Mid-Week MOT: Knee Series......Part Two
Last week we looked at the anatomy of the knee and acute conditions that can cause knee pain.
This week we will delve into more chronic disease and conditions and discuss signs and symptoms and some treatment options.
Refer back to the diagram below to familiarise yourself with the anatomical structures of the knee joint and recall that it is the strongest joint in the body, housed in a protective capsule and bathed in synovial fluid.
The knee is actually two joints, the femur/tibia and the patella/femoral and problems can occur in one or both of the joints and at the same time.
Chronic conditions can include degenerative, overuse, congenital, mechanical and pathological causes of knee pain and usually require further investigation by the GP or orthopaedic specialist.
Risk factors for knee problems include -
high impact sports
poor flexibility and strength
Probably the most common cause of pain, especially in the over 40's, is osteoarthritis of the femur-tibial joint. This is erosion of the articular cartilage covering the bone ends and presents primarily with pain, swelling, loss of range of movement and crunching sounds as the protective layer thins and the bone ends come into contact and rub off each other.
X-rays reveal loss of joint space and possible frayed edges of worn bone. Eventually a replacement joint will be necessary if all other treatment options fail. These are likely to include good physical therapy, stretching, reduction of weight, good blood sugar control in diabetics and moderate weight bearing exercise.
Rheumatoid arthritis tends to occur on both sides and effects other joints too. The joint will be hot, swollen, red, painful and deformed and there may be other systemic symptoms such as lethargy, malaise, flu-like symptoms and inflammation of the lungs.
Blood tests may reveal a specific rheumatoid factor and x-rays will be of definitive diagnosis.
Anterior knee pain can be caused by patellofemoral pain syndrome which is an irritation of the back of the knee cap as it sits on the femur. It can be referred to as chondromalacia patellae if there is cartilage damage and the pain tends to be worse on sitting, kneeling, cycling or prolonged flexion of the leg. There may be swelling on the inside of the knee cap and the quadriceps muscles may be tight. Causes often include over pronation of the foot, poor flexibility, incorrect footwear and increased training volume. Treatment will include good physical therapy, rest, stretching and correction of any biomechanical issues. This condition can often lead to osteoarthritis of the patella femoral joint as the cartilage wears away.
There are a number of fluid filled sacs around the knee called bursa and they protect areas of friction such as tendons as they run over bony landmarks and areas of high impact such as the knee! These sacs can get inflammed and unhappy and this is known as bursitis.
Due to the various muscles crossing over the knee joint such as the quadriceps and hamstrings, there are plenty of opportunities to develop tendonitis or the more advanced tendinosis particularly if there are undiagnosed mechanical imbalances or poor foot alignment. Once these issues are resolved, resolution of pain can be achieved. As discussed 2 weeks ago, the ITB or iliotibial band running from the hip to the tibia, if tight, can cause the knee joint to be malfunctioning and this will cause pain on the outside of the knee with possible swelling of its protective fat pad.
Frontal knee pain in adolescent boys or very active girls can cause a condition called Osgoods-Schlatters disease where the increase in activity and relative tightness in the patella tendon from the developing quadriceps, pulls on the bony attachment of the tendon just below the knee on the tibia. This generally resolves with stretching and activity moderation but can last into adulthood if not treated correctly.
Older ladies are often prone to a Bakers cyst, where the knee capsule pushes through the back of the knee joint and causes a large lump with associated loss of mobility and function and, of course pain. This may subside on its own or can be surgically drained. The condition can occur alongside both types of arthritis and with gout. Investigation to rule out more sinister causes of any lump or swelling must be carried out.
Lastly, pain in the knee may not be pain in the knee! That is to say, it can be referred from the lower back as nerve irritation or disc problems. Any knee pain accompanied by back pain should be investigated with possible referral for imaging.
So we have now covered the main conditions associated with knee pain. If you are in any doubt over the cause of your knee or any other joint pain then do see your GP or practice nurse.
As always, for osteopathy in High Wycombe and beyond, call Lucy from OsteoFusion on 07833 321604 or visit www.osteofusion.co.uk.
Thanks for reading.
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