Pain in the knee is a sign of pathological processes affecting the cartilage, bone or soft tissue structures of the femoral-tibial and femoral-patellar joints. Arthralgia can be based on injuries, inflammatory and degenerative diseases of the articular apparatus and periarticular structures. Patients may complain of sharp, aching, burning, throbbing and other types of pain that occur at rest or when moving, supporting, bending and unbending the leg at the knee. Diagnosis of causative pathology includes methods of instrumental imaging (Rg, ultrasound, CT or MRI, arthroscopy), puncture of the articular bag, biochemical and immunological analyzes. Until the diagnosis is clarified, rest, joint immobilization, NSAIDs and analgesics are recommended.
Causes of knee pain
Traumatic injuries
They are usually the result of a domestic injury, often found in athletes: runners, jumpers, participants in team sports. Develop when falling, direct impact or twisting of the leg. Manifested by sharp pain at the time of injury. In the future, the pain syndrome becomes less pronounced, accompanied by increasing edema. There may be bruising and bruising. In terms of frequency, the following injuries are identified:
- Knee injury . Occurs when falling on the knee or a direct blow to it. Initially, the pain is sharp, hot, sometimes burning, but bearable, later - dull, aching, aggravated by movement. Possible bruising. Support on the leg is preserved. 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 joins the pain syndrome.
- Ligament rupture. It is found after twisting the leg, its forcible twisting, bending or overextension in a non-physiological position. Pain is stronger than with a bruise, at the same time with the appearance of pain, a person can feel how something is torn (similar to how normal tissue is torn). Depending on the location of the rupture of the ligaments, the pain is localized on the outer or inner surface or in the depths of the knee, pressure on the ligament increases sharply, an attempt to deflect the lower leg in the direction opposite to the damage. Accompanied by a significant limitation of movements, support, tucking of the limb, rapidly growing hemarthrosis.
- Intra-articular fractures . They are detected when hitting, falling and twisting the leg. In case of injury, a person feels very sharp, often unbearable acute pain, sometimes a crunch is heard. Patients with an intra-articular fracture themselves describe their feelings in this way: “the pain is such that it darkens in the eyes, the world ceases to exist, you don’t understand anything.” Subsequently, the pains become not so strong, but remain high in intensity, are diffuse in nature, intensify with minor movements or touching the joint, and do not decrease over time. Support is usually impossible, movements are almost completely limited. Edema and hemarthrosis progress rapidly.
- Dislocation. It is the result of a blow or fall on the knee. At the moment of dislocation of the patella, there is a sharp pain, accompanied by a feeling of bowing of the leg and displacement in the knee. Movements are not possible, the reference function can be saved. A pronounced deformity is visible along the anterior surface of the knee, which subsequently smoothes out due to increasing edema. After some reduction, the pains also increase, become difficult to bear. Sometimes hemarthrosis joins.
- pathological fractures. They develop with minor injuries, are the result of a decrease in bone strength in osteoporosis, osteomyelitis, tuberculosis, bone tumors. They differ in insignificant intensity of manifestations of the fracture both at the time of injury and in the following days. The pains are aching, dull, reminiscent of pain when bruised. Signs indicating a pathological fracture are limited or inability to support the leg, a feeling of instability in the knee, sometimes deformity, bone crunch during movement.
- Meniscal injury. Meniscus ruptures are formed when tucking, hitting, intense forced flexion or extension of the knee, a sharp turn with a fixed leg. At first, a person feels a special click and a sharp shooting pain in the depths of the joint. Then the pain decreases somewhat, but becomes diffuse, sometimes burning, bursting, intensifies when trying to support and move. The volume of the knee increases due to edema and hemarthrosis. Support becomes impossible, movements are sharply limited.
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 contributes to the rapid development of inflammation in response to direct and indirect effects, and a large number of nerve endings causes a pronounced pain reaction. The inflammatory process is often accompanied by synovitis (accumulation of aseptic fluid in the joint), with infection, accumulation of pus is possible.
- Arthritis. Gonarthritis occurs after injuries, sometimes complicates infectious diseases, is detected in rheumatic diseases. May be acute or chronic. Pain in the knee is usually dull, aching, pressing or pulling. At first, the pain sensations are not intense and intermittent, intensifying in the evening or after exercise. Then the starting pains join, the intensity and duration of the pain syndrome increases. The joint swells, the skin over it turns red, its temperature rises. With synovitis, the contours of the knee are smoothed out, there is a feeling of fullness. With suppuration, the severity of pain increases sharply, they become twitching, deprive of sleep. The patient's condition worsens, symptoms of general intoxication join.
- synovitis. It is not an independent disease, it complicates many acute and chronic joint pathologies. Formed within hours or days. Initially, the pain is slight or absent, the feeling of fullness prevails. As the volume of the joint increases, the intensity of pain increases, but the pain remains dull and does not have a significant effect on the human condition. The knee is spherical, with a large amount of fluid, the skin is shiny. Movement is somewhat limited. When infected, the pain becomes pronounced, pulsating, twitching, aggravated by the slightest movement and touch. The knee turns red, the general condition is disturbed, hyperthermia joins.
- Bursitis. Inflammation of the articular bags located in the patella and popliteal fossa usually occurs when the knee is overloaded and re-injured (for example, with constant support on the knees). With bursitis, pain is local, dull, non-intense, appears at a certain position of the limb, after a characteristic load, decreases with a change in the position of the leg, massaging the affected area. If the back bag is affected, pain may occur during the ascent or descent of the stairs. Sometimes a slight local edema is determined. With suppuration of the bursa, the pains become sharp, jerking, baking, combined with hyperemia, swelling of the affected area, and symptoms of general intoxication.
- Tendinitis. Usually found in overweight men and athletes, it affects the patella's own ligament. At first, the pain syndrome appears only with a very intense load, then with standard sports loads, then with everyday physical activity or at rest. Pain in tendonitis is localized in front just below the knee, dull, pulling, with the progression of the disease, sometimes paroxysmal, in some cases accompanied by mild redness and swelling, aggravated by pressure. Movements are usually in full, less often slightly limited. In the later stages, pain persists even after a long period of rest. A tear or rupture of the ligament is possible due to a decrease in its strength.
- Lipoarthritis. Goff's disease affects the layers of adipose tissue located under the patella. It is observed with constant overloads of the knee or becomes the result of an old injury. More often affects athletes, older women. A person complains of dull aching pains in combination, some limitation of extension. With the aggravation of the pathology, the pain begins to bother at night, there is a feeling of instability of the knee, buckling of the leg. When pressing on the side of the patella, a soft crack or creak 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 immunocomplex aseptic inflammation of the synovial membrane and cartilage, the phenomena of vasculitis. Along with damage to the joints in many diseases, internal organs, skin, and other anatomical structures are involved in the process. Pathologies in most cases are chronic, without treatment they are prone to progression, and are often the cause of disability.
- Rheumatoid arthritis.The lesion is usually bilateral. With minimal activity of the autoimmune process, the pains are weak or moderate, intermittent, pulling, pressing, accompanied by morning stiffness. With moderate activity, the patient complains of periodic long-term aching, pressing or arching pains of moderate intensity, not only during movement, but also at rest. Many hours of stiffness, moderate recurrent synovitis are noted. With high activity of rheumatoid arthritis, the pains are strong, diffuse, exhausting, have a wave-like character, and intensify in the early morning hours. Stiffness becomes permanent, a large amount of fluid accumulates in the knees, and contractures form over time. The severity of other symptoms (local swelling and redness, fever, weakness, weakness) correlates with the activity of the process.
- Systemic lupus erythematosus. Arthralgias are often symmetrical, although one joint may be affected. They can occur at any stage of the disease; with recurrent SLE, they resemble rheumatoid arthritis. Initially, sometimes they occur in isolation, then they are combined with damage to the skin and internal organs. With a low activity of the pain process, short-term, non-intense, local, aching, pulling. In severe cases, the pain syndrome progresses, the pain is undulating, disrupts night sleep, becomes prolonged, spilled, aggravated by 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-term, but intense, migrate from one joint to another, differ in character from pulling or pressing to burning or pulsating. The knees are edematous, hot, the skin over them is reddened. Movement is severely limited. After a few days, the severity of pain decreases, movements are restored. In some patients, residual effects in the form of moderate or mild dull pain persist for a long time. A few weeks after the onset of arthralgia, the heart is involved in the process.
- reactive arthritis. It often occurs 2-4 weeks after intestinal and urogenital infections, usually affects one or two joints of the lower extremities, is combined with urethritis, conjunctivitis. The development of reactive arthritis is preceded by increased urination, pain and burning in the urethra, lacrimation, pain in the eyes. Pain in the knee is strong or moderate, constant, undulating, aching, pulling, twitching, combined with restriction of movement, deterioration in general condition, fever, severe swelling and redness of the affected area. Then the intensity of the pain decreases somewhat. Pain and signs of inflammation persist from 3 months to 1 year, and then gradually disappear.
Degenerative-dystrophic processes
They develop as a result of violations of metabolic processes in the structures of the joint and periarticular soft tissues. They are chronic and progress over many years. Often accompanied by the formation of calcifications, cysts and osteophytes, deformation of the surface of the knee. With a significant destruction of the articular surfaces, they lead to a pronounced violation of movements and support function, become a 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 older and middle-aged people. At first, the pains are weak, short-term, usually pulling or aching, occur with prolonged exertion and disappear at rest, often accompanied by a crunch. Gradually, the pain syndrome intensifies, the knees begin to hurt "for the weather" and at night, there is a restriction of movement. Distinctive features of gonarthrosis are starting pains (it hurts until you “disperse”), periodic attacks of sharp cutting, burning or shooting pains due to blockade. During periods of exacerbations, synovitis often occurs, in which the pain becomes constant, pressing, arching.
- Meniscopathies . Usually detected in athletes, people whose work involves significant stress on the knee joint. They are manifested by unilateral local deep pain inside the knee at the level of the joint space, more often in the outer half of the knee. The pain intensifies during movement and subsides at rest, it can be dull, pressing or pulling. With progression, sharp shooting pains occur when trying to move. A small painful formation is sometimes felt along the anterolateral surface of the joint in the projection of pain.
- Tendopathy . The tendons located near the knees are affected. At the initial stage, they are manifested by short-term local superficial pain at the peak of physical activity. Subsequently, pain sensations occur with moderate, and then small loads, limit the usual daily activities. The pain is pulling or aching, directly related to active movements, is not detected during passive extension and flexion of the knee, sometimes accompanied by a crunch or crack. In the area of the lesion, it is possible to feel the area of \u200b\u200bthe greatest pain. Local signs of inflammation (edema, hyperemia, hyperthermia) are insignificant or absent.
- Osteochondropathy. Children, young people are most often affected, the duration of the disease is several years. Usually they begin gradually with mild lameness or intermittent, non-intense dull pains, aggravated by exertion, disappearing at rest. With the progression of osteochondropathy, the pains become strong, constant, pressing, burning or baking, accompanied by severe lameness, limitation of movements and difficulty in supporting the limb. Then the pain gradually decreases, the function of the support is restored.
- Chondromatosis. It is usually diagnosed in older men, less often in infants. Chondromatosis of the joints is manifested by moderate dull undulating pains, often aggravated at night and in the morning. Movements are limited, accompanied by a crunch. Sometimes blockades occur, characterized by sudden sharp shooting pain, impossibility or severe limitation of movement. With the development of synovitis, the pain becomes bursting in nature, combined with an increase in the volume of the knee, swelling of the soft tissues, and a local increase in temperature.
The pain syndrome can be caused by a cyst, a benign or malignant tumor that directly affects the joint or periarticular tissues. In addition, pain in the knees can serve as an alarm signal of hypertrophic arthropathy, paracancer polyarthritis - paraneoplastic syndromes characteristic of lung cancer, breast cancer and other oncological processes.
- Baker's cyst. It is a hernial protrusion in the region of the popliteal fossa. In the initial stages, it manifests itself as unpleasant sensations or weak local pain along the back of the knee. Against the background of an increase in Baker's cyst due to compression of nearby nerves, burning or shooting pains, numbness or tingling in the sole area may appear. Symptoms are aggravated by attempting maximum knee flexion. In the popliteal fossa, an elastic, low-painful tumor-like formation is sometimes palpated.
- benign tumors. Includes chondromas, osteochondromas, non-ossifying fibromas, and other neoplasms. They are characterized by a long asymptomatic or oligosymptomatic course, may be manifested by indefinite and inconsistent local non-intense pain. With large neoplasia, a solid formation is palpable, sometimes synovitis develops.
- Malignant neoplasia. The most common malignant tumors affecting the joint area are synovial sarcoma, osteosarcoma, and chondrosarcoma. They manifest as dull local vague pains, sometimes with a certain daily rhythm (increased at night). The intensity of pain increases, they become sharp, cutting, burning or jerking, spread along the knee and adjacent tissues, accompanied by deformation, edema, synovitis, dilatation of the saphenous veins, a violation of the general condition, the formation of contractures. When palpating, a painful tumor-like formation is determined. When the process of pain is running, it is painful, unbearable, exhausting, deprives of sleep, and is not eliminated by non-narcotic analgesics.
Invasive operations and manipulations
Pain syndrome is provoked by damage to the tissues of the knee during invasive procedures. The severity of pain directly depends on the invasiveness of manipulations on the knee joint. With the penetration of pathogenic microbes into the joint area, pain is caused by inflammatory changes.
- Manipulation. The most common manipulation is puncture. Pain after puncture is short-term, non-intense, quickly subsiding, localized in the projection of the puncture, which is usually performed on the outer surface of the knee. After a biopsy, the pain may initially be twitching, then become dull in nature and disappear after a few days.
- Operations. After arthroscopy, the pain is moderate, at first quite sharp, then dull, subsiding after a few days or 1-2 weeks. After arthrotomy, the pain syndrome is more intense, can persist for up to several weeks due to significant tissue damage. Usually, in the first 2 or 3 days after the intervention, patients are prescribed analgesics that significantly reduce the severity of pain, then the pain becomes weak, dull, pulling or aching and gradually disappears.
Psychosomatic states
Sometimes arthralgia in the knees 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, since it helps to reduce emotional stress by transforming experiences into physical sensations. A distinctive feature of such pains is their uncertain nature, inconstancy, lack of visible changes, a clear connection with physical activity and other objective provoking factors. Meteopathic arthralgias are observed in people who are sensitive to changes in atmospheric pressure.
In addition, irradiation of pain to the knee is possible with coxarthrosis, lumbar osteochondrosis, Perthes disease, fibromyalgia, and sciatic nerve neuropathy. However, with these pathologies, pain syndromes of other localization usually come to the fore. Additional risk factors that increase the likelihood of injury and disease of the knee joint include overweight, professional sports, hypovitaminosis, metabolic disorders, and older age. Provoking factors of exacerbation of chronic pain can be hypothermia, stress, physical activity, diet disorders.
Survey
The diagnostic search algorithm is based on taking into account the nature of the pain syndrome, its duration, the identification of concomitant symptoms and events preceding the onset of pain in the knee. During the initial visit to a doctor (traumatologist-orthopedist, surgeon, rheumatologist), a visual examination and palpation of the knee, an assessment of the volume of active and passive movements are performed. Based on the data obtained, in the future, the patient can be assigned:
- Laboratory blood tests . A complete blood count helps to identify hematological changes characteristic of an acute infectious and inflammatory process (leukocytosis, increased ESR), eosinophilia, typical of an allergic reaction. Biochemical and serological studies are most informative in autoimmune diseases, which are characterized by the formation of specific acute-phase proteins and immunoglobulins (CRP, rheumatoid factor, ASL-O, CIC, antibodies to DNA, etc.).
- Radiography. The basic diagnostic method is an X-ray of the knee joint in 2 projections. The presence of pathology is signaled by changes in the contours of the articular head and cavity, narrowing of the joint space, changes in the thickness of the end plates, the presence of marginal defects in the articular ends of the bones, osteolysis and bone destruction. In some diseases (meniscus injury, Baker's cyst), contrast arthrography demonstrates the greatest sensitivity.
- Arthrosonography . Ultrasound of the knee joint is a fast, inexpensive, affordable and very informative diagnostic method. Allows you to judge the presence of effusion and free bodies in the joint cavity, to identify damage and pathological changes in the periarticular soft tissues (signs of calcification, hemorrhage, etc.). They help with high accuracy to differentiate the etiology of pain in the joint.
- CT and MRI . They are the methods of choice for arthropathy of any origin. They are used for a more detailed assessment of the nature and extent of pathological changes, to identify signs typical of traumatic, inflammatory and tumor lesions of bone structures and soft tissues. CT and MRI of the joints are usually resorted to with limited information content of other instrumental studies.
- Joint puncture . It is performed with indications of the accumulation of exudate or transudate in the articular bag. As part of the differential diagnosis of inflammatory, degenerative and neoplastic diseases, a cytological, bacteriological or immunological examination of the synovial fluid is performed. To establish the diagnosis of autoimmune damage to the knee joint, tuberculous arthritis, synovioma, it is extremely important to conduct a biopsy of the synovial membrane.
- Arthroscopy . The purpose of invasive endoscopic diagnostics can be taking a biopsy specimen, clarifying the necessary diagnostic information during a visual examination of the elements of the joint. In some cases, diagnostic arthroscopy develops into a therapeutic one (atroscopic removal of intraarticular bodies, meniscectomy, ligament autoplasty, etc.).
Arthroscopy of the knee
Symptomatic treatment
Treatment of the causes of pain in the knees is carried out differentially, taking into account the identified disease. At the same time, symptomatic care is an essential part of a comprehensive treatment process aimed at reducing discomfort and improving the quality of life. Immediately after the injury, it is recommended to apply a cold compress to the knee area - this will help reduce pain sensitivity. Chlorethyl has a local cooling and anesthetic effect. In all cases, rest helps to reduce pain in the knee. It is necessary to limit movement, to give the leg a position in which pain is minimal. When walking, a fixing bandage is applied to the knee, it is possible to immobilize the limb with the help of a plaster splint.
In the acute period of injury or illness, it is strictly forbidden to massage the knee, apply warm compresses, or wear high-heeled shoes. 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. These measures can 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 emergency medical care. 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 the contours, asymmetry), the impossibility of performing flexion-extensor movements, balloting of the patella,