Knee pain

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

Causes of knee pain

Traumatic injury

They are usually the result of domestic trauma, which is often found in athletes: runners, jumpers, participants in sports games. Developed by a fall, direct kick or torso. Manifested by sharp pain at the time of injury. In the future, the pain syndrome becomes less pronounced, accompanied by increased edema. Abrasions and bruising are possible. As the frequency increases, the following injuries are identified:

• Knee injury. . . Occurs when he falls to his knee or hits him directly. At first, the pain is sharp, hot, sometimes burning, but bearable, later - dull, painful, aggravated by movements. Bruising is possible. The foot support is maintained. 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.
• Ligament fracture.It is found after twisting the leg, twisting it forcefully, bending or excessive stretching in an abnormal position. Painful sensations are stronger than with a bruise; simultaneously with the onset of pain, a person may feel how something is torn (similar to how ordinary tissue is torn). It is accompanied by a significant restriction of movement, support, twisting of the limbs, rapidly increasing hemarthrosis.
• Intra-articular fractures. . . They are detected by shocks, falls and torsion of the foot. In case of injury, a person feels a very sharp sharp pain, often unbearable, sometimes a crackling is heard. Patients with intra-articular fracture themselves describe their feelings as follows: "the pain is such that it darkens in the eye, the world ceases to exist, understands nothing. "Subsequently, the pain becomes less severe but remains of high intensity. Support is usually impossible, movement is almost completely restricted. Edema and hemarthrosis progress rapidly.
• Dislocation.It is the result of a blow or fall to the knee. At the moment of dislocation of the patella, a sharp pain appears, accompanied by a feeling of bending of the leg and displacement in the knee. No movement possible, reference function can be saved. A pronounced deformity is visible on the anterior surface of the knee, which then subsides due to increased edema. Sometimes hemarthrosis joins.
• Pathological fractures.They develop with minor injuries, are a consequence of decreased bone strength in osteoporosis, osteomyelitis, tuberculosis, bone tumors. The pains are painful, dull, reminiscent of pain syndrome with a bruise. Signs that indicate a pathological fracture are restriction or inability to support the foot, feeling of instability in the knee, sometimes deformity, bone fractures during movement.
• Meniscus damage.Meniscus jumps are formed during torsion, stroke, forced forced flexion or knee extension, sharp turn with one foot fixed. At first, a person feels a distinct click and a sharp pain shooting deep into the ankle. Then the pain diminishes somewhat, but becomes diffuse, sometimes - it burns, explodes, intensifies when you try to support and move. Knee volume increases due to edema and hemarthrosis. Support becomes impossible, movements are severely restricted.

Inflammatory pathologies

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

• Arthritis.Gonarthrosis appears after injuries, sometimes complicates infectious diseases, is detected in rheumatic diseases. It can be acute or chronic. Knee pain is usually dull, painful, oppressive or traumatic. At first, the pain is not intense and intermittent, intensifying in the evening or after exercise. The initial pain then joins, increasing the intensity and duration of the pain syndrome. This joint swells, the skin over it reddens, the temperature rises. With synovitis, the contours of the knee soften, there is a feeling of eruption. With suppuration, the severity of the pain increases significantly, they become shaky, deprive of sleep.
• Synovitis.It is not an independent disease, it complicates many acute and chronic pathologies of the wrist. Forms within a few hours or days. Initially, the pain is insignificant or absent, a feeling of satiety 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, tightening, intensifying with the slightest movement and touch.
• Scholarships. Inflammation of the joint capsules located in the patella and popliteal fossa usually occurs when the knee is overloaded and its injuries repeated (for example, with constant support in the knee). With bursitis, the pain is local, dull, not intense, appears in a certain position of the limb, after a characteristic load, decreases when the position of the foot changes, massaging the affected area. If the backpack is touched, painful sensations are possible while climbing or descending stairs. Sometimes small local edema is defined. With bursal choking, the pain becomes sharp, trembling, tingling, combined with hyperemia, edema of the affected area, symptoms of general intoxication.
• Tendiniti.Usually found in overweight men and athletes, it affects the ligament of the patella itself. Initially, pain syndrome manifests itself only with very intense effort, then with standard sports loads, then with daily physical activity or at rest. The tendon pain is localized just below the knee, dull, attractive, progressive, sometimes paroxysmal, in some cases accompanied by slight redness and swelling, aggravated by pressure. Movement is usually complete, rarely slightly restricted. A rupture or rupture of the ligament is possible due to a decrease in its strength.
• Lipoarthritis.Hoff's disease affects the layers of adipose tissue located under the patella. It is noticed with constant overload of the knee or becomes the result of an old injury. Most often it affects athletes, older women. A person complains of dull aching pain in combination, some limitations of extension. With the worsening of the pathology, the pain begins to bother at night, there is a feeling of instability of the knee, flexion of the leg. When pressed on the side of the patella, a soft crack or crackle is heard.

Autoimmune processes

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

• Rheumatoid arthritis.The loss is usually bilateral. With minimal activity of the autoimmune process, the pain is weak or moderate, intermittent, pulling, oppressive, accompanied by stiffness in the morning. With moderate activity, the patient complains of prolonged periodic pain, suppressive or explosive pain of moderate intensity, not only during movement but also at rest. Has stiffness for many hours, moderately repetitive synovium. With high activity of rheumatoid arthritis, the pain is strong, diffuse, exhausting, wavy in nature, increases in the early hours of the morning. Stiffness becomes constant, a large amount of fluid accumulates in the knees, contractions form over time.
• Systemic lupus erythematosus. Arthralgias are often symmetrical, although a joint may be affected. They can occur at any stage of the disease; with a recurrent course of SLE, they resemble rheumatoid arthritis. With low process activity, the pain is short-lived, non-intense, local, aching, attractive. In severe cases, the pain syndrome progresses, the pain is wavy, disturbs the night's sleep, becomes prolonged, diffuse, increases with movement, combined with synovitis, edema, hyperemia.
• Rheumatism.Joint pain is one of the first manifestations of rheumatic fever, appears 5-15 days after an acute infection, affects several joints at once (usually paired). The pains are quite short-lived but intense, migrating from one joint to another, varying in nature from pulling or pressing on burning or throbbing. The knees are swollen, hot, the skin above them is red. Movement is very limited. After a few days, the severity of the pain decreases, the movements return. In some patients, the residual effects in the form of moderate or mild dull pain persist for a long time.
• Reactive arthritis.Most often it appears 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, curvature and eye cramps. Knee pain is strong or moderate, constant, wavy, aching, pulling, trembling, combined with restriction of movement, worsening of the general condition, fever, severe swelling, and redness of the affected area. Painful sensations and signs of inflammation last from 3 months to 1 year, and then gradually disappear.

Degenerative-dystrophic processes

They develop as a result of metabolic disorders in the structures of key and periarticular soft tissues. They have a chronic course, which progresses over many years. It is often accompanied by the formation of calcifications, cysts and osteophytes, deformation of the knee surface. With considerable destruction of articular surfaces, they lead to marked impairment of movement and supporting function, become the cause of disability, and require the installation of an endoprosthesis.

• Osteoarthritis.It develops for no apparent reason or against the background of various injuries and diseases, mainly in the elderly and middle-aged people. Initially, the pain is weak, short-lived, usually tingling or aching, appears with prolonged exertion, and disappears at rest, often accompanied by a crack. Gradually, the pain syndrome intensifies, the knees begin to ache "in the weather" and at night, there is a restriction of movements. Distinctive features of gonarthrosis are initial pain (aching until "dissipated"), periodic sharp cutting attacks, burning pain, or shooting due to blockage. During periods of deterioration, synovitis often occurs, in which the pain becomes constant, pressing, erupting.
• Meniscopathy. . . It is commonly found in athletes whose work involves significant loads on the knee joint. Manifested by deep local unilateral pain inside the knee at the level of the key space, most often in the outer half of the knee. The pain intensifies during movement and decreases at rest, it can be dull, oppressive or pulling. With progression, there is acute shooting pain when trying to move. On the anterolateral surface of the joint in the projection of pain, sometimes a small painful formation is felt.
• Tendopathies. . . The tendons near the knees are affected. In the initial stage, they manifest with short-term local superficial pain at the peak of physical activity. Subsequently, painful sensations arise with moderate loads and then light, limiting normal daily activity. The pain is tingling or aching, directly related to active movements, not detected during passive stretching and bending of the knee, sometimes accompanied by a crack or crack. In the lesion area, it is possible to investigate the site of greatest pain. Local signs of inflammation (edema, hyperemia, hyperthermia) are insignificant or absent.
• Osteochondropathy.Most often affected children and young people, the duration of the disease is several years. They usually begin gradually with slight lameness or permanent dull pain, not intense, aggravated by exertion, which disappears at rest. With the progression of osteochondropathy, the pain becomes strong, constant, pressing, burning or burning, accompanied by severe lameness, restriction of movement, and difficulty in resting the limb. Then the pain gradually decreases, the supporting function is restored.
• Chondromatosis.It is usually diagnosed in older men, less commonly in infants. Joint chondromatosis manifests with moderate dull pain like waves, often worsening at night and in the morning. Movement is limited, accompanied by a crack. Sometimes blockages occur, characterized by sudden sharp pain, inability or severe restriction of movement. With the development of synovitis, the pain acquires an explosive character, combined with an increase in knee volume, soft tissue swelling, and a local increase in temperature.

Tumors and tumor-like formations

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

• Kist and Baker.Represents a hernial protrusion in the popliteal fossa. In the initial stages, it manifests as discomfort or slight local pain along the back of the knee. Against the background of the growth of Baker cyst due to compression of nearby nerves, burning or stinging pain, numbness or tingling sensation may appear in the sole area. The symptoms are worse when you try to bend the knee as much as possible. In the popliteal fossa, an elastic, slightly painful tumor-like formation is sometimes felt.
• Benign tumors.Includes chondromas, osteochondromas, non-ossifying fibroids and other neoplasms. They are characterized by a prolonged asymptomatic course or with low symptoms, they may be manifested by vague and intermittent non-intense 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 sarcomas, osteosarcomas, and chondrosarcomas. They appear with faint faint local pain, sometimes with a certain circadian rhythm (worse at night). The intensity of the pain increases, they become sharp, cutting, burning or trembling, spreading along the knee and adjacent tissues, accompanied by deformity, edema, synovitis, dilation of the saphenous veins, violation of the general condition, contracture formation. When palpated, a painful tumor-like formation is determined. When the process begins, the pain is excruciating, unbearable, exhausting, deprives you of sleep and is not eliminated by non-narcotic analgesics.

Invasive surgeries and manipulations

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

• Manipulation.The most common procedure is drilling. Post-puncture pain is short-lived, not intense, fades quickly, localized to the puncture projection, which is usually performed on the outer surface of the knee. After a biopsy, the pain may initially tremble, then become dull and disappear after a few days.
• Operations.After arthroscopy, the pain is moderate, at first quite acute, then dull, subsiding after a few days or 1-2 weeks. After the arthrotomy, the pain syndrome is more intense, it can last up to several weeks due to significant tissue damage. Usually, in the first 2 or 3 days after the interventions, patients are prescribed analgesics, then the pain becomes weak and gradually disappears.

Psychosomatic conditions

Sometimes knee arthralgia occurs in the absence of an organic basis (trauma, inflammation, destruction, etc. ) under the influence of psychological factors. It is believed that such pain plays a protective role, as it helps reduce emotional stress by turning experiences into physical sensations. A distinctive feature of such pains is their indeterminate nature, inconsistency, lack of noticeable changes, a clear connection to physical activity, and other objective provocative factors. Meteopathic arthralgias are seen in people who are sensitive to changes in atmospheric pressure.

In addition, radiation of knee pain is possible with coxarthrosis, lumbar osteochondrosis, Perthes disease, fibromyalgia, sciatic nerve neuropathy. However, these pathologies usually highlight other localization pain syndromes. Additional risk factors that increase the chance of knee injury and disease include overweight, occupational sports, hypovitaminosis, metabolic disorders, and old age. Hypothermia, stress, physical exertion and diet disorders can be provocative factors for exacerbating chronic pain.

Survey

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

• Laboratory blood tests. . . A complete blood count helps identify the hematological 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 phase-specific proteins and immunoglobulins (CRP, rheumatoid factor, ASL-O, CEC, antibodies to DNA, etc. ).
• Radiography.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 articular cavity, narrowing of the joint space, changes in the thickness of the end plates, the presence of edge defects at the articular ends of the bone, osteolysis, and bone destruction. . In some diseases (meniscus trauma, Baker cyst), contrast arthrography shows greater sensitivity.
• Arthrosonography. . . Knee ultrasound is a fast, cheap, affordable and very informative diagnostic method. Allows you to judge the presence of shedding and free bodies in the joint cavity, to identify damage and pathological changes in the soft periarticular tissues (signs of calcification, hemorrhage, etc. ). They help to distinguish with high accuracy the etiology of joint pain.
• CT and MRI. . . They are the methods of choice for arthropathy of any genesis. They are used for a more detailed assessment of the nature and extent of pathological changes, to identify typical signs of traumatic, inflammatory, and tumor lesions of bone structures and soft tissues. CT and MRI of the joints are usually used with limited information content of other instrumental studies.
• Joint puncture. . . It is performed when there are indications of exudate or transudate accumulation in the articular capsule. As part of the differential diagnosis of inflammatory, degenerative and tumor diseases, a cytological, bacteriological or immunological study of synovial fluid is performed. To establish the diagnosis of autoimmune damage of the knee joint, tuberculous arthritis, synovioma, it is extremely important to perform a biopsy of the synovial membrane.
• Arthroscopy. . . The purpose of invasive endoscopic diagnosis may be to take biopsy specimens, clarifying the necessary diagnostic information during a visual examination of key elements. In some cases, diagnostic arthroscopy is performed in therapeutic (atroscopic removal of intra-articular bodies, meniscectomy, ligament autoplasty, etc. ).

Symptomatic treatment

Treatment of the causes of knee pain is carried out differently, taking into account the identified disease. At the same time, symptomatic care is an essential part of a comprehensive treatment process aimed at reducing anxiety 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 the sensitivity to the pain. Ethyl chloride has a local cooling and anesthetic effect. In all cases, knee rest helps reduce pain. It is necessary to restrict movement, give the foot a position in which the pain is minimal. When walking, a fixative bandage is applied to the knee, immobilization of the limb is possible with the help of a cast.

In the acute period of injury or illness, knee massage, the application of heat compresses and the wearing of high-heeled shoes are strictly forbidden. The main classes of drugs used for the symptomatic treatment of pain and inflammation are analgesics and NSAIDs in the form of ointments, tablets and injections. The measures listed may only temporarily reduce pain, but 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 urgent medical attention. You can not postpone a visit to the doctor if the pain is combined with a change in the shape of the knee (swelling, smoothing of contours, asymmetry), inability to perform flexion-extensor movements, patella voting, damaged limb support.