Parts Of The Knee Pain

Prevention Of Knee Injuries

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There are several things you can do to reduce your chance of damaging your knee ligaments. This will help to prevent other sports injuries too.

Exercise regularly to keep your fitness levels up, and include some resistance training . Regular exercise will make your muscles stronger and more flexible, so they can support your joints, including your knees. If you haven’t been active for a while, start off gently and gradually increase the number, length and intensity of your exercise sessions.

My GP says I have housemaids knee. What is this?My GP says I have housemaids knee. What is this?

Housemaids knee is the common name for prepatellar bursitis. Its often caused by the pressure of kneeling forwards for long periods. These days, prepatellar bursitis is often seen in carpet fitters or roofers anyone who spends a lot of time working on their knees.

See our Types of knee injury section for more information.

Pain Located In The Middle Of The Knee

Pain in the middle of the knee, including under the kneecap, may be the result of the following conditions:

Anterior cruciate ligament tear: Also known as an ACL tear, this is an injury that can occur during sports, motor vehicle collisions, severe falls, and work-related injuries.
Tricompartment osteoarthritis: This is a form of osteoarthritis in which all three compartments of the knee have arthritis.

What Are The Possible Causes Of Knee Pain

Many conditions and injuries can make your knees hurt. Some common knee pain causes can include overuse, injuries and arthritis.

Overuse

Repetitive activities can lead to pain Some examples are:

Patellofemoral pain : pain under or around the kneecap, often related to mechanics, shape of the knee cap, or
Osgood-Schlatter disease: In children, swelling in the shinbone below the kneecap due to overuse.
Tendonitis, involving the quadriceps or patella tendon: repetitive jumping sports such as volleyball or basketball.

Injury

Sudden trauma can damage parts of your knee joint. Common knee injuries can include:

Anterior cruciate ligament injury or medial collateral ligament injury: Damage to the main stabilizing ligaments of the knee.
Bursitis: Inflammation of the fluid-filled sacs that cushion the knee joint.
Kneecap dislocation: Movement out of place by your kneecap .
Meniscus tear: Tear in the knees cartilage .

Arthritis

Arthritis is a condition that can impact many different joints in your body. When you have arthritis in your knee, it causes the joint to swell. This can be a painful condition. Arthritis in your knee is more likely to develop over time as you age. There are several different types of arthritis that can affect the knees, including:

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How To Know If Your Knee Pain Comes From Your Spine

Many people assume knee pain is always caused by a problem in the knee joints. However, that is not necessarily the case. If youre suffering knee pain or discomfort, there is a possibility that a problem with your spine is the cause.

So how do you know if your knee pain comes from your spine? The muscles around your knees are connected to the nerves in your lower spine so if these nerves are irritated or compressed, your knees may be affected by symptoms such as intermittent back pain, hamstring tightness, weakness in the hips or quads, and the development of bunions on your feet.

Pain Located At The Back Of The Knee

Pain at the back of the knee is commonly caused by things like:

Baker’s cyst: This is a fluid-filled sac that occurs when excess synovial fluid sees through the back of the knee capsule .
Posterior cruciate ligament injuries: Also known as a PCL tear, this usually occurs when the knee is directly hit, such as during contact sports like soccer, football, or rugby.

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Rheumatoid Arthritis Of The Knee

Rheumatoid arthritis is an autoimmune condition that causes the tissue around the joint to become inflamed and thickened. Chronic inflammation often leads to damage and loss of cartilage.

Rheumatoid arthritis occurs in about 0.6 percent of the U.S. population and is two to three times more common in women.

Symptoms of rheumatoid arthritis are similar to other types of arthritis in the knee:

Can Arthritis Represent A Medical Emergency

In the situation that the patient presents high fever, severe inflammation and leg pain, he/she might suffer from what is known as septic arthritis.

This is a medical emergency, requiring immediate intervention if the condition is not treated in due time, life-threatening symptoms can occur and the risk of death becomes considerably higher.

It is common for the joints of the hip and knee to be affected by this infection, with a negative impact on the entire leg.

This condition is present in both children and adults, especially in those who have a compromised immune system.

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Accurate Diagnosis Is Key

If your physician examines your hip joint and notes no hip pain, and then examines your back and notes leg pain, the spine is usually the source of the problem. Some people may have localized hip pain without leg pain, but are found to have a normal hip and an abnormal spine. Others may have only leg pain, but are found to have an abnormal hip and a normal spine. Therefore, in addition to a good physical examination, imaging is important. Plain X-rays may be helpful, but sometimes an MRI is needed as well. If imaging does not determine the source of the pain, the next step would typically be to perform an injection of pain-relieving medication directly into the area suspected of causing pain. Whether you get pain relief from the injection can help your physician better understand where the pain is coming from.

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Anterior Cruciate Ligament Injuries

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The anterior cruciate ligament is often injured during sports activities. ACL injuries are more likely to occur in athletes who participate in cutting and pivoting sports like soccer, football, and basketball. Changing direction rapidly or landing from a jump incorrectly can tear the ACL.

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Learn more about ACL injuries:

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Medial Collateral Ligament Injury

The medial collateral ligament runs along the outside of your inner knee to stabilize the joint. If the ligament overstretches, you may have an MCL sprain.

The MCL can also tear partially or fully. An MCL injury most commonly occurs after force is applied to the outer knee, such as in contact sports.

Symptoms of an MCL injury include:

Surgery For Knee Injuries

Your doctor or physiotherapist may refer you to an orthopaedic surgeon for some knee injuries. You may need surgery to repair the damage to your knee especially if other treatments havent worked.

Your surgeon is more likely to suggest you have an operation if you have one of the following injuries.

Youve torn your anterior cruciate ligament , especially if you do a lot of sport or have also torn a meniscus. In ACL reconstruction, your surgeon will take a piece of tendon to replace the damaged ligament.
Your knee is still painful or locks after an injury to your meniscus. Your surgeon may repair or partially remove your damaged meniscus.
Youve injured your medial collateral ligament and it hasnt healed after three months of other treatments. Your surgeon may repair or reconstruct your MCL.

You may be able to have a type of keyhole surgery called knee arthroscopy to get to the damaged area of your knee.

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How Can A Physical Therapist Help

Your physical therapist will develop a personalized rehabilitation program for your condition. This program can help you safely return to your desired activities. Some general treatment techniques may include:

Your physical therapist may refer you to an orthopedic doctor who specializes in knee conditions and injuries. They may recommend diagnostic imaging . An X-ray helps to identify bone abnormalities . An MRI will help confirm the diagnosis of tendon and ligament injuries and provide a different view of your bones and cartilage.

Ligaments Of The Knee

Ligaments are structures that connect two bones together. There are four major ligaments that surround the knee joint.

Two of these ligaments are in the center of the joint, and they cross each other. These are called the cruciate ligaments and consist of the anterior cruciate ligament and the posterior cruciate ligament.

One ligament is on each side of the knee jointthe medial collateral ligament on the inner side, and the lateral collateral ligament on the outer side. Ligament injuries typically result in complaints of the instability of the knee joint.

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How Are Knee Injuries Diagnosed

To diagnose a knee injury, health care providers ask about how the injury happened and what symptoms it causes.

The health care provider will do a physical exam that includes pressing on the knee and legs and moving them in certain ways. These tests can show what part of the knee is injured.

Imaging tests done sometimes used include:

X-rays to check for injuries to the bones
a CT scan or MRI to look inside the knee

Pain Located At The Bottom Of The Knee

Pain at the bottom part of the knee is commonly associated with four conditions:

Osgood-Schlatter disease: This is a condition common in children in which the tendons of the knees pull on the knee’s growth plate during rapid growth spurts.
Osteochondritis dissecans: This is an uncommon disorder that causes the knee meniscus starts to loosen and, in some cases, detach from the bone.
Patellar tendonitis: This is the inflammation of the tendon of the kneecap, also known as “jumper’s knee,” that commonly occurs in athletes who jump or run
Patellofemoral instability: This is a condition, once known as traumatic patellar dislocation, in which the patella gets moved out of the groove that connects it to the bottom of the femur.

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What Causes Arthritis Of The Knee

Experts have identified some genes that might cause arthritis, including arthritis of the knee. They predict that there are more genes not yet discovered. You could have a gene linked to arthritis without knowing it and a virus or injury could trigger arthritis of the knee.

Though the cause is unknown, some risk factors increase the possibility of arthritis of the knee. Risk factors of osteoarthritis, specifically, include:

Age. Osteoarthritis happens to older adults more often than younger adults and children.
Bone anomalies. Youre at a higher risk for osteoarthritis if your bones or joints are naturally crooked.
Gout. Gout, also a type of inflammatory arthritis, might lead to osteoarthritis.
Injuries. Knee injuries can cause arthritis of the knee.
Stress. A lot of stress on your knees from jogging, playing sports or working an active job can lead to osteoarthritis of the knee.
Weight. Extra weight puts more pressure on your knees.

Possible Causes Of Pain

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Quadriceps tendonitis this is caused by the irritation, strain or injury to the quadriceps tendon.

Patellofemoral Arthritis

This affects the underside of the kneecap and the trochlear groove in the femur in which it moves. When the articular cartilage covering the surfaces of the bone wears away and becomes inflamed the bones come into contact with each other resulting in pain.

Plica Syndrome

A plica is the fold in the thin synovial membrane that lines the knee joint. There were four of these folds in the knee joint originally, but they often become absorbed during foetal development. About 50% of the population is thought to have the remains of the embryonic plicae. When a plica becomes inflamed, perhaps because of repetitive knee movement, trauma or twisting, it causes pain and weakness in the knee.

Lateral patellar facet overload syndrome

This refers to dull aching pain underneath, around the sides or below kneecap. It is caused by increased pressure on the lateral facet of the patella. The reason for this is improper tracking, poor alignment or dislocation of the kneecap. The condition is often apparent during repetitive exercise such as climbing stairs.

Synovitis

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Quadriceps & Patellar Tendinopathy

This is an overuse injury in jumping athletes. Upon presentation, they have pain localized to the superior border of the patella that worsens with activity. There is frequently associated swelling to the affected area also. Risk factors are sports that highly involve jumping .

Mechanism of InjuryThe injury occurs as a result of repetitive eccentric contractions of the extensor mechanism. Microtears of the tendon most commonly at the bone-tendon interface then inflammation of the suprapatellar tendon of the quadriceps muscle.

Physical ExaminationThere is tenderness to deep palpation at quadriceps tendon insertion at the patella. A palpable gap over the affected area would suggest a quadriceps tendon tear. Upon evaluation the range of motion, there is pain upon knee extension but patient is able to actively extend the knee against gravity.

Evaluation: Imaging

X-rays : Recommended views include AP and lateral. Optional view are sunrise or Mechant views for evaluation of patellar instability. Usually, radiograph findings are normal. Occasionally, there are tendon calcinosis are seen in chronic degeneration.
Ultrasound is more effective at detecting and locating disruption in tendon.
MRI is the most sensitive imaging modality. Common finding is the thickening of the affected tendon.

ManagementUsually a non-operative approach is the mainstay of therapy: activity modification , NSAIDs, and physical therapy. Cortisone injections are contraindicated due to risk of tendon rupture.

Brief Anatomy Of The Knee

The knee is a vulnerable joint that bears a great deal of stress from everyday activities, such as lifting and kneeling, and from high-impact activities, such as jogging and aerobics.

The knee is formed by the following parts:

Tibia. This is the shin bone or larger bone of the lower leg.
Femur. This is the thighbone or upper leg bone.
Patella. This is the kneecap.

Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles , which straighten the legs, and the hamstring muscles , which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments on the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia .

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Fast Facts On Pain In The Back Of The Knee

There are many possible causes of this kind of pain.
Receiving early treatment for knee pain often prevents the injury from getting worse.
In some cases, the pain may be due to fatigue or not stretching before exercise.

It is important to work closely with a doctor to diagnose pain in the back of the knee, as some causes require long-term treatment to heal completely.

Some possible causes of pain in the back of the knee include the following.

When To See A Doctor About Pain In Outer Side Of Knee

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We recommend you see a doctor if you have any of the following:

outer knee pain after trauma
pain that has not settled after a few weeks with simple treatments such as ice and oral NSAIDs
mechanical symptoms such as locking or giving way
nerve symptoms such as numbness or tingling suggestive of nerve damage

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How To Get Rid Of Leg Pain Caused By Bunions

Fortunately, you can get rid of any leg pain you experience as a result of bunions by removing the source of the problem. A bunionectomy can either correct the malalignment of your joints or remove the bunion entirely. In any case, this minimally-invasive procedure will permanently fix the issue of bunions, thereby eliminating any bunion-related pain in your feet, ankles, or legs.

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Medial Collateral Ligament Sprain

Injury to the medial collateral ligament is fairly common and is usually the result of acute trauma. The patient reports a misstep or collision that places valgus stress on the knee, followed by immediate onset of pain and swelling at the medial aspect of the knee.11

On physical examination, the patient with medial collateral ligament injury has point tenderness at the medial joint line. Valgus stress testing of the knee flexed to 30 degrees reproduces the pain . A clearly defined end point on valgus stress testing indicates a grade 1 or grade 2 sprain, whereas complete medial instability indicates full rupture of the ligament .

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Lower Leg Bone Fracture

A bone break or fracture in one of your lower leg bones may be caused by falling or by a traumatic blow to your leg, such as a car accident.

This injury may cause severe calf pain. Additionally, your lower leg may be quite swollen, making it difficult to walk or bear any weight on your leg.

A complete bone break can cause your leg to look deformed. This can also happen if the broken bone does not heal properly. To prevent this from happening, you may need a cast or, in some cases, surgery.

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Patellar Instability And Dislocation

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Patellar instability and patellar dislocation may occur from a direct blow, tight lateral structures , or ligamentous laxity . It presents with knee instability with anterior knee pain.

Mechanism of InjuryThis is typically a noncontact twisting injury with the knee extended and foot externally rotated. Patient will usually reflexively contract quadriceps subsequently reducing the patella. Osteochondral fractures frequently occur as the patella relocates.

Direct blow is a less common mechanism. Examples include knee to knee collision in basketball, or football helmet to the side of the knee.

Physical Examination

Acute dislocation is usually associated with a large hemarthrosis. Absence of swelling supports ligamentous laxity and habitual dislocation mechanism
Medial-sided tenderness
Patellar apprehension: passive lateral translation results in guarding and a sense of apprehension
J-sign: Examiner observes patellar deviation laterally in the shape of the letter “J” with knee extension which “pops” into groove as the patella engages the trochlea early in flexion. It is associated with patella alta .