Knee pain can be caused by problems with the knee joint itself or problems outside knee joint. Like ligament / tendons or bursa.  Knee pain is common cause of pain n middle age and in elderly. It is commonly caused by injury, age and overuse of knee or repeated stress on the knee.

Symptoms:

Knee is stiff and swollen

Weakness of knee or instability

Weight holding is very difficult

Can not able  to extend knee

Cracking sensation in knee , while walking

Unable to walk or climbing stair because of ligament injury

Persistant or intermitttent pain while walking

Causes of knee pain

Risk factor of knee pain

Obesity

Weakness of knee muscles

Previously injury to knee

Sports activity

When you should visit a doctor?

Your knee is swollen, red or painful

Your knee can not able to support your weight

When you have difficulty in flexing and extending your knee

You have unpleasant burning sensation in your knee

Sharp, shooting pain with movement of your knee

Persistant pain ,despite of taking pain-killers

You have knee deformity

Difficulty in up-stair climbing.

How can we diagnose knee pain?

Pain physician will take history and physical examinations. In addition to this your doctor might advise some tests to rule out the exact source of pain.

• X ray
• Ultrasound
• Magnetic resonance imaging ,MRI
• CT Scan.
• Arthroscopy

Conservative treatments

You can apply ice-pack for 10 minutes, 3 times per day.

Wear proper fitted, well cushioned shoes

Loose your weight , if you are overweight

Medications:  under doctor’s guidance, take Anti-inflammatory medicines, to relieve pain

Physiotherapy: by doing physical therapy or strengthening exercises, you can make muscles holding knee , much stronger and stable.

Injection theraphy :

If  pain killers and other medicines are not working well, then depending on your knee grade, your pain physician might be recommend following injectons

• Intra-articular steroid
• Ozone injection to knee
• Prolotheraphy
• Hyaluronic acid injections
• PRP theraphy ( Platelet Rich Plasma)

Radio-frequency Abation of the Genicular Nerves of Knee-

 It is an excellent mod e of theraphy , beneficial in patients of knee arthritis, who is physically unfit, in whom knee replacement can not be done or risk with knee replacement. Or in patients who wants to avoid spine surgery.

Surgical procedures:

• Arthroscopic repair: it is best modality for patient of Meniscus injury or ACL OR PCL  injury  not responding with INTERVENTION approach, or grade 3 to 4 injury.
• Knee replacement: it is only the last option, when all treatments are failed. Or patients have severe knee arthritis with deformity.

How can we can prevent knee pain?

Remains fit

Reduce your weight , if you are obese

Do warm up , before doing any sports activity

Do regular knee exercises

Take adequate and necessary calcium and vitamin  D3 supplementation

Stay active and flexible

What is osteoarthritis ?

In this patients have inflammation in the knee joint. It is a gradual breakdown of the cartilage in the knee. As the cartilage wears away, the bones around it, can grow thickened and developed bony spurs and this can be make friction between the bones and disruption in the movement in your knee. Ultimately in your knee, it leads to problems with the synovium a membrane in your knee that produces a liquid to keep your cartilage glossy (slippery). This synovium membrane can become inflamed and produce too much fluid. This results in swelling or water in the knee. In most severe cases, the knee can become deformed as continuous friction wears away the bone. The pain is usually worses after activity.

Rheumatoid Arthritis

It can affect joints on both sides of body ( both knee, both hand, both wrist ). In this arthritis, patient’s body cells attach their tissues.

Over time, it can cause the cartilage, to wear away, swelling in synovium and excess fluid in the knee.

Bursitis : Bursa is a fluid filled sac, which provides lubrication and protects the joint. Because of over use of muscles, injury to joint, there is inflammation in joint.

Tendinitis : It is a rope like tissues, connecting muscles to the bone at the knee joint. It is very common in sports injury. It is caused by over use of same part of the body. Patellar tendinitis or jumper’s knee is a inflammation or irritation at tendon between the knee cap and skin bone.

Patello-femoral pain syndrome (PFPS) / Runner’s or jumper’s knee :

In this condition, pain occurs under or around knee cap (patella). It occurs in one or both knees. It affects both children and adults. Usually pain increases with activities or after sitting for long time with knee bending. Their exact cause of syndrome is unknown.

Several factors may contribute for this.

Weak muscles surrounding knee

Certain anatomy of knee joint

Over use of knee joint

Issue with knee cap alignment

Playing on hard surfaces

Improper foot wares

Injuries :

It can be fall trauma or sports injury and usually it involves the ligaments that keep holding of two bones at the knee – the femur and the tibia together.

Meniscus Injury

Ligament Injury

Knee pain osteoarthritis :

It is one of the most commonest cause of disability, affecting 20 millions Indians (40% populations), every year.

It is most common age of in the 65, however because of faulty life style, it is also seen in age group of 35 to 50 years.

Figure of damaging cartilages and healthy cartilages

Wear and tear in knee joint cartilage

Symptoms of osteoarthritis knee

• It varies according to the grading of arthritis, patient may have dull aching pain and swelling of the knee.
• Difficulty in walking, getting up from sitting positions.
• Cracking sensation, during the knee movement.
• Stiffness in the knee ,in the morning.

Causes of the knee arthritis

• Obesity or sudden weight gain
• Older age
• Genetics
• Over use of knee
• Low vitamin D level

What investigations are required to diagnose ?

Knee examine patient clinically and advised to do x-ray – to see grading of arthritis.

Blood test to see inflammation

Treatment of knee arthritis

Pharmacological : Considering the age of patient, we prescribe NSAIDS and opioid medications.

Steroid injections 

Hyaluronic acid injection (viscous supplementation)

Hyaluronic acid a gel like substance, naturally present in the synovial fluid, surrounding joint. It acts as lubricant.

People with osteoarthritis have lower concentration of this hyaluronic acid.

Visco-supplementation was approved by US fluid and drugs administration in 1997.

Procedure

It is directly injected into intra-articular knee joint.

The result of the injection :

It varies with each patient. Pain relief is not immediately, it begins around the 3^rd week after initial injection. Multiple injections may be more effective than a single injection.

How it reduces pain and inflammation?

By providing lubrication, It reduces friction within joint and ultimately reduces pain and stiffness.

It acts as anti-inflammatory.

It provides strengthening to existing cartilage by providing protein and carbohydrates.

It protects existing chondrocytes (Cartilage producing cells).

It acts as a lubricant to enable bones to move smoothly over each other and acts as a shock absorber for joint loads.

What are the side effects of Hyaluronic acid injection ?

There is probably no any risk to this injection.

Some minor side effect, like pain at injection site, redness around the knee joint can be seen. These reactions are mild and don’t last long.

Exercise / Weight loss :

In many cases, if you loose weight, then it can help reduce pain and risk of osteoarthritis.

More weight put more pressure on your knee and it may leads to chronic pain.

According to American College of Arthritis Foundation, losing 5% or more of your body weight, can have better impact on your knee function.

Together, with dietary element, exercise can help you loose weight and reduced the risk of arthritis.