Knee Pain

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Knee pain can be caused by injury, overuse, medical conditions or age. Some knee pain can be treated at home with over-the-counter medications or ice. More serious joint conditions may need more intensive medication or even surgery. Here’s what you should know about knee pain and what you can do about it.

Do You Need to See a Hip or Knee Specialist?

Find out whether it’s time to talk to a medical professional about your hip or knee pain.

The assessment takes a few minutes.

Clearly describing knee pain or knee issues to your health care team is an important tool in helping you feel better. Knee pain can originate in one place and be felt in another. (This is called referred pain.) It may be in the front, back or side of the joint. It may feel sharp and stabbing or dull and achy. Being able to identify where the pain is and what it feels like will help your provider effectively treat your knee pain.

  • Type of pain: Various types of knee pain include a dull ache; sudden onset of pain during activity; sharp, stabbing-type pain; or pain that gets worse with activity
  • Swelling: Inflammation and swelling around the knee joint
  • Stiffness: Difficulty in moving or bending the knee, with or without pain
  • Instability: Feeling of the knee giving way or being unstable, or difficulty in bearing weight on the affected leg
  • Limited range of motion: Inability to fully extend or flex the knee joint
  • Warmth or redness: Presence of warmth or redness in the knee area
  • Audible Sound: Grating, grinding or popping sensations in the knee joint, or audible “pop” sound at the time of injury

Common Causes of Knee Pain

Knee pain can affect your quality of life. Understanding the cause of your pain will help you get the best treatment for your condition.

The knee is made of skin, bones and muscles. Ligaments and tendons connect the bones to muscles and other bones. The meniscus is a cushion of cartilage in the joint that protects the knee. The bursae are fluid-filled pads that also cushion the joint. Damage to any of these parts of the knee can cause knee pain.

Mechanical or structural causes

This type of pain comes from damage to the parts of the knee. These can include:

  • Ligament tear, such as an anterior cruciate ligament (ACL) tear
  • Meniscus tear
  • Cartilage damage
  • Dislocation
  • Loose body (a piece of bone or knee cartilage floating in the joint space that prevents the joint from working correctly or is causing irritation)
  • Patellar misalignment, describing when the kneecap is out of its correct place (This is sometimes a result of hip or foot pain that causes you to change how you walk.)

Inflammatory or rheumatic conditions

Some medical conditions cause inflammation and pain in the soft tissues in the knee. These include:

  • Osteoarthritis
  • Tendinitis, for example, patellar tendinitis or iliotibial (IT) band syndrome
  • Bursitis, which is an inflammation of the bursae
  • Arthritis and rheumatoid arthritis
  • Gout, which is a form of arthritis that causes sudden, severe pain and swelling in the joint
  • Reactive arthritis, which is joint pain and swelling caused by an infection elsewhere in the body

Overuse Injury or Repetitive Strain

Repeating movements the same way many times can put stress on the bones, joints and muscles.  The movement may be related to your job, exercise or how your body naturally moves. This can cause such injuries as a stress fracture, which is a tiny crack in the bone, or conditions such as runner’s knee, which is called that because it is common in people who run or play sports that involve running and jumping.

WWE superstar Al Snow chooses rare double knee replacement to relieve pain

Former WWE wrestler Al Snow instructs two wrestlers-in-training

Double knee replacement requires two surgeons working simultaneously with two surgical assistants. 

Soft-tissue Knee Injuries

ACL injury – The anterior cruciate ligament (ACL) connects your thighbone (femur) to your shinbone (tibia) and runs under your kneecap (patella). A sprain or tear is most common during activities involving sudden starts and stops or sudden changes in direction. It’s very common in activities such as basketball, football and soccer, but can affect nonathletes as well.

MCL injury – The MCL connects the bottom of your thighbone to the inside of your upper shinbone (tibia) and helps keep it in place. Stress on the outside of the knee can put sudden and intense pressure, stretching the ligament.

The result can be a sprain, partial tear or complete tear of the ligament. The same event that injures the MCL often injures the ACL as well.

PCL injury – The posterior cruciate ligament (PCL) runs down the back of the knee. The PCL is larger and stronger than the ACL and isn’t injured as frequently, but still can be sprained or torn. Bending your knee backward, dislocation, a hard hit to the front of the knee or a bad landing after a jump are typical causes of a PCL tear.

Meniscus tear – The menisci are wedge-shaped rubbery discs that fit between the bottom of your thigh bone and the top of your shin, providing cushioning and stability to the knee. A meniscus can tear due to an injury or degeneration over time. Pivoting or cutting while running can cause a meniscus to tear. So can intense contact. In a degenerated meniscus, tears can result from less challenging, everyday activities.

Sometimes a torn meniscus doesn’t cause much difficulty right away. But after a few days, the knee can become stiff, swollen and painful. Sometimes the knee seems to “give out.”

Patella Fractures

The kneecap (patella) is a round bone embedded on a tendon and helps protect the knee joint. Ligaments attach it to the thigh muscles and the shinbone. Patella fractures can range from hairline cracks to shattering into three or more pieces. Patella fractures are capable of piercing the skin.

Falls, auto accidents and impact with ball or stick while playing sports are some of the causes of a patella fracture.

Other Pain Causes

Septic arthritis occurs when the joint fluid and surrounding tissue are infected. Septic arthritis can be caused by bacteria, fungi or viruses.

Systemic chronic diseases such as lupus and fibromyalgia also can cause joint pain in the knee.

Home Treatment for Knee Pain

Mild to moderate knee pain often can be treated at home. Pain due to inflammation, arthritis or minor injury often will resolve without medical help. Home remedies can improve your comfort levels and help you manage symptoms.

If pain is moderate to severe, however, or if symptoms persist or get worse, you may need to seek medical attention for a full assessment.

A strain or sprain can be soothed with the RICE method:

  • Rest: Stop doing the activity that is causing the pain, if you can.
  • Ice: Apply a bag of ice wrapped in a towel to the knee. A bag of frozen vegetables, such as peas, can work if you don’t have ice.
  • Compression: Wrap the knee with a compression bandage to prevent swelling. Don’t wrap it too tightly; you want to keep good circulation.
  • Elevation: Keep the leg and foot elevated while resting.

You may find relief in alternating cold and heat therapy. A heating pad can help relieve pain, while cold treatment can help reduce inflammation.

  • Apply heat for up to 20 minutes at a time.
  • For the first two days after an injury, apply cold pads for 20 minutes, four to eight times a day.
  • Use a gel pack or other cold pack more often during the first 24 hours after the injury.
  • Never apply ice directly to the skin — use a towel or cloth between ice and skin.
  • Check that a heat pad isn’t too hot before applying.
  • Don’t use heat therapy if your joint is warm during a flare.
  • A warm shower or bath in the morning may ease stiff joints.

Over-the-counter medicines such as nonsteroidal anti-inflammatories (NSAIDs) also can relieve pain.

When to See a Doctor for Your Knee Pain

You can treat many causes of knee pain at home, but some will need medical attention, especially if your symptoms aren’t responding to home treatments.

Contact your health care provider if you notice any of the following:

  • Severe pain and swelling
  • Deformity or severe bruising
  • Symptoms in other parts of the body
  • Symptoms that persist longer than a few days or get worse instead of better
  • Signs of infection, such as a fever

Seek treatment if you can’t walk or your knee feels unsteady, if you have severe swelling, bruising or redness, or if you have had a recent injury to the knee area.

Risk Factors That Can Contribute to Knee Pain

  • Weight: Excess body weight puts increased stress and pressure on the knee joints, leading to increased wear and tear, and an elevated risk of developing knee pain, especially osteoarthritis.
  • Aging and degenerative changes: As people age, the knee cartilage may naturally wear down, leading to conditions like osteoarthritis. Age-related changes in joint structure and function also can contribute to knee pain.
  • Repetitive activities: Engaging in activities that involve repetitive motions or prolonged stress on the knees, such as running, jumping, squatting, or kneeling, can lead to knee pain. These activities may cause overuse injuries, tendinitis or bursitis.
  • Muscle weakness or imbalances: Weak or imbalanced muscles around the knee can affect joint stability and alignment, leading to increased stress on the knee joint and potential pain. This is often seen in conditions like patellofemoral pain syndrome.
  • Improper footwear or training technique: Wearing inappropriate footwear or using incorrect techniques during physical activities can place additional stress on the knees and contribute to knee pain.

Diagnosing Knee Pain

The first step in diagnosing a knee condition is a physical exam and a health history. You will be asked questions about your current medical conditions, family health history and more. You may have blood taken to check for inflammation.

Although a thorough physical examination can help your health care provider understand your condition, sometimes more information is needed. There are several other types of tests your doctor may give you to help figure out what is going on. Those tests include:

  • X-ray:This uses electromagnetic waves to get a picture of your bones. X-ray can help see bone fractures and degenerative joint disease.
  • CT scan:CT scanners combine X-rays taken from many different angles to create a more detailed image of the inside of your body. CT scans can help see bone conditions and subtle fractures. A special kind of CT scan can identify gout with accuracy, even when the joint is not inflamed.
  • Ultrasound:This technology uses sound waves to produce real-time images of the soft tissue structures within and around your knee. The doctor may move your knee into different positions during the ultrasound to check for specific conditions.
  • MRI:This test uses radio waves and a powerful magnet to create 3D images of the inside of your knee. This test is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.

Sometimes, an even more detailed look at what’s happening in the knee joint may be necessary. Arthroscopy is a minimally invasive surgery that uses a tiny camera to look inside your knee. Small cuts are made to insert a camera, and small surgical tools are used inside your knee for the procedure.

Treatments for Knee Pain

Once your doctor has given you a diagnosis, you will have a better idea of what treatment options are available to you. Knee pain treatment falls into roughly two categories: nonsurgical and surgical. Many people try nonsurgical treatment first, hoping to avoid surgery, but your health care team will help you make those choices.

Nonsurgical treatments for knee pain

  • Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
  • Physical therapy to strengthen the muscles around the knee and improve range of motion
  • Injections, such as corticosteroids
  • Assistive devices such as knee braces or orthotics that give added stability and alleviate pressure on the knee joint

Surgical treatments

Surgery is a good option if the joint is badly damaged or all other treatments have been considered or tried.

  • Arthroscopy. While this can be a diagnosing tool, arthroscopy also can be used to perform surgery. A minimally invasive procedure where a tiny camera is inserted into your knee to allow the orthopedist precisely to trim damaged cartilage, remove loose debris, irrigate the inside of the knee and even reconstruct a damaged ligament such as a torn ACL — a common injury.
  • Osteotomy (bone cutting). This procedure is usually done to correct joint damage from arthritis. The surgery realigns the knee by either cutting the top of the shinbone or the bottom of the thighbone, while reshaping to shift weight off the knee.
  • Partial knee replacement. The surgeon removes either the inside or outside of the knee joint and replaces it with artificial parts.
  • Total knee replacement. The surgeon will replace the ends of the femur (both inside and outside parts of the joint) and tibia with metal and plastic pieces. The surgeon may place a plastic button on the back of the kneecap to replace worn-out cartilage.

Norton Orthopedic Institute surgeons are leaders in the use of robotics that help your surgeon implant the parts of your new knee with superior precision. Placing the metal parts of the new joint and attaching them to your bone requires skill and planning to provide the best possible feel.

Choose Norton Orthopedic Institute for Your Shoulder, Hip or Knee Replacement

  • Same-day appointments are available with no referral required. When you’re ready to take care of the pain, you want to get started.
  • Our fellowship-trained and board-certified orthopedic surgeons have the experience you can trust. They perform more than 800 hip replacements, 1,000 knee replacements and hundreds of shoulder replacements every year.
  • Lower-cost, nonsurgical options, such as physical therapy, are considered and tried before we recommend surgery.
  • Robotic-assisted surgeries provide added precision when placing your new joint and, with advanced, minimally invasive techniques, often allow you to go home the same day.
  • Choose from 30 locations in Louisville and Southern Indiana for follow-up care.
  • Norton Healthcare is the first health system in the nation to be recognized as an Advanced Orthopedic & Spine Center of Excellence by DNV.
  • We help you get ready for surgery and support your recovery with educational programs available online and in person.
  • Medicare, Medicaid and most major commercial insurance plans are accepted. Financial assistance also is available.
  • Your free Norton MyChart account allows you to communicate with your provider, manage appointments, refill prescriptions and more from a mobile device or computer.

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