( in the form of ointments(diclofenac), lotions(dimethyl sulfoxide), injection(tramadol)and inside(ketorolac));
- chondroprotectors ( glucosamine hydrochloride, glucosamine sulfate, chondroitin sulfate, etc.);
- hormonal drugs ( in the form of ointments and injections - dexamethasone, betamethasone, triamcinolone, etc.).
For the treatment of pain in the knee of a neurogenic nature, the following are used:
- painkillers ( orally, by injection or in the form of blockades);
- anti-inflammatory drugs ( nimesulide, meloxicam, celecoxib, etc.);
- anticonvulsants ( carbamazepine, phenytoin, gabapentin, etc.);
- physiotherapy ( UHF, electrophoresis, magnetotherapy, etc.);
- B vitamins.
- opening of a purulent focus with appropriate treatment of the wound with antiseptics;
- restoration of the integrity of menisci, ligaments, tendons;
- removal of a foreign body, excision of a tumor;
- sclerotherapy and removal of varicose veins;
- popliteal cyst removal Baker);
- stenting ( artificial expansion of the site of narrowing of the vessel with the help of a cylindrical mesh implant - a stent) popliteal artery;
- elimination of an aneurysm of the popliteal artery
- the use of thrombolytics and antiplatelet agents ( urokinase, streptokinase, heparin, etc.).
- antihistamines ( loratadine, clemastine, cetirizine, etc.);
- hormonal drugs ( dexamethasone, prednisolone, etc.);
- adsorbents ( activated carbon, smectite, etc.);
- mast cell membrane stabilizers ( mast cells) (ketotifen, nedocromil, etc.);
- laxatives ( lactulose, bisacodyl, glycerin, etc.);
- bed rest 5 - 10 days ( to avoid complications from the cardiovascular system);
- glucocorticosteroids ( prednisolone);
- NSAIDs (non-steroidal anti-inflammatory drugs) ( indomethacin).
- NSPV;
- pain relievers ( lotions with dimethyl sulfoxide, ketorolac, etc.);
- antipyretics ( paracetamol, ibuprofen);
- antihistamines ( loratadine, clemastine, etc.);
- drugs for the treatment of the underlying disease ( antibiotics, antivirals).
For the treatment of knee pain associated with diseases of the digestive tract(Crohn's disease and ulcerative colitis), apply:
- glucocorticosteroids ( prednisolone - courses of short and medium duration);
- intestinal anti-inflammatory drugs ( mesalazine, sulfasalazine);
- NSPV;
- painkillers.
- painkillers of various strengths ( including opiates.(tramadol, morphine, fentanyl, etc.));
- anti-inflammatory drugs ( enhance the effect of painkillers);
- treatment of the underlying disease surgical removal of the tumor, chemotherapy, radiotherapy).
Features of knee pain
Since the concept of knee pain is so broad, many patients find it difficult to describe in detail the problem that bothers them. In this regard, in order to make more specific, the reader is given the opportunity to independently choose the most appropriate description of the pains that torment him from the list below. Most often, patients ask:
- Why does it hurt under the knee?
- Why does it hurt at the back of the knee?
- Why is my knee sore and swollen?
Why do my knees hurt after running?
The most common causes of pain in the knee area after running are stretching of the ligamentous apparatus, muscle tendons and destruction of articular cartilage in deforming arthrosis.
The knee joint is one of the most complex joints in the human body. Its stable functioning is ensured by a system of intra-articular and extra-articular ligaments that prevent pathological displacement of the articular surfaces. During running, there is a multiple increase in the likelihood of subluxations and dislocations compared to walking. The reason lies in the increase in the impact force when the articular surfaces collide with each other. A slight deviation of the leg from the usual axis while running is compensated by the strength of the ligaments, which prevent dislocation in the joint. When the leg deviates from the usual axis to a degree exceeding the tensile strength of the ligament, it is stretched or completely torn.
Clinically, a ligament or ligament injury is manifested by pain in the corresponding part of the knee. If there is a rupture of one of the internal ligaments of the knee, inflammation of the synovial capsule often joins, and the pain becomes diffuse. Rupture of the intermeniscal ligament is often accompanied by a rupture of one of the menisci with free wandering of the torn fragment within the joint cavity. If this fragment gets between the articular surfaces in extreme positions, joint jamming may occur. At rest, the pain is often pulling, and when you try to move, it sharply increases. Complete rupture of the ligaments requires surgical restoration of their integrity.
Tendon sprain
Stretching tendons is a fairly common mistake beginner athletes make. The reason lies in the fact that the set of muscle mass, and, accordingly, the strength of the muscle fiber, occurs faster than the strengthening of the tendons. Thus, the load on the tendons and their attachments to the bone increases without increasing their strength, which eventually leads to their stretching or tearing. In order to avoid such injuries, it is recommended that, in addition to dynamic loads ( running, swimming, aerobics, etc.) at the end of the workout, perform several solo static exercises. Static loading rather leads to functional restructuring of the muscle tendon, reducing the likelihood of its stretching.
Pain during tendon sprain at rest, as a rule, constant, dull. When the corresponding muscle is tense, the pain intensifies. Tendon rupture is considered a more severe pathology, manifested by much more pronounced pain, hematoma ( interstitial bleeding), functional failure of the corresponding muscle ( inability to perform the movement for which she is responsible). With a complete rupture of the tendon, it is necessary to restore its integrity surgically.
Destruction of articular cartilage in deforming arthrosis
Deforming arthrosis is a dystrophic degenerative disease of cartilage with a complex mechanism. Its essence is a shift in the balance between the processes of formation of cartilage tissue and the processes of its destruction. As a result, the surface layers of the cartilage are gradually erased, and the nerve endings that were previously in the thickness of the cartilage are exposed. Even their slight irritation with a simple movement causes pain.
During rest, the exposed nerve fibers are covered with an inconspicuous layer of fibrin, which protects them from irritation. However, when running, fibrin is erased, again exposing the nerve endings. Thus, a patient with deforming arthrosis can start a run in good health, and finish it in pain. A few hours after running, the pain persists or even intensifies due to the development of aseptic inflammation in the capsule of the knee joint. However, after several days of rest, the pain gradually disappears, which is explained by the formation of another protective layer of fibrin on the articular surfaces.
Pain in deforming arthrosis manifests itself mainly after an increase in the load on the damaged joint and, as indicated above, disappears after rest. In the more advanced stages of the disease, pain is absent in the morning, appears a few hours after waking up and reaches a peak in the evening, even in the absence of heavy loads throughout the day. The intensity of pain depends on the severity of pathological changes in the articular cartilage.
Why does it hurt under the knee?
Pain in the popliteal space can be caused by stretching of the ligamentous apparatus, inflammation at the level of the neurovascular bundle, as well as the growth of a volumetric formation.Tension of the ligamentous apparatus
Stretching of the ligamentous apparatus of the knee joint, in particular, its posterior part, can occur with excessive forced extension of the leg. Often, injuries of this kind are associated with intra-articular fractures, since at the moment of stretching, the entire load that the ligaments carried is redistributed to the lateral parts of the articular surfaces of both bones ( femoral and tibial). Since the lateral parts of the articular surfaces are anatomically not adapted to the loads that fall on the share of the central parts, a split occurs in the weakest place with a crack extending deep into parallel with the axis of the bone. In other words, the so-called T-shaped impacted intra-articular fracture is formed.
When the ligaments and tendons behind the knee are stretched, there is excessive mechanical irritation of the proprioceptive nerve endings, which are normally responsible for the sense of displacement of body parts relative to each other. The edema that develops after some time increases the compression of these endings, causing a sensation of pain. The restoration of the integrity of the ligaments occurs on average after 2-3 weeks, however, the tone of the affected tendon or ligament is almost never fully restored, and therefore, even years later, repeated sprains, dislocations and fractures with the same mechanism can occur.
Inflammation of the neurovascular bundle in the area of the popliteal fossa
The neurovascular bundle of the popliteal fossa most often consists of the popliteal artery, popliteal vein, and tibial nerve.
The main cause of inflammation of the popliteal artery is the formation of a blood clot in it. Less often, the cause of inflammation is an aneurysm and a traumatic factor. When a thrombus forms or enters in the area of blockage, an acute oxygen deficiency develops, which is manifested by severe local pain and blanching of the affected area. Due to the fact that the popliteal artery is the main vascular highway that delivers blood to the lower parts of the leg, its blockage immediately affects the functional viability of the knee, lower leg and foot. However, since there is an extensive network of collaterals in the knee area, the deficit may not be absolute, but relative, leading to pain during exercise and absence at rest. However, in fairness, it should be noted that in most cases these anastomoses turn out to be inconsistent, and in case of failure to provide urgent medical or surgical care, the patient develops gangrene of the leg below the blockage site, which is accompanied by monstrous pain and a pronounced syndrome of general intoxication.
Inflammation of the popliteal vein develops, as a rule, with its varicose veins. The blood flow at the site of varicose veins slows down, blood cells ( erythrocytes, leukocytes, platelets) are deposited on microscopic cracks in the vein wall. Then the density and size of the sediment increases, and it transforms into a thrombus. Blockage of blood flow in the popliteal artery, as well as blockage of the popliteal artery, can lead to gangrene of the leg, but more often this does not happen due to the developed system of superficial veins, through which blood flows back to the heart. Pain in the area of a thrombus is caused by a lack of blood supply, as well as the addition of bacteria that gradually destroy the vascular wall. The intensity of pain in thrombosis of the popliteal artery, no doubt, is high, but an order of magnitude lower than pain in thrombosis of the popliteal artery.
Inflammation of the tibial nerve neuritis) is rarely isolated at knee level. Pain usually radiates along the sciatic nerve and its largest branch, the tibial nerve, from the sacrum down the back of the thigh, knee, and upper third of the leg. The cause of neuritis is the pinching of the nerve in one of the bone canals, bruising, sprain, as well as local cooling in the flow of cold air ( air conditioning, draft, etc.). Less common is a viral or autoimmune lesion of the above nerves, which develops, as a rule, systemically. Pain at rest is moderate, often pulsating. Their strengthening occurs when the nerve is stretched ( positive symptom of Lasegue's tension).
Growth of mass formation in the popliteal fossa
Among the volumetric formations found in the popliteal fossa, a cyst is determined ( Baker), an aneurysm of the popliteal artery, an enlarged lymph node, and a tumor formation.
Baker's cyst is an accumulation of synovial fluid in the synovial sac on the back of the knee joint. This cyst may communicate with the joint cavity, or may be isolated. In this regard, its consistency may be soft ( if there is a message) or dense ( if there is no message). As a rule, the cyst is mobile, not soldered to the surrounding tissues, slightly painful and protrudes when the knee is extended.
Popliteal artery aneurysm- the phenomenon is quite rare, but occasionally occurs in surgical practice. It is a local extension or additional cavity connected to the main trunk of the artery. The walls of the aneurysm are thinned, and therefore there is always a risk of its rupture and severe interstitial bleeding. As a rule, the aneurysm is not soldered to the surrounding tissues; it pulsates on palpation. Soreness can be felt periodically at the time of growth of this formation and with high blood pressure ( sports, arterial hypertension, etc.).
The lymph nodes The popliteal fossa can increase as a result of their local inflammation or inflammation of the underlying tissues of the leg. As a rule, they are painful, especially when bending the leg at the knee and when feeling. There may also be local redness and an increase in skin temperature. The inflamed lymph node is slightly mobile, elastic, with even contours.
Tumor processes popliteal fossa are not common. Their characteristics ( density, elasticity, cohesion with surrounding tissues, soreness, etc.) depend on the type of tumor.
Why does it hurt at the back of the knee?
Pain in the back of the knee is often caused by stretching of the ligaments and tendons, inflammation of the nerve and vascular structures, as well as the growth of a mass in this area.Tendon ligament stretching
Both in the ligaments and in the tendons there are proprioceptive nerve endings that transmit information to the brain about how great the tension of these fibers is at any given time. In the brain, nerve impulses received from all proprioceptive receptors are summarized and processed, as a result of which a person can feel his position in space, even with his eyes closed.
When the fibers of a tendon or ligament are stretched, the proprioceptive receptors located between them experience irritation ten times greater than normal, which is why the impulses they send are perceived by the brain as pain.
Stretching of the ligament-tendon apparatus of the back of the knee joint can occur when it is hit in the anteroposterior direction, as well as when falling from a height onto straight legs. Often, such injuries are associated with intra-articular impacted fractures of the tibia and/or femur.
Inflammation of the nerve and vascular structures of the popliteal fossa
The neurovascular bundle of the popliteal fossa consists of the popliteal artery, vein, and tibial ( sometimes ischial) nerve. Inflammation of vascular structures most often occurs due to blockage of their lumen by thrombotic masses. The resulting oxygen deficiency in the surrounding tissues and in the vessel itself leads to acute ischemic pain ( due to lack of blood supply). Bacteria that are deposited on thrombotic masses and cause a local inflammatory process can lead to direct destruction of the vascular wall from the inside. Pain, as a rule, is clearly localized, acute. Their severity depends on the degree of oxygen deficiency in the surrounding tissues. Thus, with an increase in physical activity on the legs, the pain also increases in proportion.
Inflammation of the tibial nerve in most cases develops after a mechanical injury ( bruise, sprain). Frostbite of this nerve is also possible, however, in those of its segments that are located more superficially. In the popliteal fossa, this nerve is located deep enough and is covered with a layer of fatty tissue, so it is rarely supercooled. In some cases, inflammation spreads to it from surrounding tissues with purulent arthritis, osteomyelitis, tendinitis, soft tissue phlegmon, etc. In rare cases, autoimmune damage to the nerve fiber by the body's own antibodies is noted. Pain in neuritis is acute and, as a rule, pronounced. Their weakening during immobility and strengthening, even with a slight movement of the leg, are characteristic.
Volumetric formation of the popliteal fossa
Among the volumetric formations that occur in the popliteal fossa, cysts, aneurysms, lymph nodes and tumor formations are distinguished.
Cysts are cavitary fluid formations that may be isolated or associated with the capsule of the knee joint. The elasticity of the cyst depends on the connection with the synovial cavity. Thus, if the cyst is soft, then most likely it is associated with the joint capsule and, conversely, if the cyst is dense, then it develops in isolation from the capsule. When trying to displace the cyst is quite mobile, smooth to the touch. In the bent position of the knee, the cyst is practically not felt, and when the leg is straightened, it protrudes from the popliteal fossa.
An aneurysm is a site of expansion of an artery or a sac-like outgrowth connected to it by a narrow mouth. Pain in an aneurysm occurs when its walls are stretched due to an increase in systemic blood pressure, for example, when running, squatting, etc. A distinctive feature of an aneurysm is a clear pulsation that coincides with heart contractions. Its surface is smooth, mobility is moderate. Elasticity may be different depending on the level of blood pressure at the time of the examination.
Lymph nodes are a kind of filters that trap bacteria and viruses that are in the lymph. In some diseases, the size of regional lymph nodes can increase tenfold compared to the norm. In this case, the node becomes dense, painful, smooth to the touch and almost motionless. Unlike an aneurysm, there is no pulsation. Often the skin over the knot is plethoric ( red), the local temperature is increased. Often a red, painful streak leads to an inflamed lymph node - an inflamed lymphatic duct ( lymphangitis).
Tumors of the popliteal fossa can grow from almost any type of tissue ( connective, muscle, fat, cartilage, bone, nervous, epithelial, etc.). Tumors of this localization are rare, but this is not a sufficient reason to exclude this disease from the differential diagnosis. The density of tumors is usually high. Benign tumors are usually more mobile than malignant ones because they do not have infiltrative growth. The surface can be difficult to define. Only lipomas have their own capsule, so they are smooth on palpation. Pain occurs when the tumor begins to compress surrounding tissues or disintegrate. In malignant tumors, there are corresponding clinical signs ( weight loss, lack of appetite, anemia, metastatic damage to other organs and systems).
Why do you have knee pain while walking?
The most common cause of pain in the knee joint when walking is deforming arthrosis. Less commonly, pain may be caused by arteritis obliterans, varicose veins, or aneurysm.Pain in deforming arthrosis
Deforming arthrosis is a complex dystrophic-degenerative disease of articular cartilage. Due to the fact that the knee joints are among the largest joints of the human body, their defeat by this disease is the most likely. Pain in deforming arthrosis is manifested due to the fact that the articular cartilage of the knee joint is gradually compressed and erased, exposing free nerve endings. Even with a slight impact on these endings, for example, with a simple movement or walking, there is an acute pain that disappears after a short rest.
As the disease progresses, the number of exposed nerve endings increases, the inflammatory process joins, the depreciation role of cartilage decreases and its nutrition worsens. As a result, the pain manifests itself more often, becomes more intense and disappears only after a long rest, combined with taking anti-inflammatory drugs and chondroprotectors.
Pain in obliterating arteritis
Arteritis obliterans is an inflammation of an artery. The main mechanism for the development of this pathology is blockage of the lumen of the artery ( in this case, popliteal) atherosclerotic plaque. As a result, there is an acute violation of the blood circulation of the lower limb after the blockage. Tissues that do not receive oxygen secrete biologically active substances and products of anaerobic ( anoxic) metabolism, which irritate the nerve endings and cause pain in the knee area. Almost always they are accompanied by pain in the lower leg and foot, they are extremely pronounced and do not go away until blood circulation is restored.
With incomplete blockage of the lumen of the artery, pain occurs only during exercise, when oxygen consumption increases, and its amount is not enough. After rest, the pain goes away. In severe cases, when the lumen of the artery is completely blocked and drug therapy does not help, the pain is constantly intensifying due to the ongoing destruction of tissues and the accumulation of their decay products in the limb. In the absence of appropriate medical and endoscopic treatment, gangrene develops over time.
Pain in varicose veins
With this pathology, a slow stretching of the superficial veins occurs, more often than the popliteal space, causing irritation of the nerve endings located in their wall. Excessive irritation of these receptors during an increase in venous pressure ( during pregnancy, hypothyroidism, heart failure, etc.) is manifested by moderate local pain. The addition of the inflammatory process leads to increased pain and progression of vein deformity.
Pain from an aneurysm
An aneurysm is an expansion of a certain section of an artery or the formation of a sac-like cavity formation connected to a given artery. The aneurysm has thin walls, and therefore the risk of its rupture with the development of severe interstitial bleeding increases many times over. Pain in an aneurysm is due to its stretching during an increase in blood pressure, and their intensity, as a rule, is not high.
Why is my knee sore and swollen?
Pain in the knee area, associated with its swelling, most often indicates the development of acute arthritis.In acute arthritis, inflammation of all structures located in the synovial cavity of the knee joint occurs. In particular, inflammation affects articular cartilage, intra-articular ligaments, menisci, and the synovial membrane. The causes of inflammation are varied - autoimmune, viral, bacterial damage, mechanical or thermal injury ( frostbite) and etc.
Inflammation of the synovial membrane leads to its significant swelling and thickening. In addition, there is a violation of the circulation of the synovial fluid, due to which its production increases, and the reabsorption slows down. Thus, fluid pressure gradually increases in the joint cavity, and the patient feels pain and a feeling of fullness in connection with this.
An increase in pressure in the knee joint is also dangerous because a free space is formed between the articular surfaces of the femur and tibia, which is normally absent. Because of this, the articular surfaces are no longer in close contact with each other, and the risk of dislocation or subluxation increases significantly.
Inflammation of the ligaments of the knee joint leads to increased pain during flexion or extension of the leg. Inflammation of the articular surfaces is also manifested by pain during movement, and their intensification is noted with compression of the articular cartilage during walking. Thus, for example, during an attack of gout, the inflammation of the knee joints is so pronounced that the patient is unable to stand up.
Why does the knee hurt when bending?
Pain when bending the leg at the knee is most often a sign of deforming arthrosis, sprain of the ligamentous apparatus of the knee, or fracture of the patella. Osteophytes in deforming arthrosis
Deforming arthrosis involves damage to the articular cartilage. In response to damage, an inflammatory process develops, in which the rate of cell division increases. In the first phase of inflammation, the division of leukocyte cells is accelerated ( immune system cells). In the second and third phases of the inflammatory process, there is an increase in the rate of cell division, restoring the structure of destroyed tissues ( fibroblasts, chondroblasts, osteoblasts, etc.). As a result, the synovial membrane thickens, and cartilaginous growths form along the edges of the articular surfaces. After some time, these growths calcify, turning into bone growths - osteophytes. Thus, the articular surface, which should normally be smooth and round, becomes bumpy with bony outgrowths at the edges. When the joint is brought to an extreme position, for example, at maximum flexion, these growths injure the synovial membrane and the opposite cartilage, which causes the patient to feel sharp pains.
Tension of the ligamentous apparatus
The knee joint is held in a stable position by a system of internal and external ligaments. With their complete structural and functional integrity, movements in the joint occur only up to a certain limit. If, with the help of an external force, the joint is bent or unbent beyond the physiological aisle, stretching or rupture of the tendons and ligaments holding it develops.
Injured tendons form a focus of inflammation around themselves, into which leukocytes, platelets, mast cells, etc. migrate from peripheral blood. These cells secrete a number of biologically active substances that support the inflammatory process for as long as necessary to restore the damaged tendon or ligament. In particular, such a substance is bradykinin, which, in contact with nerve endings, causes their irritation, which is transmitted to the brain and causes a sensation of pain.
At rest, when the tendon is not stretched, pain is minimal. They are supported by the presence of the above bradykinin in the inflammatory focus, as well as soft tissue edema. When the patient performs a leg movement, the injured ligament or tendon is stretched and, in addition to the above stimuli, a mechanical factor is added.
Fracture of the patella
A fracture of the patella is a fairly rare injury, despite the fact that this bone is not protected from the front by anything other than a layer of connective tissue fibers and skin. The reason for the rare injury is that the patella is not tightly fixed to the articular surfaces of the femur and tibia, but freely ballots in front of them. The displacement of the patella up and down is carried out with the contraction and relaxation of the quadriceps femoris muscle, the tendons of which are woven into the capsule of the knee joint in front of the patella and exit it below in the form of a patellar ligament.
Thus, a patella fracture is more likely to occur when falling on bent knees. If a crack has formed after an injury, then the patella will remain in a physiological position, however, any attempt to bend the knee will lead to severe pain due to the distance between the edges of the crack from each other. If two fragments have formed after an injury, then, as a rule, they always move away from each other due to the fact that the tendon of the quadriceps muscle of the thigh pulls the upper fragment upward, and the patellar ligament pulls the lower fragment downward. Pain with such a fracture is much more pronounced. Often associated with intra-articular bleeding. The patient is practically unable to straighten the leg at the knee. If there is any suspicion of a fracture of the patella, it is recommended to immediately call an ambulance, immobilize the thigh and lower leg in a position that minimizes pain, and put an ice pack on the knee.
Why do my child's knees hurt?
Pain in the knee knees) in a child can develop due to many reasons. The most common of these are traumas in which children often do not recognize for one reason or another. Also, pain can be caused by acute rheumatic fever or be a manifestation of a congenital orthopedic disease. Knee injuries in children
Knee injuries can vary in severity. Most often, children injure the knees only superficially due to their relatively small weight, as well as the higher flexibility of the bone tissue. In such cases, abrasions and bruises can be found on their surface, when touched, the child experiences pain. Abrasions must be detected in time and treated accordingly ( running water, hydrogen peroxide, iodine, brilliant green, etc.), otherwise they can fester and seriously aggravate the general condition of the child.
If the knee joint is swollen, reddened, felt hot to the touch and hurts a lot, then it is necessary to call a family doctor, an ambulance as soon as possible or bring the child to the nearest emergency room on your own for examination by specialists.
This disease is characteristic of both adults and children who often had a sore throat in the past. In their body, antibodies are produced against group A beta-hemolytic streptococcus, which cross-infect endocardial tissues similar in antigenic composition ( inner lining of the heart), synovial membrane and cartilage of large joints ( knee, hip, ankle). Thus, in acute rheumatic fever, a child may complain of pain and swelling of the knees, severe general weakness, fatigue, palpitations and a feeling of heat. Body temperature can reach 38 - 40 degrees.
This condition is dangerous for its complications, because with improper treatment it often leaves behind acquired heart defects and persistent changes in the shape of large joints. In connection with the foregoing, it is recommended that a doctor examine a child in this condition, and preferably at home, since in the acute phase of the disease, complete physical rest and bed rest are necessary to avoid excessive stress on the heart muscle.
Orthopedic pathology
Orthopedic diseases mean various violations of the correct growth of the skeleton. These diseases include scoliosis, hip dysplasia, congenital clubfoot, varus or valgus deformity of the knee joints, etc.
Normally, such diseases should be detected at the age of a child up to 2-3 years during routine examinations by an orthopedic traumatologist. The type of treatment for a particular pathology depends on how much it has progressed and is prescribed individually in each case. In particular, almost any deviation of the growth of the lower limb from the usual axis poses a threat to the knee joints. This is due to the fact that in order to maintain balance, the child unconsciously bends his knees and initially learns to walk incorrectly. The load on the knee joints is uneven, that is, certain areas of the articular surfaces experience more pressure than they are designed for. As a result, these areas of cartilage wear out and become thinner. Nerve endings are exposed, and the child experiences pain, which intensifies after running, and later after a short walk. Treatment of these pathologies can last the entire period of bone growth, that is, theoretically, up to 30 years. The earlier it starts, the more effective it ends up being.
Are folk remedies effective for knee pain?
Since knee pain is almost always caused by inflammation, folk recipes can help to some extent. The main task of traditional medicine in this case is a local reduction in the intensity of the inflammatory process. It should be noted right away that these recipes are applicable only for chronic pain in deforming arthrosis, osteochondrosis, etc. If pain occurs for the first time, then it is imperative to find out their cause and not self-medicate blindly.
To reduce the inflammatory process, mainly local dosage forms are used, such as compresses, lotions and ointments. The compress means making an infusion ( on the water), tinctures ( on alcohol) or decoction ( pouring boiling water) followed by impregnation of a piece of cloth or cotton wool with them. The material impregnated with a medicinal solution is placed on the knee and wrapped in layers with oilcloth and a dry cloth. The compress is on the knee from half an hour to 6 - 8 hours and is applied daily or every other day. Lotions involve placing a drug-soaked cloth on the knee and changing it every 10 to 15 minutes. Homemade ointments contain crushed plants, mud or concentrated aqueous or alcoholic extracts from them as an active substance. Honey, petroleum jelly, coconut oil, and even melted beeswax are used as a thickener.
On the Internet and countless books on traditional medicine, there is a huge variety of recipes for preparing medicines to relieve inflammation in the knee area. The ingredients used in them are available or rare and cost so much that a more effective finished product could be purchased at the pharmacy for the same price. In connection with this fact, in order to make life easier for the patient, the main methods for the manufacture and use of dosage forms for topical use were previously described. As the main ingredient, you can take any of the available plants with anti-inflammatory properties ( listed below). In this way, you can create your own recipe for an effective remedy, while using the minimum amount of cheap ingredients.
Substances and plants with anti-inflammatory properties are:
- lilac flowers;
- blue and yellow clay;
- flowers and fruits of chestnut;
- flowers and tubers of potatoes;
- olive oil;
- leaves and flowers of St. John's wort;
- leaves, flowers and yarrow root;
- Bay leaf;
- chamomile flowers;
- calendula flowers;
- raspberry leaves and stems;
- horseradish root, etc.
Why do knees and fever hurt?
Pain in the knees and high body temperature may be a manifestation of acute rheumatic fever or purulent arthritis. Also, one should not exclude the version in which the high temperature is not a consequence of a disease of the knee joint, for example, with the parallel development of arthritis and any other inflammatory disease ( acute cholecystitis, appendicitis, tonsillitis, etc.).Acute rheumatic fever
This disease is a consequence of the imperfection of the immune system, in which antibodies created to combat group A beta-hemolytic streptococcus mistakenly attack endocardial tissues similar in antigenic structure ( inner lining of the heart), articular cartilage and synovium of large joints. At the same time, patients have a triad of symptoms - disorders of the cardiovascular system ( strong and rapid heartbeat, shortness of breath, severe weakness), knee inflammation ( swelling, redness, stiffness, and pain with movement) and an increase in body temperature to 38 degrees or more.
In the acute period of the disease, which corresponds to the onset of fever, the patient is advised to receive appropriate treatment from a family doctor or rheumatologist and to observe bed rest, which provides for the complete exclusion of any physical exertion.
Purulent arthritis
Purulent arthritis is usually a bacterial inflammation of the joint. The entry of pathogenic microorganisms into its capsule occurs either by direct or hematogenous route. The direct route involves infection of the cavity of the knee joint with an open fracture, surgery, or infection during an injection. The hematogenous route of infection involves the entry of pathogenic microorganisms into the cavity of the knee joint along with the blood flow from another focus of infection located in the body ( purulent otitis, tonsillitis, chronic osteomyelitis, etc.).
With this disease, there is a pronounced swelling and redness of the knee, a local increase in the temperature of the skin. The pain is characteristic both at rest and when trying to bend and unbend the leg. The temperature rises in proportion to the severity of the inflammatory process and can reach 38 degrees or more.
Why does knee pain occur in pregnant women?
Knee pain in pregnant women is usually due to weight gain. Also, one should not exclude the possibility of developing somatic diseases in them, characteristic of all other people ( injuries, acute rheumatic fever, allergic arthritis, etc.).During pregnancy, almost all women recover significantly. It is considered normal to increase the weight by 12 kg for all 40 weeks of gestation. However, according to statistics, more than half of expectant mothers overcome this milestone, being still 5-6 months old. Some even manage to double their weight.
The reasons for weight gain are extremely diverse. The simplest option is when a woman simply starts to eat more because of an increased appetite or, even worse, just like that. It is more difficult when a woman eats the same way as before, and the weight is steadily growing. This condition is usually caused by a condition called preeclampsia. This disease has a complex mechanism, but its manifestations are always the same - slowly rising edema and increased blood pressure. This condition can lead to partial or complete abruption of the placenta, which is definitely dangerous for both the mother and the child, and this problem must be dealt with in advance with the doctor in charge of the pregnant woman.
So, as mentioned earlier, knee pain in a pregnant woman most often occurs due to excess weight, to which her osteoarticular apparatus is not adapted. Increasing pressure on the articular cartilage of the knee joints leads to their more pronounced deformation and compression. At the same time, the capillaries located in the subcartilaginous base are compressed, blocking the blood supply and nutrition of the cartilage themselves. As a result, the processes of cartilage destruction begin to prevail over the processes of its restoration, the thickness of the articular cartilage decreases, and the nerve endings become exposed. Due to excessive friction, an aseptic inflammatory process develops, in which the exposed nerve endings are irritated both mechanically ( due to friction and swelling) and chemically ( through exposure to inflammatory mediators). Further, nerve impulses are summed up, transmitted to the brain and perceived by it as pain sensations.
A similar mechanism for the occurrence of pain in pregnant women is relevant not only for the knees. Often associated with excess weight, pain also appears in the hip, ankle, intervertebral and other joints.
The knee is a large joint with a complex structure. If the joints are very sore, then this may indicate the presence of various pathologies or disorders, or be the result of overload.
However, discomfort in the knee joint, requiring urgent medical intervention, must be able to distinguish, for example, from vascular pain that appears suddenly and disappears without a trace.
Severe pain in the knee area can be a symptom of a chronic illness. In about 30% of cases of pain in the leg in people over 40, gonarthrosis develops. And it can hurt one joint or two at once.
Initially, the pathology is asymptomatic, while minor discomfort appears only occasionally. Then more severe symptoms develop.
The causes of the disease include:
- age-related changes in the knee;
- intra-articular damage to bone and cartilage tissues;
- bone tumors, arthrosis, rheumatoid arthritis, etc.
Symptoms of arthrosis are stiffness in the joint that occurs in the morning, a crunch that appears in the process of movement and the subsequent limitation of its motor function. As a result, destructive processes lead to deformation of the joint.
Severe pain in gonarthrosis can occur when getting up from a chair or rising from a squat. In addition, discomfort is felt in the process of walking short distances and when climbing or descending stairs.
Pain does not appear only when a person is resting. So, there are no unpleasant sensations if the patient is in a lying position, sitting or when he is sleeping. However, in comparison with vascular pain, with age, pain in gonarthrosis increases.
In addition, pain in the knee with arthrosis must be able to distinguish from the discomfort that occurs after running or long walks.
If your knees are very sore, you need to do a diagnosis. This procedure includes interviewing the patient, examining him and checking the motor capabilities of the joint. In addition, it is necessary to conduct an X-ray examination, arthroscopy (examination of the inside of the joint with the help of an apparatus) and an ultrasound scan.
If the knees are very sore and aching with arthrosis, then the doctor prescribes treatment, including physiotherapy and taking medications. In this case, you need to do baths with salt in the joint area.
In advanced cases, a radical treatment of arthrosis can be carried out, which consists in, which must be done if there are no other options.
Arthritis
Arthritis is a group of diseases characterized by swelling and inflammation in the knee. There are different types of arthritis. The most common type of the disease is osteoarthritis, and gout and rheumatoid arthritis appear a little less frequently.
Osteoarthritis is characterized by joint friction that occurs when walking. The reasons may lie in age-related changes and in a decrease in the quality and quantity of intra-articular fluid that lubricates the joint.
Constant friction causes the cartilage surfaces to thin out. Osteoarthritis develops in people over 45 in 80% of cases.
However, the disease can appear not only because of the age factor. Frequent damage to the knee and excess weight lead to early wear of the joints.
Symptoms of osteoarthritis:
- pain that occurs during movement;
- puffiness;
- inability to lean on the affected limb.
Manifestations grow slowly, over months or years. Initially, the patient experiences minor discomfort, pain and friction sensations in the knee.
If the joints are very sore, then conservative therapy is carried out. However, treatment is not a guarantee that the joint will function as before. But this will significantly slow down the development of destructive processes, reduce pain and allow you to lead a full life.
Arthritis treatment includes:
- weight normalization;
- regular rest, excluding excessive physical activity;
- physiotherapy procedures;
- taking medications;
In addition, it is useful to do special exercises aimed at strengthening the muscular system around the knee and improving blood circulation.
It is worth noting that if you do not seek medical help at the first manifestations of the disease, then everything can end with disability, which will lead to a complete absence of an active lifestyle.
In especially neglected situations, surgical intervention is carried out. So, you need to do joint arthroplasty, in which damaged tissues are replaced with prostheses made of metal and plastic.
By the way, an arthrologist or rheumatologist is engaged in the treatment of arthritis.
Rheumatoid arthritis
The disease appears due to a malfunction in the immune processes. However, the exact causes of the development of this disease have not been established to this day. This pathology affects not only the knees, but also other joints, such as the hands.
Symptoms of the disease include an increase in local body temperature, reddening of the periarticular skin and swelling. Moreover, even a slight touch to the affected joint during the period of exacerbation causes unbearable pain. Sometimes the affected joints are very deformed.
In rheumatoid arthritis, the joints are affected symmetrically. If destructive processes occur in the left leg, then over time the right one will also start to hurt. Multiple joint damage indicates the presence.
Treatment for rheumatoid arthritis consists of:
- taking medications that increase the aggression of immune cells on the joints;
- physical therapy and adherence to a certain lifestyle;
- taking anti-inflammatory, analgesic drugs;
- surgery when the joint is deformed.
Gout
Appears due to chronic concentration of uric acid in the body. When the uric acid index is normal, it is excreted in the urine, and in the presence of gout, it is excreted poorly or accumulates in large quantities. An excess of uric acid leads to the fact that it is concentrated in the body, in particular, in the knee joint.
It is worth noting that uric acid is formed during the processing of certain types of food, which contain purines. In addition, its content may increase in the case of drinking alcohol and taking certain drugs.
Symptoms of the disease are redness and very severe pain that occurs with an attack of gouty arthritis. If appropriate treatment is not carried out, this condition can last a couple of weeks.
Diagnosis of gouty arthritis consists of a medical examination, urinalysis, microscopic examination of tissues and patient interviews.
In addition, you need to pass a blood test to determine the level of uric acid and conduct an X-ray examination, which can be used to detect tophi (deposits of uric acid salts in the knee).
Gout is treated by a surgeon, rheumatologists and an endocrinologist.
To damage the rounded cartilage of the knee joint, just one sharp movement is enough. Symptoms of a meniscus rupture: very sharp intra-articular pain, limited mobility, inability to make extensor movements, swelling.
But what to do if after a rupture of the meniscus, the knees hurt a lot? How to provide first aid to the victim? First aid involves taking analgesics and immobilizing the knee joint with a splint. In this case, an ice compress should be applied to the affected area and seek medical help.
In the process of diagnosis, it is customary to do an ultrasound scan, conduct an X-ray examination and a medical examination.
When the articular cartilage is torn, an operation is necessary in which the damaged tissues are sewn together. The dislocation of the meniscus is reduced by a traumatologist, after which a plaster cast is adjusted on the bent knee for 3 weeks. You can resume your usual way of life after 1 month of performing physiotherapy exercises after removing the plaster.
If the knees are very sore when the meniscus is torn, then it is better not to resort to traditional medicine recipes. After all, non-traditional treatment is appropriate only in the presence of minor injuries, which are confirmed by the doctor's conclusion.
The treatment of damage to the rounded articular cartilage is carried out by a surgeon, orthopedist and traumatologist.
Torn or sprained ligaments
Such an injury can occur in the event of a direct blow, a fall, a strong physical impact, or an awkward turn of the leg. The manifestations of pathology include:
- puffiness;
- limited mobility or absolute lack of motor function;
- sharp pain;
- the occurrence of a characteristic crack during the movement of the foot;
- the appearance of pain when touching the knee.
- darkening of the skin.
When ligaments are torn, first aid must be provided: apply an ice compress and take painkillers. When the pain becomes less pronounced, the knee should be bent at an angle of 90 degrees, and then apply an elastic bandage and apply ice. However, a cold compress should not be applied on the second and third days after the injury.
When sprained, and especially torn ligaments, it is necessary to make a diagnosis. It consists in a medical examination and an x-ray examination, or with which you can determine the presence of fractures and other types of damage that were not noticed during the examination.
If the knees are very sore after a rupture of the ligaments, then home treatment before visiting a doctor consists in resting the knee in the first days after the injury. When the pain subsides a little, you should gradually bend and unbend the knee.
In addition, ice should be applied to the damaged area. For this purpose, a hypothermic package can be purchased at the pharmacy, which is activated at any time with the help of pressure.
Moreover, an elastic bandage must be applied to the knee, due to which the displacement of the joint is prevented for the period of treatment of the ligaments.
The bandage must be changed once a day. In addition, the elastic bandage can be replaced with a caliper - a medical device that eases the load on the joint during movement.
Moreover, in case of damage to the ligamentous apparatus, it is important that the knee is in an elevated position. To do this, the leg must be placed on a soft roller so that it is above the level of the heart.
Treatment in a hospital setting involves taking NSAIDs (Diclofenac, Ketanov, Ibuprofen). These funds contribute to a speedy recovery, in particular, they eliminate swelling and relieve pain.
During the rehabilitation period, it is necessary to do special gymnastics and carry out physiotherapy procedures. However, this stage of treatment can only be started if the knees no longer hurt or swell.
Risk factors
In osteoporosis, the concentration of calcium in the bones is significantly reduced. Often, the disease develops in women after menopause or at any age due to a malfunction in calcium metabolism.
Calcium, washed out of the bones, breaks the strength of bone tissue, thereby destroying the knee joint. In the presence of osteoporosis, the knees most often hurt in the morning, and the aggravation of the disease occurs during a change in the weather.
Excessive physical activity on the lower extremities often causes microtrauma of the joint, chronic damage to the ligaments and cartilage of the knee joint.
Chronic injuries, untreated chronic joint diseases, non-compliance with recommendations for rehabilitation and subsequent lifestyle after a knee injury.
Violations in the structure of the knee, for example, the lower and upper articular heads do not correspond to each other, as a result of which friction appears in the areas of discrepancy and injury. Different lengths of the limbs or flat feet, which contributes to an uneven distribution of the load and premature wear of the joints.
Age-related changes, in which the resources of the body decrease and chronic diseases join, which affects the condition of the knee joints. Often, older people develop pseudogout or osteoporosis and gout. And adolescents develop patellar tendonitis and Osgood-Schlatter disease, which is more common in boys.
Having determined the causes of pain in the knees, it is necessary to immediately begin to treat the pathology. Pain treatment will be most effective if medications are used at the very beginning of the development of the pathology, when conservative therapy can still cope with destructive changes in the body. Otherwise, doctors have to resort to surgical intervention and eliminate the disease exclusively by surgery.
Urgent care
Very often, knee pain appears as a sudden attack, and people do not know what to do in such a situation. If it is not possible to consult a doctor at the moment, in this case it is necessary to take all measures in order to get rid of knee pain at home as quickly as possible. Here are some tips on how to relieve soreness, swelling and tension in the knee:
- provide complete rest for the damaged knee joint - any activity should be stopped, you need to lie down for a while, and you need to put a pillow under your feet;
- when pain and swelling appear in the knee, it is recommended to use cold compresses. Ice is perfect for this, which must be wrapped in a cloth so as not to provoke frostbite. If there is no ice, you can apply any cold object from the refrigerator to the swelling, for example, a pack of sour cream or mayonnaise. Cold application time - 10-20 minutes, no more, frequency - 3-5 times a day;
- if the knee hurts from a blow, it is necessary to avoid any actions that can provoke increased swelling (hot showers, baths, hot compresses, warming up the legs);
- if two days have passed after the injury and the pain in the knee has become much less, you can start doing exercises to restore the joint and maintain its flexibility. When recovering a knee after a blow, be sure to wrap the damaged joint with an elastic bandage or wear a knee brace. This will help not only eliminate swelling, but will also contribute to the correct position of the articular parts during movement. The bandage should not be too tight so as not to impair the blood supply to the joint. If there is numbness, tingling or pain, the bandage must be loosened;
- during pain relief, light massages are also possible, but do not massage for a long time, just 5-10 minutes several times a day is enough to stimulate blood circulation in the area of damage and relieve pain. If during the massage the pain increases, it is recommended to stop the procedure;
- as soon as the pain in the knee joints completely disappears, it is advisable to spare the injured limb for several weeks - do not get too carried away with active games, walk for a long time and carry heavy loads. All this can contribute to the return of pain.
If your knee joints are very sore, for example, during a blow or inflammation, you can take pills to relieve pain. As tablets for a single dose, Ibuprofen, Ketorol are suitable, but when the pain resumes, it cannot be drowned out with painkillers. It is necessary to consult a doctor who will prescribe non-steroidal anti-inflammatory drugs for long-term use.
Conservative treatment
Conservative treatment of discomfort in the joint begins primarily with the removal of pain. If the knee hurts, doctors recommend a group of non-steroidal anti-inflammatory drugs - these are the most common drugs that are used for soreness in any organs. Available as an ointment, gel, and also in the form of tablets. The most famous representatives:
- indomethacin,
- ibuprofen,
- Nimesulide,
- diclofenac,
- flurbiprofen,
- lornoxicam,
- Sulindak.
A wide group of NSAIDs allows you to choose the right drug for the patient
The group of non-steroidal anti-inflammatory drugs provides three types of action:
- anti-inflammatory,
- painkiller,
- antipyretic.
Medicines block the production of prostaglandins - the triggers of the inflammatory process that appear when the cartilage tissue in the knees is damaged. As a result of taking non-steroidal anti-inflammatory drugs, all signs of the inflammatory process decrease, redness and swelling disappear, pain decreases, temperature decreases and joint functions are restored.
Among the adverse reactions that may occur when taking these drugs are side effects from the gastrointestinal tract. Therefore, with ulcers, gastritis, some cardiac pathologies and individual intolerance, NSAIDs are not prescribed.
Treatment of pain in the knee joint is not complete without the appointment of chondroprotectors. The preparations contain the active substances glucosamine and chondroitin - the main building components of cartilage tissue. Opinions on the use of these drugs are still controversial, but doctors believe that at an early stage of treatment, these very components can stop such serious diseases as arthritis and arthrosis. With serious articular damage in the knee, they will not be effective.
Chondroitin and glucosamine have an anti-inflammatory effect, since they suppress prostaglandins and interleukins, but chondroprotectors are much easier to tolerate than non-steroidal anti-inflammatory drugs. Among the well-known drugs that eliminate pathological processes in cartilage, we can recommend:
- Hondrolon,
- Chondroitin
- Structum,
- Elbona,
- dona,
- artra,
- Teraflex.
To quickly relieve pain in the knee joint, doctors eliminate it with glucocorticoids. These are drugs Diprospan, Kenalog, Celeston, Hydrocortisone. Some prefer to inject drugs into the joint. Such funds have received the common name "liquid prostheses". The preparations Ostenil, Synvisc, Fermatron, Dyuralan help well. They become substitutes for joint fluid and improve the nutrition of the cartilage surface.
Operation
In some cases, conservative treatment of knee pain is simply not possible. Doctors recommend surgery. The most common surgical interventions are performed for a knee joint injury - ligament rupture or meniscus injury. The most serious operations are interventions for fractures, because with them it is far from always possible to restore former mobility and the joint remains limited in movement.
The operation is performed under anesthesia. Can be used as endotracheal anesthesia, and intravenous, spinal anesthesia or conduction anesthesia. Local anesthesia with anesthetics is practically not used, since the operations are quite extensive.
Knee surgeries are of the following types:
- puncture of the knee joint is the simplest manipulation, during which you can remove exudate or administer drugs to treat diseases of the knee joint. The operation is performed under local anesthesia;
- stitching of ruptures of the ligamentous apparatus - an operation to restore the integrity of the ligaments. Plastic surgery is carried out using special suture materials, which then dissolve. Usually, ligament ruptures occur during dislocations, fractures, therefore, for such interventions, wide access is required or arthroscopy is used;
- knee arthroscopy is an endoscopic operation performed for diagnostic or therapeutic purposes, for example, in Hoff's disease. Arthroscopy has become an excellent substitute for wide abdominal surgery;
- Arthroplasty is an intervention to restore the articular surfaces. It is most often carried out in areas of ossification on cartilage. Defects in arthroplasty are eliminated with special mixtures, which are not inferior in density to hyaline cartilage. In parallel, drug treatment is carried out;
- surgery to remove the cyst involves an incision in the knee joint and removal of the neoplasm. In general, the operation is not complicated and lasts about 30-40 minutes.
The most complex interventions are resection of the knee joint and prosthetics. Resection is performed in case of complete crushing or extensive purulent process, when the disease has led to the melting of bone and cartilage tissue. Prosthetics is an operation to replace the knee joint with a prosthesis made of special metals and polymers. Prostheses successfully replace their own joints, but such an operation is expensive.
Physiotherapy
If pain occurs in the knee, conservative therapy can be supplemented with physiotherapy. Excellent results in pathologies of the knee joint gives manual therapy. It is useful not only for arthrosis, but also for traumatic injuries of the meniscus, when it is possible to set the displacement of the joints into place.
With arthritis, when there is inflammation of the knee joint, manual therapy is not performed. Manual therapy for gonarthrosis will be effective, but only at the first and second stages. Symptoms of the disease can be reduced if manual therapy is carried out simultaneously with the appointment of chondroprotectors, cryotherapy and injections of hyaluronic acid.
Laser treatment allows you to warm up the knee well and relieve pain, but it is contraindicated with an active inflammatory process.
A new method in the treatment of the knee joint is laser therapy. It is used everywhere, it helps to get rid of knee pain in various diseases. Laser therapy gives excellent results in the complex treatment of arthrosis of the 1st and 2nd stages, damage to the knee tendons and vascular pain. If a person suffers from arthritis, then the laser is used only from the side of the popliteal fossa, but they do not directly affect the damage zone. The course of laser treatment is at least 15 sessions, repeated every other day.
Laser treatment is not used in the following cases:
- in the presence of infectious diseases;
- hypertensive crisis;
- tumor diseases of the patella and other organs;
- pathologies of the blood and thyroid gland;
- risk of myocardial infarction and stroke;
- if the patient is diagnosed with tuberculosis or cirrhosis of the liver.
An excellent effect, if the knee joints hurt, is the treatment with cryotherapy. Cryotherapy can be used in two forms:
- dry cryotherapy, when exposed to ultra-low temperature air;
- liquid cryotherapy, in which liquid nitrogen is applied to the joint.
This type of treatment enables the body to increase blood circulation in the damaged area and improve metabolism during illness. In the future, the success of therapy helps to reduce swelling in the knee joint, relieve muscle spasm and relieve pain. The course should consist of 10 procedures, it is better to perform them daily or at least every other day.
For arthrosis, arthritis and meniscus damage, cryotherapy is considered one of the most effective procedures. It has practically no contraindications. Cryotherapy can be used even for knee pain in the elderly and debilitated patients.
Folk remedies
Alternative methods of treatment for knee pain are no less effective than traditional treatment. Not everyone knows how to treat a knee along with tablet preparations, so we offer an overview of the most effective folk recipes. With many diseases of the knee, you do not need to give up, even if doctors do not place much hope on conservative therapy.
One of the most popular and easiest ways to get rid of knee pain is an alcohol solution of iodine. Iodine together with alcohol must be combined in equal amounts and placed in a glass dish for one day in a warm place. After twenty-four hours, the solution will become clear. That is when therapy can begin. An alcoholic solution of iodine is recommended to be rubbed into the skin over the area of the damaged joint. There is no need to wrap or bandage the leg.
Mankind has long known that urine is not only a sterile liquid, but due to its unique composition, it is able to relieve inflammation in the joints. This property is actively used by populists who use urine to treat joint pain in both large and small joints.
For treatment, it is necessary to collect a certain amount of urine, preferably morning, and soak a tampon in it. It is applied to the injured knee in the form of a compress and wrapped in a film. Top can be tied with a cloth so that the film does not move. The course of treatment is not limited, you can do the procedure until the inflammation subsides.
Another popular way to treat folk remedies is potatoes with kerosene. One medium-sized raw potato must be washed and cut into small pieces along with the peel. You can also rub it on a grater. 40 g of kerosene is added to the resulting potato mass, which is about one tablespoon.
In the process of treatment, it is necessary to control the area of damage and make a tight bandage
All ingredients are mixed and applications are made before going to bed for about 15 minutes. The resulting mixture is applied to the knee, kept for the right time, and then the knee is wiped and bandaged with a warm cloth or woolen scarf. It is necessary to repeat the procedure for 7 days. This remedy can relieve even severe arthritis pain.
A very effective remedy in the treatment of knee pain is potatoes with horseradish.
Grated potatoes together with horseradish root in equal proportions are ground on a grater and mixed. An application is applied to the affected knee for about 30-40 minutes, while the joint is wrapped with plastic wrap and wrapped.
The medicine can be used more than once. After the manipulation is carried out, the mass of potatoes and horseradish is carefully removed from the knee and transferred to a glass jar. Store the medicinal mixture under a tight lid in a cold place. The next day, the mixture can be warmed up and the procedure repeated. Note that one mixture can only be used twice. It is necessary to treat the knee joint for at least six days.
Knee pain can be treated in a variety of ways. Which one to choose, the doctor will tell you after he conducts a complete diagnosis and determines the cause of discomfort in the knee joint. It is not always possible to get by with conservative methods of therapy. In order to avoid disability, it is necessary to agree to an operative intervention on the joint.
