| | Underlying
diagnosis: | Comments: |
| septic
arthritis | red, hot, swollen knee; mostly
Staph. aureus, also streptococcal and gonococcal |
| inflammatory
arthritis | gout, osteoarthritis, RA,
AS, psoriatic | | knee
trauma | strain/sprain, meniscal tear,
ACL tear, ligamentous tear, bone/cartilage injury |
| bursitis | carpenter's
knee, Baker's cyst, prepatellar bursitis, Anserine bursitis |
| growing
pains | in children during growth spurts |
| Osgood-Schlatter
disease | in athletically minded adolescents |
| avascular
necrosis | at medial compartment of knee
in elderly females | | congenital
knee problems | hypermobility, congenital
plicae | | alignment
problems | bowlegs,
knock knees |
| malignant
bone tumors | osteosarcoma and others |
Common
Causes Of Knee Pain Introduction: The
knee is very exposed and therefore easily injured. It is weight bearing and for
his reason is at a higher risk when the patient is overweight.The
knee is a complex structure with a medial (inside) and lateral (outside)
compartment as well as a patellofemoral joint. All of these strucutures
are held together with ligaments, a joint capsule and muscle tendons that are
providing significant support to the knee. Knee pain can develop when any of these
structures get injured. When there is pain in the knee, the patient usually starts
limping as weight bearing may be painful and the range of motion is reduced. With
inflammation the synovial pouches, called bursae, can contain fluid (called an
"effusion") as does the knee joint. This makes the knee cap disappear
and the normal contours of the knee are blunted. Knee pain can also be referred
from the lower back, the hip, pelvis and in an adolescent even from a slip in
the femoral growth plate ("slipped femoral epiphysis"). In the
following I will describe each of these conditions in more detail, how to diagnose
and how to treat it.
Inflammatory
Arthritis These traditional forms of arthritis tend to lead to
synovitis, which is swelling of the synovial lining of the knee joint. Tests to
diagnose and treatments to deal with these conditions vary according to the underlying
diagnosis. The following links can be used to get more details regarding each
of these forms of arthritis: Growing
Pains They are harmless, but can be very hard on the parent's
mind: they occur in the middle of the night in children who are in the middle
of a growth spurt. The legs (and also the arms) are very painful, but this disappears
very quickly upon treatment with massage. In the morning there is absolutely no
pain and no loss of function. Excamination a the doctor's office is normal. Usually
within a few weeks even the nightly aches and pains are disappeared (Ref. 2). Avascular
necrosis (also called "osteochondritis dissecans") This
conditiontends to happen suddely and occurs on one side, usually
the medial aspect of a knee. There are predisposing risk factors such as prior
treatment with systemic corticosteroids, a history of lupus, alcohol abuse, history
of sickle cell anemia or the hormone changes of pregnancy. Also, a history of
deep sea diving with exposure to increased barometric pressure can often be found.
Part of the bone and hyaline cartilage of the medial femoral condyle is cut off
the circultaion and dies off, but then gets regenerated. Technetium-99 bone scan
or MRI scan can help in the diagnosis. Treatment consists of high tibial osteotomy
or total knee arthroplasty (knee replacement), both of which would require a referral
to an orthopedic surgeon (Ref. 4). Alignment
problems The two major alignment problems are the bowleg
(genu varus) andthe knock-knee (genu valgus).
Bowleg (genu varus) For a period of time
it is normal for a toddler to have bowlegedness.
However, by about 18 months this normalizes on its own. If it persists, rickets
(Vit. D deficiency) has to be ruled out. An orthopedic surgeon should be consulted
as uncorrected genu
valgus leads to premature osteoarthritis and the need for total knee replacement
later in life, which can be prevented by intervening at a young age. Bracing usually
helps to normalize it, if not, correctve surgery might be needed in order to prevent
premature osteoarthritis.
Knock-knee
(genu valgus) Thisis not as common and usually
peaks at age 3, then outgrows itself by age 9. It is more common in girls. If
it persists, a referral to an orthopedic surgeon should be made as uncorrected
genu valgus leads to premature osteoarthritis and the need for total knee replacement
later in life, which can be prevented by intervening at a young age. There is
a surgical stapling method available that can straighten out the malalignment
(Ref. 3,p.2404). Malignant
bone tumors: there are a number of malignant bone
tumors, the most common around the knee are the osteosarcoma
and the malignant
giant cell tumor (X-ray here shown of a distal radius). These are dealt
with under this link: bone cancer,
where diagnostic tests and treatment are also discussed. |
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