Knee Pain & Symptoms
Knee pain is a common complaint that impacts people of all ages. At Aptiva Health, we offer same-day and walk-in appointments for knee injuries and conditions to evaluate, diagnose, and make the appropriate referral for additional treatment based upon your specific knee injury or condition. We treat these conditions in our General Medicine, Orthopedics, Sports Medicine, Pain Management, and Physical Therapy departments.
The cause or source of knee pain can vary widely. Common causes of knee pain include:
Injury - Ruptured Ligament or Torn Cartilage
Gout
Infection
Many types of minor knee pain will resolve with time on their own or with rest, ice, compression, and elevation (RICE method).
SYMPTOMS
The location and severity of knee pain can also vary depending on the cause. Some of the signs and symptoms that can accompany knee pain are below:
Redness and Warmth to Touch
Swelling
Stiffness
Weakness or Instability
Popping or Crunching Noise
Difficulty Straightening Knee
Locking, Catching, or Giving Way
Causes
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:
ACL injury. The anterior cruciate ligament (ACL) is located toward the front of the knee. It is the most common ligament to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.
ACL injuries are diagnosed through clinical examination and MRI, and can be classified by the amount of damage to the ligament (partial or complete disruption). Injury to the ACL is usually a complete disruption, classifying it as a Grade III complete tear.
Grade I Sprain - There is some stretching and micro-tearing of the ligament, but the ligament is intact and the joint remains stable. These injuries rarely require surgery.
Grade II Sprain (Partial Disruption) - There is some tearing and separation of the ligament fibers and the ligament is partially disrupted. The joint is moderately unstable. Depending on the activity level of the patient and the degree of instability, these tears may or may not require surgery.
Grade III Sprain (Complete Disruption) - There is total rupture of the ligament fibers. The ligament is completely disrupted and the joint is unstable. Surgery is usually recommended in young or athletic people who engage in sports that involve cutting or pivoting.
MCL Injury. The medial collateral ligament (MCL) is one of the four ligaments that are critical to maintaining the mechanical stability of the knee joint. The ligamentous sleeve connects the top of the shinbone (tibia) to the bottom of the femur (thighbone). Located outside of the knee joint, this ligament helps hold the bones together and adds stability to the knee.
Since the MCL resists widening of the inside of the knee joint, the ligament can be injured when the outside of the knee joint is struck or if there is a strong lateral force exerted on the outside of the knee. This force causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury. This is the injury can occur when the outside of the knee is struck and is one of the major reasons “chop blocking” is illegal in football.
An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the ACL, or the meniscus, may be torn along with an MCL injury.
Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
Fractures. The bones of the knee, including the kneecap (patella), can be broken during motor vehicle collisions or falls. People whose bones have been weakened by osteoporosis can sometimes sustain a knee fracture simply by stepping wrong.
Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
Patellar tendinitis (Jumper’s Knee). Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Runners, skiers, cyclists, and those involved in jumping sports and activities may develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.
Knee dislocation. A knee dislocation occurs when the bones that form the knee are out of place. A knee dislocation, more specifically, is when the bones of the leg (the tibia and fibula) are moved in relation to the bone in the thigh (femur). The bones of the knee are held together by strong bands of tissue called ligaments. Each ligament is responsible for stabilizing the knee in a certain position.
For a knee dislocation to occur, these ligaments must tear.
A partial dislocation is referred to as a subluxation.
In some injuries, the kneecap (patella) and its ligaments are also disrupted.
Inappropriate or delayed treatment of a knee dislocation may result in loss of the leg.
Chondromalacia. Chondromalacia patellae, also known as “runner’s knee,” is a condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. This condition is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee. Chondromalacia is often seen as an overuse injury in sports, and sometimes taking a few days off from training can produce good results. In other cases, improper knee alignment is the cause and simply resting doesn’t provide relief. The symptoms of runner’s knee are knee pain and grinding sensations, but many people who have it never seek medical treatment.
Mechanical problems
Some examples of mechanical problems that can cause knee pain include:
Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.
Iliotibial band syndrome. This occurs when the tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners and cyclists are especially susceptible to iliotibial band syndrome.
Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation.
Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can place more stress on your knee joint. In some cases, problems in the hip or foot can cause knee pain.
Types of arthritis
More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:
Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It's a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
Other problems
Patellofemoral pain syndrome is a general term that refers to pain arising between the kneecap (patella) and the underlying thighbone (femur). It's common in athletes; in young adults, especially those who have a slight maltracking of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.
Diagnosis
Accurate diagnosis for the source of your knee pain will require a comprehensive physical examination. In the physical examination, your doctor will likely:
Inspect your knee for swelling, pain, tenderness, warmth and visible bruising
Check to see how far you can move your lower leg in different directions
Push on or pull the joint to evaluate the integrity of the structures in your knee
Imaging tests
In some cases, your doctor might suggest tests such as:
X-ray. X-ray is used to help detect bone fractures and degenerative joint disease.
Computerized tomography (CT) scan. CT scanners combine X-rays taken from many different angles, to create cross-sectional images of the inside of your body. CT scans can help diagnose bone problems and subtle fractures. A special kind of CT scan can accurately identify gout 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. Your doctor may want to move your knee into different positions during the ultrasound to check for specific problems.
Magnetic resonance imaging (MRI). An MRI 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.
Lab tests
If your doctor suspects an infection or inflammation, you're likely to have blood tests and sometimes a procedure called arthrocentesis, in which a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis.
Treatments
Treatments will vary, depending upon what exactly is causing your knee pain.
Medications
Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout.
Physical Therapy
Strengthening the muscles around your knee will make it more stable. Your doctor may recommend physical therapy or different types of strengthening exercises based on the specific condition that is causing your pain.
If you are physically active or practice a sport, you may need exercises to correct movement patterns that may be affecting your knees and to establish good technique during your sport or activity. Exercises to improve your flexibility and balance also are important.
Arch supports, sometimes with wedges on one side of the heel, can help to shift pressure away from the side of the knee most affected by osteoarthritis. In certain conditions, different types of braces may be used to help protect and support the knee joint.
Injection Therapy
In some cases, your doctor may suggest injecting medications or other substances directly into your joint. Examples include:
Corticosteroids. Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that may last a few months. These injections aren't effective in all cases.
Hyaluronic acid. A thick fluid, similar to the fluid that naturally lubricates joints, hyaluronic acid can be injected into your knee to improve mobility and ease pain. Although study results have been mixed about the effectiveness of this treatment, relief from one or a series of shots may last as long as six months.
ORTHOVISC® injections. ORTHOVISC® is a viscous (thick) sterile mixture made from highly purified hyaluronan from rooster combs. Hyaluronan is a natural chemical found in the body. High amounts of hyaluronan are found in the joint tissues and in the fluid that fills the joints. The body's own hyaluronan acts like a lubricant and a shock absorber in the joint. It is needed for the joint to work properly. When you have osteoarthritis, there may not be enough natural hyaluronan in the joint, and the quality of that hyaluronan may be poorer than normal. ORTHOVISC® is given in a shot (injection) directly into the knee joint. ORTHOVISC® is used to relieve knee pain due to osteoarthritis. It is used for patients who do not get adequate pain relief from simple pain relievers like acetaminophen or from exercise and physical therapy.
Surgery
If you have an injury that requires surgery, it's usually not necessary to have the operation immediately. Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what's most important to you. If you choose to have surgery, your options may include:
Arthroscopic surgery. Depending on your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage (especially if it is causing your knee to lock), and reconstruct torn ligaments.
Partial knee replacement surgery. In this procedure, your surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed through small incisions, so you're likely to heal more quickly than you are with surgery to replace your entire knee. Find more information about partial knee replacements here and our post-operative instructions here.
Total knee replacement. In this procedure, your surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers. Find more information about total knee replacements here and our post-operative instructions here.