Having Knee Pain?
The knee joints are hinge type joints where your upper and lower leg bones come together. Just as with any other moving joint, the knee can become a source of pain. There are several conditions that can cause your knee to become a source of pain. Some are from injuries while others are from wear and tear over time. Each type of condition has something to do with either the cartilage (otherwise known as the meniscus), the bones, ligaments, tendons, muscles, tissues or a combination of these issues.
One of the most common conditions that we treat is osteoarthritis. This is a degenerative condition of the bones and meniscus. The meniscus is the cushioning of the knee. When this becomes worn down, it can cause inflammation, swelling, pain, dysfunction and can eventually lead to deformity if severe. There are many reasons that arthritis of the knee can form, including injury, aging, and other disease processes. The condition can often be diagnosed by x-ray, but sometimes an MRI is necessary. Once we establish that arthritis is the diagnosis, there are several options that can be offered, including anti-inflammatory medications, activity modification, bracing, steroid injections, viscosupplementation and surgical intervention. Surgeries for knee arthritis include partial and total joint replacement, depending on the location and degree of arthritic change. This entails making one incision over the midline of the knee and replacing the diseased joint space with a joint prosthesis. This requires a 2-3 night stay in the hospital and several weeks of physical therapy to help regain function.
Another common condition that we treat in our practice is meniscus tears. These can be the result of an injury or degeneration. These cause pain, swelling, inflammation and can often cause a patient to limp. These initially can be treated conservatively with anti-inflammatory medications and activity modification for a period of time. In some cases, the pain and symptoms will resolve completely with these measures, allowing the patient to return to normal function with no further treatment. In some cases, however, more is necessary to treat the issue. If the pain continues, an MRI will need to be obtained to definitively diagnose the tear. Once a tear is confirmed, the patient may elect to live with the pain, use anti-inflammatory medications as needed, try a steroid injection or resort to arthroscopic surgery. This entails making small incisions on the knee to place a camera and tools within the joint to remove the torn meniscus. This is an outpatient procedure. Recovery time ranges from 2 to 6 weeks typically, depending on the degree of injury, and often patients do not need physical therapy.
Injuries can also happen to the ligaments of the knee. Within the knee, there are four ligaments that provide stability. These are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). Any one of these can be stretched (sprained) or torn due to injury. If there is a sprain, often physical therapy and anti-inflammatory medications can help correct the issue. If the ligament is torn, however, this may require either therapy or surgery. An MRI is ordered to determine the degree of injury. If required, surgical treatment is performed where a donor ligament is used to replace the damaged ligament. Recovery usually entails physical therapy to regain normal function.
Tendon and Muscle Injuries
Tendons are the tissues that connect our muscles to our bones. With injury or overuse, the tendons and muscles can also become a source of pain. If a tendon or muscle is strained, it means it is stretched beyond its normal tensioning. This causes inflammation, pain and sometimes can make movement difficult. Often, rest, activity modification and time can help this resolve. If the pain continues, however, measures such as bracing, physical therapy and steroid injections can be employed to help treat the condition. Occasionally, a tendon or muscle can actually tear (or rupture). This is a more serious issue. Once a tendon is torn, the muscle can no longer do its job in moving the knee and the patient will experience a lack of a certain motion (such as knee bending or straightening). When this happens, surgery is often necessary. First, an MRI would be necessary to confirm the diagnosis. Once confirmed, the tendon will need to be surgically sewn back together and the patient will often need to be placed in a brace called an immobilizer for a period of time to let the tendon heal before motion is instituted. Once the tendon is healed, a period of physical therapy will be necessary to help the patient return back to normal function.
Fractures are another condition that can affect the knee joint. The knee is made up of three bones: the tibia, the femur and the patella (or knee cap). Any one of these bones can break, causing a need for treatment. Depending on the fracture, a patient may need something as simple as immobilization with a cast or brace, limited weightbearing on the leg or in some cases, may require surgery to fix the fracture. An x-ray can often diagnose the problem, but sometimes an MRI, CT or even a bone scan is necessary to further decide the best type of treatment.
Painful Joint Prosthetics
Even though in most cases joint replacement is a successful long-term treatment for pain, it is still possible for an issue to arise. Issues that can cause a prosthesis to become painful include infection, loosening, wear and tear, damage to the components, fracturing around the prosthesis and improper fit. When a patient has a joint prosthesis in place, several tests are necessary to determine the cause of the problem. These tests include blood work, x-ray, bone scan and needle sampling of the joint fluid to check for infection. Also, the original report of the operation is often necessary to determine the prosthetics used in the replacement. If one of the above problems is present, often surgery is necessary to correct the base issue. This may mean replacing a part of or the whole prosthesis. If infection is present, this may also require antibiotic medication to help fight off the infection. Additional prosthetics may be required if a fracture is present. After surgery, the patient will also have to participate in a physical therapy regimen to help regain normal function.
Other Causes of Knee Pain
This information, while extensive, is not an all inclusive list of all issues that can cause knee pain. It is simply a guide to give you an idea of some more common knee problems. If you have pain in your knee, it is best to seek medical attention to properly diagnose your issue. This will include a comprehensive review of history and examination as well as appropriate imaging studies to help us determine the diagnosis and best treatment options in your case.