Knee pain

Knee pain- It is a sign of pathological processes affecting the cartilage, bone or soft tissue structures of the thigh-tibial and thigh-patellar joints. Arthralgia can be based on trauma, inflammatory and degenerative diseases of the articular apparatus and periarticular structures. Patients may complain of sharp, aching, burning, tingling, and other pains that occur when the foot moves, supports, bends, and stretches at rest or on the knee. Diagnosis of the underlying pathology includes instrumental imaging techniques (Rg, ultrasound, CT or MRI, arthroscopy), joint capsule puncture, biochemical and immunological analysis. Rest, joint immobilization, NSAIDs and analgesics are recommended until the diagnosis is clarified.

Causes of knee pain

Traumatic injury

They are usually the result of domestic trauma, often in athletes: runners, jumpers, participants in sports. Developed by foot drop, direct impact, or bending. It manifests itself with sharp pain during injury. In the future, the pain syndrome is less pronounced, accompanied by increased edema. Abrasions and bruises are possible. As the frequency increases, the following injuries are identified:

• Knee injury. . . Occurs when the knee falls or hits directly. At first the pain is sharp, hot, sometimes burning, but unbearable, and then - dull, painful, aggravated by movements. Itching is possible. The support of the foot is protected. Sometimes a knee injury is complicated by hemarthrosis, in which case the joint gradually increases in size, becomes spherical, and the pain syndrome is accompanied by a feeling of pressure or explosion.
• Ligament hernia.It is found in a non-physiological condition after the leg is bent, forcibly bent, bent, or overstretched. Painful feelings are stronger than bruises; Simultaneously with the onset of pain, a person can feel how something is torn (similar to how ordinary tissue is torn). Significant restriction of movement, support, twisting of the joint is accompanied by rapidly increasing hemarthrosis.
• Intraarticular fractures. . . They are detected by kicks, falls and twists of the foot. In case of injury, a person feels very sharp, often unbearable sharp pain, sometimes a crisis is heard. Patients with intra-articular fractures express their feelings as follows: "The pain is so dark in the eyes, the world disappears, you do not understand anything. "Later, the pain becomes less severe, but the intensity remains high. Support is usually not possible, movement is almost completely limited. Edema and hemarthrosis progress rapidly.
• Dislocation.A blow or knee is the result of the enemy. When the patella is dislocated, there is a sharp pain accompanied by bending of the leg and a feeling of displacement in the knee. No action is possible, the reference function can be saved. An open deformation appears on the anterior surface of the knee, which is subsequently smoothed due to increased edema. Sometimes hemarthrosis is combined.
• Pathological fractures.They develop with minor injuries, are the result of osteoporosis, osteomyelitis, tuberculosis, decreased bone strength in bone tumors. The pain is painful, dull, reminiscent of pain syndrome with rot. Symptoms of a pathological fracture include limited or impossible support of the foot, a feeling of instability in the knee, sometimes deformity, and compression of the bones during movement.
• Damage to the meniscus.Meniscus hernias occur during bending, impact, tight bending or knee extension, and sharp turning with a fixed foot. At first, a person feels a sharp click and a sharp shooting pain in the depths of the joint. Then the pain decreases slightly, but becomes diffuse, sometimes - burning, bursting, intensifying when trying to support and move. Knee volume increases due to edema and hemarthrosis. Support is impossible, movements are severely limited.

Inflammatory pathologies

They can be infectious and non-infectious (traumatic, toxic-allergic, metabolic, post-vaccination). An 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 an open pain reaction. The inflammatory process is often accompanied by synovitis (accumulation of aseptic fluid in the joint), the infection can accumulate pus.

• Arthritis.Gonarthritis occurs after injuries, sometimes complicates infectious diseases, is found in rheumatic diseases. It can be acute or chronic. Knee pain is usually dull, aching, pressing or tightening. Initially, the pain is not intense and intermittent, but intensifies in the evening or after exercise. Then the initial pains combine, increasing the intensity and duration of the pain syndrome. The joint swells, the skin turns red, the temperature rises. With synovitis, the contours of the knee are smoothed, there is a feeling of explosion. With relief, the severity of the pain increases sharply, they twitch and lose sleep.
• Synovit.It is not an independent disease, but complicates many acute and chronic pathologies of the joint. Formed in a few hours or days. In the beginning, the pain is insignificant or not, the feeling of fullness prevails. The knee is spherical, with lots of fluid, and the skin is radiant. Movement is somewhat limited. When infected, the pain is pronounced, pulsates, twitches, intensified by the slightest movement and touch.
• Bursitis.Inflammation of the joint capsules in the patella and popliteal fossa usually occurs when the knee is overloaded and damaged again (for example, with constant support in the knee). Pain with bursitis is local, dull, not intense, it appears in a certain position of the joint, after a characteristic load, when the position of the foot changes, it decreases when massaging the affected area. If the posterior sac is affected, painful sensations are possible when ascending or descending stairs. Minor local edema is sometimes identified. Swelling of the bursa becomes acute, accompanied by convulsions, nausea, hyperemia, edema of the affected area, general signs of intoxication.
• Tendinitis.It is usually found in overweight men and athletes, affecting the patella's own garden. Initially, the pain syndrome appears only with very intense intensity, then with standard sports loads, and then during daily physical activity or rest. Pain with tendinitis, localized immediately below the knee, dull, tingling, localized with progression of the disease, sometimes paroxysmal, in some cases accompanied by slight redness and swelling, intensified by pressure. Movement is generally complete, less often limited. It is possible to tear or tear the bond due to loss of strength.
• Lipoarthritis.Hoff's disease affects the layers of adipose tissue beneath the patella. It is observed with constant overload of the knee or is the result of an old injury. More often it affects athletes, older women. One person complains of dull aching pains, some limitations of prolongation. With the aggravation of the pathology, the pain begins to bother at night, there is a feeling of instability in the knee, bending of the leg. When you press on the side of the patella, you hear a soft crack or tear.

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 phenomenon of vasculitis. In most cases, the pathologies are chronic, without treatment they tend to progress and often cause disability.

• Rheumatoid arthritis.Defeat is usually two-sided. With minimal activity of the autoimmune process, the pain is accompanied by mild or moderate, intermittent, tingling, tingling, morning stiffness. With moderate activity, the patient complains of intermittent pain, squeezing or exploding pain of moderate intensity, not only during movement, but also at rest. There is stiffness, moderate recurrent synovitis for many hours. With high activity of rheumatoid arthritis, the pain is strong, diffuse, tiring, wavy, increasing in the morning. The stiffness is constant, a large amount of fluid accumulates in the knees, and over time contractures occur.
• Systemic lupus erythematosus.Arthralgias are often symmetrical, although a joint can be affected. They can occur at any stage of the disease, with a recurrent course of SLE they resemble rheumatoid arthritis. Pain with low activity of the process is short-term, non-intense, local, aching, traction. In severe cases, the pain syndrome progresses, the pain becomes undulating, disturbs sleep at night, stretches, spreads, increases with movement, is associated with synovitis, edema, hyperemia.
• Rheumatism.Joint pain is one of the first manifestations of rheumatic fever, which occurs 5-15 days after acute infection, affecting several joints at once (usually in pairs). The pain is very short-lived, but intense, migrating from one joint to another, ranging in nature from burning or pulsation without pulling or pressing. The knees are swollen, hot, and the skin on them is red. Movement is severely restricted. After a few days, the pain subsides and movements are restored. In some patients, residual effects in the form of moderate or mild dull pain last for a long time.
• Reactive arthritis.More often it occurs 2-4 weeks after intestinal and urogenital infections, usually urethritis, conjunctivitis affects one or both joints of the lower extremities. The development of reactive arthritis occurs before increased urination, pain and burning sensation in the urethra, lacrimation and cramps in the eyes. Knee pain is associated with severe or moderate, persistent, wavy, aching, tingling, twitching, limited movement, worsening of general condition, fever, severe swelling and redness of the affected area. Pain 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 the joint and periarticular soft tissues. They have a chronic course that lasts for many years. The formation of calcifications, cysts and osteophytes is often accompanied by deformation of the knee surface. With significant destruction of articular surfaces, they cause obvious impairment of movement and support function, lead to 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 mild, short-lived, usually cramping or aching, occurs with long-term force and disappears at rest, and is often accompanied by a crisis. Gradually the pain syndrome intensifies, the knees begin to ache "in the air" and at night, there is a restriction of movement. Distinctive features of gonarthrosis are initial pain ("pain until collapse", periodic attacks of sharp cuts, burning or shooting pains due to blockade. During periods of exacerbation, synovitis often occurs, during which the pain stabilizes, compresses, explodes.
• Meniscopathy. . . It is usually found in athletes, whose work is found in people with significant loads on the knee joint. At the level of the joint space inside the knee, more often it manifests itself with unilateral local deep pain in the outer half of the knee. The pain intensifies during movement and decreases at rest, can be dull, pressing or pulling. There are sharp shooting pains while moving, trying to move. In the projection of the pain, a small painful formation is sometimes felt on the anterolateral surface of the joint.
• Tendopathies. . . The tendons near the knee are affected. In the initial stage, they manifest themselves with short-term local superficial pain at the peak of physical activity. Then there are painful sensations with moderate and then light loads, limiting normal daily activities. Pain or soreness is directly related to active movements, is not detected during passive stretching and flexion of the knee, and is sometimes accompanied by tingling or tingling. It is possible to investigate the location of the greatest pain in the lesion area. Local signs of inflammation (edema, hyperemia, hyperthermia) are insignificant or absent.
• Osteochondropathy.Children and young people are more affected, the duration of the disease is several years. They usually begin slowly with mild lameness or intermittent, non-intense, dull pain that worsens as a result of tension and disappears at rest. With the development of osteochondropathy, the pain becomes intense, constant, squeezing, burning or burning, accompanied by severe lameness, limited mobility and difficulty standing on the limb. Then the pain gradually decreases, support function is restored.
• Chondromatosis.It is usually diagnosed in older men, and less often in infants. Chondromatosis of the joints manifests itself as moderately dull wave-like pain, often worsening at night and in the morning. Movement is limited, accompanied by a crisis. Occasionally, blockages occur, characterized by sudden sharp shooting pain, impossibility, or severe restriction of movement. With the development of synovitis, the pain becomes explosive, accompanied by an increase in knee volume, swelling of the soft tissues 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 joint or periarticular tissues. In addition, knee pain can serve as an alarm signal for hypertrophic arthropathy, paracancrotic polyarthritis - paraneoplastic syndromes characteristic of lung cancer, breast cancer and other oncological processes.

• Baker's cyst.Represents a hernia protrusion in the popliteal fossa. In the early stages, it manifests itself as unpleasant sensations or mild local pain along the back of the knee. Burning or burning pains, numbness or tingling in the heel area may appear against the background of an increase in Baker's cyst due to compression of nearby nerves. Symptoms get worse when you try to bend your knee as much as possible. In the popliteal fossa, an elastic, slightly painful tumor-like formation is sometimes felt.
• Benign tumors.These include chondromas, osteochondromas, non-ossifying fibroids, and other neoplasms. They are characterized by a long-lasting asymptomatic or low-symptomatic course, may manifest themselves with indeterminate and intermittent local non-intense pain. With large neoplasms, a solid formation is felt, sometimes synovitis develops.
• Malignant neoplasms.The most common malignancies affecting the joint area are synovial sarcoma, osteosarcoma, and chondrosarcoma. They manifest themselves with dull local vague pains, sometimes with a certain circadian rhythm (worse at night). The intensity of pain increases, they become sharp, cut, burn or bend, spread along the knee and adjacent tissues, are accompanied by deformity, edema, synovitis, dilation of the saphenous veins, deterioration of the general condition, the formation of contractures. Palpation reveals a painful tumor-like formation. At the beginning of the process, the pain becomes unbearable, unbearable, tiring, sleep deprived, and can not be eliminated with non-narcotic analgesics.

Invasive operations and manipulations

Pain syndrome is triggered by damage to the knee tissue during invasive procedures. The severity of the pain directly depends on the trauma of the manipulations in the knee joint. Pain is caused by inflammatory changes as pathogenic microbes penetrate the joint area.

• Manipulation.The most common procedure is a puncture. After the puncture, the pain is short-lived, not intense, and decreases rapidly, is localized in the projection of the puncture, and is usually performed on the outer surface of the knee. After the biopsy, the pain may first be convulsions, then dim, and disappear after a few days.
• Operations.After arthroscopy, the pain is moderate, initially quite acute, then dull, and decreases after a few days or 1-2 weeks. After an arthrotomy, the pain syndrome becomes more intense, lasting up to several weeks due to significant tissue damage. Usually, in the first 2 or 3 days after the intervention, patients are prescribed analgesics, then the pain subsides and gradually disappears.

Psychosomatic situations

Sometimes arthralgia in the knees occurs under the influence of psychological factors in the absence of an organic basis (trauma, inflammation, destruction, etc. ). Such pain is believed to play a protective role because it helps reduce emotional stress by turning experiences into physical feelings. A distinctive feature of such pains is their uncertain nature, inconsistency, lack of visible changes, a clear connection with physical activity and other objective stimuli. Meteopathic arthralgia is observed 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, with these pathologies, pain syndromes of other localizations usually come to the fore. Additional risk factors that increase the likelihood of knee joint damage and disease include overweight, professional sports, hypovitaminosis, metabolic disorders, and old age. Hypothermia, stress, physical exertion, and dietary disorders can exacerbate chronic pain.

Inquiry

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

• Laboratory blood tests. . . Complete blood count helps to identify hematological changes (leukocytosis, increased ESR), characteristic of an acute infectious and inflammatory process, eosinophilia, which is characteristic of an allergic reaction. Biochemical and serological studies are the most informative for autoimmune diseases characterized by the formation of specific acute phase proteins and immunoglobulins (CRP, rheumatoid factor, ASL-O, CEC, antibodies to DNA, etc. ).
• Radiography.The main diagnostic method is X-ray of the knee joint in 2 projections. The presence of pathology is indicated 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 external defects at the articular ends of the bones, osteolysis and bone destruction. . In some diseases (meniscus trauma, Baker's cyst), contrast arthrography shows the greatest sensitivity.
• Arthrosonography. . . Knee ultrasound is a fast, inexpensive, affordable and highly informative diagnostic method. It allows to judge the presence of effusions and free bodies in the joint space, to identify lesions and pathological changes in the periarticular soft tissues (signs of calcification, bleeding, etc. ). They help to differentiate the etiology of joint pain with high accuracy.
• CT and MRI. . . They are the preferred method for arthropathy of any genesis. They are used to assess in more detail the nature and extent of pathological changes, to identify the symptoms characteristic of traumatic, inflammatory and tumor lesions of bone structures and soft tissues. CT and MRI of the joints are commonly used with limited data content from other instrumental studies.
• Joint puncture. . . It is performed when there is an indication of accumulation of exudate or transudate in the joint capsule. Cytological, bacteriological or immunological examination of synovial fluid is performed as part of the differential diagnosis of inflammatory, degenerative and tumor diseases. It is extremely important to perform a biopsy of the synovial membrane to diagnose autoimmune damage to the knee joint, tuberculous arthritis, synovioma.
• Arthroscopy. . . The purpose of invasive endoscopic diagnostics may be to clarify the biopsy specimen, the necessary diagnostic information during the visual examination of the joint elements. In some cases, diagnostic arthroscopy becomes a therapeutic one (atroscopic removal of intraarticular objects, meniscectomy, autoplasty of ligaments, etc. ).

Symptomatic treatment

Treatment of the causes of knee pain is carried out differently depending on the identified disease. At the same time, symptomatic care is an important part of a comprehensive treatment process aimed at reducing anxiety and improving quality of life. It is recommended to apply a cold compress to the knee area immediately after the injury - this will help reduce the sensitivity to pain. Ethyl chloride has a local cooling and anesthetic effect. In all cases, resting the knee helps reduce pain. It is necessary to limit movement, to give the foot a position with minimal pain. During the walk, a fixation bandage is applied to the knee, immobilization of the joint is possible with the help of gypsum plaster.

It is strictly forbidden to massage the knee, apply warm compresses, wear high heels during the acute period of injury or illness. 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 the pain, but do not eliminate the root cause of arthralgia. Therefore, all cases of knee pain require specialized diagnosis and treatment, and some conditions (fractures, dislocations, hemarthrosis) require urgent medical attention. If the pain is combined with a change in the shape of the knee (swelling, smoothing of the contours, asymmetry), inability to perform flexion-extensor movements, the sound of the patella, damaged support, you can not delay a visit to the doctor. limb.