Knee pain

Knee pain- It is a sign of pathological processes that affect the cartilaginous, bone or soft tissue structures of the femoral-tibial and femoral-patellar joints. Arthralgia can be based on trauma, inflammatory and degenerative diseases of the joint apparatus and periarticular structures. Patients may complain of sharp, aching, burning, stabbing, and other types of pain that occur at rest or when moving, supporting, bending, and extending the leg at the knee. The diagnosis of causal pathology includes instrumental imaging methods (Rg, ultrasound, CT or MRI, arthroscopy), puncture of the joint capsule, biochemical and immunological analyzes. Until the diagnosis is clear, rest, joint immobilization, NSAIDs, and pain relievers are recommended.

Causes of knee pain

Traumatic injury

Usually they are the result of domestic trauma, which is often found in athletes - runners, jumpers, participants in sports. Developed by a fall, direct impact, or twisting of the leg. Manifested by acute pain at the time of injury. In the future, the pain syndrome becomes less pronounced, accompanied by increased edema. Abrasions and bruises are possible. As the frequency increases, the following injuries are identified:

• Knee injury. . . It occurs by falling on the knee or hitting it directly. At first, the pain is sharp, hot, sometimes burning, but bearable, later - dull, painful, aggravated by movements. Bruising is possible. The legrest is preserved. Sometimes a knee injury is complicated by hemarthrosis; in such cases, the joint gradually increases in volume, becomes spherical, a feeling of pressure or bursting is added to the pain syndrome.
• Torn ligament.It is found after twisting the leg, its forced twisting, bending or overextension in a non-physiological position. Painful sensations are stronger than with a bruise; simultaneously with the onset of pain, a person can feel something tear (similar to how ordinary tissue tears). It is accompanied by significant limitation of movement, support, torsion of the limb, rapidly increasing hemarthrosis.
• Intra-articular fractures. . . They are detected by impacts, falls and twists of the leg. In case of injury, a person feels a very sharp, often excruciating, sharp pain, sometimes a cracking noise is heard. Patients with intra-articular fracture themselves describe their feelings as follows: "the pain is such that it darkens in the eyes, the world ceases to exist, you don't understand anything. "Subsequently, the pains become less severe, but are still of high intensity. Support is usually impossible, movement is almost completely limited. Edema and hemarthrosis progress rapidly.
• Dislocation.It is the result of a knee blow or fall. At the time of dislocation of the patella, sharp pain occurs, accompanied by a sensation of bowing of the leg and displacement of the knee. No movement is possible, the reference function can be saved. On the front surface of the knee, a pronounced deformation is seen, which is subsequently smoothed out due to increased edema. Sometimes hemarthrosis is attached.
• Pathological fractures. They develop with minor lesions, they are a consequence of a decrease in bone strength in osteoporosis, osteomyelitis, tuberculosis, bone tumors. The pains are aching, dull, reminiscent of pain syndrome with a bruise. The signs that indicate a pathological fracture are limitation or impossibility of support in the leg, feeling of instability in the knee, sometimes deformity, bone cracking during movement.
• Damage to the menisci.Meniscus tears form during twisting, impact, severe forced flexion or extension of the knee, a sharp twist with a stationary leg. At first, a person feels a special click and sharp stabbing pain deep in the joint. Then the pain subsides a little, but becomes diffuse, sometimes: burning, popping, intensifying when trying to support and move. The volume of the knee increases due to edema and hemarthrosis. Support becomes impossible, movements are very limited.

Inflammatory pathologies

They can be infectious and non-infectious (post-traumatic, toxic-allergic, metabolic, post-vaccination). The abundant blood supply to the synovium and periarticular tissues promotes the rapid development of inflammation in response to direct and indirect effects, and a large number of nerve endings causes a pronounced pain reaction. The inflammatory process is often accompanied by synovitis (accumulation of aseptic fluid in the joint), with infection, pus can accumulate.

• Arthritis.Gonarthritis occurs after injuries, sometimes complicates infectious diseases, is detected in rheumatic diseases. It can be acute or chronic. Knee pains are usually dull, aching, pressing or pulling. At first, the pain is not intense and intermittent, it intensifies at night or after exercise. Then the initial pains are added, the intensity and duration of the pain syndrome increases. The joint swells, the skin over it becomes red, its temperature rises. With synovitis, the contours of the knee are smoothed, there is a feeling of popping. With suppuration, the severity of pain increases sharply, they become spasmodic and sleep deprived.
• SynovitisIt is not an independent disease, it complicates many acute and chronic pathologies of the joint. It forms in a few hours or days. Initially, the pain is insignificant or absent, a feeling of fullness prevails. The knee is spherical, with a large amount of fluid, the skin is shiny. Movement is somewhat limited. When infected, the pain becomes pronounced, throbbing, spasmodic, intensifying with the slightest movement and touch.
• Bursitis.Inflammation of the joint capsules located in the patella and popliteal fossa usually occurs when the knee is overloaded and its repeated injuries (for example, with constant support on the knees). With bursitis, the pain is local, dull, not intense, appears in a certain position of the limb, after a characteristic load, it decreases when the position of the leg changes, massaging the affected area. If the posterior bursa is affected, painful sensations are possible during the ascent or descent of the stairs. Sometimes a minor local edema is determined. With suppuration of the bag, the pains become sharp, spasmodic, baking, combined with hyperemia, edema of the affected area, symptoms of general intoxication.
• TendinitisIt is usually detected in overweight men and athletes, it affects the ligament of the patella itself. At first, the pain syndrome appears only with very intense exertion, then with standard sports loads, then with daily physical activity or at rest. Pain with tendinitis is localized to the front just below the knee, dull, pulling, with disease progression, sometimes paroxysmal, in some cases accompanied by mild redness and swelling, aggravated by pressure. Movement is usually complete, less often a little limited. A tear or rupture of the ligament is possible due to a decrease in its strength.
• Lipoarthritis.Hoff's disease affects the layers of fatty tissue located under the kneecap. It is seen with constant overload of the knee or it becomes the result of an old injury. Most often it affects athletes, older women. A person complains of combined dull aches, some limitation of extent. With the worsening of the pathology, the pain begins to bother at night, there is a feeling of instability of the knee, bowing of the leg. When pressing on the side of the kneecap, a soft cracking or cracking sound is heard.

Autoimmune processes

The cause of diseases of this group is the production of antibodies against normal cells of the body with the development of immune complex aseptic inflammation of the synovial membrane and cartilage, the phenomenon of vasculitis. The pathologies in most cases are chronic, without treatment they are prone to progression and are often the cause of disability.

• Rheumatoid arthritis.The defeat is usually bilateral. With minimal activity of the autoimmune process, the pain is weak or moderate, intermittent, pulling, pressing, accompanied by morning stiffness. With moderate activity, the patient complains of periodic prolonged pains, oppressive or explosive pains of moderate intensity, not only during movement, but also at rest. There is stiffness for many hours, moderate recurrent synovitis. With a high activity of rheumatoid arthritis, the pain is strong, diffuse, exhausting, wavy in nature, increasing in the hours before the morning. The stiffness becomes constant, a large amount of fluid accumulates in the knees, contractures form over time.
• Systemic lupus erythematosus.Arthralgias are usually symmetrical, although one joint can be affected. They can occur at any stage of the disease; With a recurrent course of SLE, they resemble rheumatoid arthritis. With low activity of the process, the pain is short-term, not intense, local, painful, pulling. In severe cases, the pain syndrome progresses, the pain is wavy, disrupts night sleep, becomes prolonged, diffuse, increases with movement, combined with synovitis, edema, hyperemia.
• Rheumatism.Joint pain is one of the first manifestations of rheumatic fever, it appears 5-15 days after an acute infection, it affects several joints at the same time (usually paired). The pains are quite brief, but intense, migrate from one joint to another, differ in nature from pulling or pressing to burning or pulsation. The knees are swollen, hot, the skin over them is reddened. Movement is very limited. After a few days, the severity of the pain subsides, movements are restored. In some patients, residual effects in the form of moderate or mild dull pain persist for a long time.
• Reactive arthritisOccurs most often 2-4 weeks after intestinal and urogenital infections, usually affects one or two joints of the lower extremities, combined with urethritis, conjunctivitis. The development of reactive arthritis is preceded by increased urination, pain and burning sensation in the urethra, tearing, and cramps in the eyes. The pain in the knee is severe or moderate, constant, wavy, painful, drawing, spasmodic, combined with limitation of movement, deterioration of the general condition, fever, severe swelling and redness of the affected area. Painful sensations and signs of inflammation persist for 3 months to 1 year and then gradually disappear.

Degenerative-dystrophic processes

They develop as a result of metabolic disorders in the structures of the joints and periarticular soft tissues. They have a chronic course that progresses over many years. It is often accompanied by the formation of calcifications, cysts and osteophytes, deformation of the surface of the knee. With significant destruction of the articular surfaces, they lead to a pronounced impairment of movement and support function, become the cause of disability, and require the installation of a stent.

• Osteoarthritis.It develops for no apparent reason or in the context of various injuries and illnesses, mainly in the elderly and middle-aged. At first, the pain is weak, short-lived, usually pulling or aching, occurs with prolonged exertion, and disappears at rest, often accompanied by a cracking sound. Gradually the pain syndrome intensifies, the knees begin to ache "in the weather" and at night, there is a limitation of movements. The hallmarks of knee osteoarthritis are the initial pains (it hurts until it "disperses"), periodic bouts of cutting, burning, or stabbing pains due to the blockage. During periods of exacerbation, synovitis often occurs, in which the pain becomes constant, pressing, and explosive.
• Meniscopathy. . . It is usually detected in athletes, people whose work involves significant loads on the knee joint. Manifested by unilateral local deep pain within the knee at the level of the joint space, most often in the outer half of the knee. The pain intensifies during movement and subsides at rest, it can be dull, pressing or pulling. With progression, there are sharp stabbing pains when trying to move. On the anterolateral surface of the joint in the projection of pain, a small painful formation is sometimes felt.
• Tendopathies. . . The tendons near the knees are affected. In the initial stage, they are manifested by short-term local superficial pain at the peak of physical activity. Subsequently, painful sensations arise with moderate and then light loads, they limit the usual daily activity. The pain is drawing or aching, directly related to active movements, it is not detected during passive extension and flexion of the knee, sometimes accompanied by a crunch or crack. In the area of the injury, the site of greatest pain can be probed. Local signs of inflammation (edema, hyperemia, hyperthermia) are insignificant or absent.
• Osteochondropathy.Children and young people are most often affected, the duration of the disease is several years. They usually begin gradually with mild lameness or non-intense intermittent dull pains, aggravated by exertion, which disappear at rest. With the progression of osteochondropathy, the pain becomes strong, constant, oppressive, burning or baking, accompanied by severe lameness, limitation of movement, and difficulty in resting on the limb. Then the pain gradually subsides, the support function is restored.
• ChondromatosisIt is usually diagnosed in older men, less often in babies. Chondromatosis of the joints is manifested by moderate dull wave-shaped pains, which are often worse at night and in the morning. Movement is limited, accompanied by a creak. Blockages sometimes occur, characterized by sudden stabbing pain, inability, or severe limitation of movement. With the development of synovitis, the pains take on an explosive character, combined with an increase in the volume of the knee, swelling of the soft tissues and a local increase in temperature.

Tumors and tumor-like formations

The pain syndrome can be caused by a cyst, a benign or malignant tumor that directly affects the articular or periarticular tissues. In addition, knee pain can serve as an alarming sign of hypertrophic arthropathy, paracancrotic polyarthritis - characteristic paraneoplastic syndromes of lung cancer, breast cancer and other oncological processes.

• Baker's cyst.Represents a hernial protrusion in the popliteal fossa. In the initial stages, it manifests as unpleasant sensations or mild local pain along the back of the knee. Against the background of an increase in Baker's cyst due to compression of nearby nerves, burning or shooting pains, numbness, or tingling may appear in the sole area. Symptoms get worse when trying to bend the knee as much as possible. In the popliteal fossa, an elastic, slightly painful, tumor-like formation is sometimes felt.
• Benign tumorsIt includes chondromas, osteochondromas, non-ossifying fibromas, and other neoplasms. They are characterized by a prolonged asymptomatic course or low symptoms, they can manifest with non-intense, vague and intermittent local pain. With large neoplasms, a solid formation is felt, sometimes synovitis develops.
• Malignant neoplasms.The most common malignant tumors affecting the joint area are synovial sarcoma, osteosarcoma, and chondrosarcoma. They manifest with dull local vague pains, sometimes with a certain circadian rhythm (worse at night). The intensity of pain increases, they become sharp, cutting, burning or spasmodic, spreading along the knee and adjacent tissues, accompanied by deformation, edema, synovitis, expansion of the saphenous veins, violation of the general condition, contracture formation . Upon palpation, a painful tumor-like formation is determined. When the process begins, the pain is excruciating, exhausting, deprives you of sleep, and is not eliminated with non-narcotic pain relievers.

Invasive operations and manipulations

The pain syndrome is triggered by damage to knee tissue during invasive procedures. The severity of the pain is directly dependent on the trauma of manipulations on the knee joint. With the penetration of pathogenic microbes into the joint area, pain is caused by inflammatory changes.

• Handling. The most common procedure is puncture. Pain after puncture is short-lived, not intense, disappears quickly, is localized in the projection of the puncture, which is usually done on the outer surface of the knee. After a biopsy, the pain may be jerky at first, then become dull and disappear after a few days.
• Operations.After arthroscopy, the pain is moderate, at first quite sharp, then dull, disappearing after a few days or 1-2 weeks. After arthrotomy, the pain syndrome is more severe, it can persist for up to several weeks due to significant tissue damage. Usually in the first 2 or 3 days after the interventions, patients are prescribed painkillers, then the pain gradually weakens and disappears.

Psychosomatic conditions

Sometimes arthralgia in the knees occurs in the absence of an organic basis (trauma, inflammation, destruction, etc. ) under the influence of psychological factors. Such pain is believed to play a protective role, helping to reduce emotional stress by transforming experiences into physical sensations. A distinctive feature of such pains is their indeterminate nature, inconsistency, absence of visible changes, a clear connection with physical activity and other objective provoking factors. Meteorological arthralgias are seen in people who are sensitive to changes in atmospheric pressure.

Also, irradiation of knee pain is possible with coxarthrosis, lumbar osteochondrosis, Perthes disease, fibromyalgia, sciatic nerve neuropathy. However, with these pathologies, pain syndromes from another location often come to the fore. Additional risk factors that increase the likelihood of knee joint injury and disease include excess weight, professional sports, hypovitaminosis, metabolic disorders, and old age. Hypothermia, stress, physical exertion, and dietary alterations can be triggers for exacerbation of chronic pain.

Poll

The diagnostic search algorithm is based on taking into account the nature of the pain syndrome, its duration, identifying the symptoms and concomitant events that precede the onset of knee pain. At the first visit to a doctor (traumatologist-orthopedist, surgeon, rheumatologist), a visual examination and palpation of the knee is performed, an evaluation of the volume of active and passive movements is made. Taking into account the data obtained, in the future the patient may be assigned:

• Laboratory blood tests. . . A complete blood count helps to identify the haematological changes characteristic of an acute infectious and inflammatory process (leukocytosis, increased ESR), eosinophilia, typical of an allergic reaction. Biochemical and serological studies are more informative for autoimmune diseases, which are characterized by the formation of specific acute phase proteins and immunoglobulins (CRP, rheumatoid factor, ASL-O, CEC, antibodies against DNA, etc. ).
• Bone scan.The basic diagnostic method is radiography of the knee joint in 2 projections. The presence of pathology is indicated by changes in the contours of the head and joint cavity, narrowing of the joint space, changes in the thickness of the end plates, presence of defects at the edges of the articular ends of the bones, osteolysis and destruction that is. . In some diseases (meniscal trauma, Baker's cyst), contrast arthrography demonstrates the greatest sensitivity.
• Arthrosonography. . . Knee ultrasound is a fast, inexpensive, affordable, and highly informative diagnostic method. It allows to judge the presence of effusions and loose bodies in the joint cavity, to identify damage and pathological changes in the periarticular soft tissues (signs of calcification, hemorrhage, etc. ). They help to differentiate with great precision the etiology of joint pain.
• Computed tomography and magnetic resonance imaging. . . They are the methods of choice for arthropathy of any genesis. They are used for a more detailed assessment of the nature and degree of pathological changes, to identify typical signs of traumatic, inflammatory and tumor lesions of bone structures and soft tissues. Joint computed tomography and magnetic resonance imaging are generally used with limited information content from other instrumental studies.
• Joint puncture. . . It is performed when there is an indication of accumulation of exudate or transudate in the joint capsule. As part of the differential diagnosis of inflammatory, degenerative and tumor diseases, a cytological, bacteriological or immunological study of the synovial fluid is carried out. To establish the diagnosis of autoimmune damage to the knee joint, tuberculous arthritis, synovioma, it is extremely important to perform a synovial membrane biopsy.
• Arthroscopy. . . The purpose of invasive endoscopic diagnostics may be biopsy sampling, clarification of necessary diagnostic information during a visual examination of joint elements. In some cases, diagnostic arthroscopy becomes therapeutic (atroscopic removal of intra-articular bodies, meniscectomy, autoplasty of ligaments, etc. ).

Symptomatic treatment

Treatment of the causes of knee pain is carried out differentially, taking into account the identified disease. At the same time, symptomatic care is an essential part of a comprehensive treatment process aimed at reducing discomfort and improving quality of life. Immediately after the injury, it is recommended to apply a cold compress to the knee area; This will help reduce sensitivity to pain. Ethyl chloride has a local cooling and anesthetic effect. In all cases, resting the knee helps reduce pain. It is necessary to limit movement, give the leg a position in which pain is minimal. When walking, a fixation bandage is applied to the knee, it is possible to immobilize the limb with the help of a cast.

In the acute period of injury or illness, it is strictly forbidden to massage the knee, apply hot compresses and wear high-heeled shoes. The main classes of drugs used for the symptomatic treatment of pain and inflammation are pain relievers and NSAIDs in the form of ointments, tablets, and injections. The listed measures can only temporarily reduce pain, but they do not eliminate the root cause of arthralgia. Therefore, all cases of knee pain require qualified diagnosis and treatment, and some conditions (fractures, dislocations, hemarthrosis) require emergency medical attention. You cannot postpone a visit to the doctor if the pain is combined with a change in the shape of the knee (swelling, smoothing of the contours, asymmetry), inability to perform flexion-extension movements, ballot of the patella, poor knee support tip.