Knee joint pain: causes, effective treatment, diagnosis

Every person experiences pain in the knee joint from time to time. This can be the result of sudden movement or a symptom of a progressive disease. The knee joint is the largest and most anatomically complex element of the musculoskeletal system. It accounts for up to 80% of physical weight, which leads to increased physical activity and the risk of injury. A large number of capillaries, nerve fibers and muscle tissues make any injury, even the smallest one, extremely painful. Injured nerves cause an infectious-inflammatory process, which is accompanied by swelling, discoloration of the skin and an increase in local temperature.

As progress progresses, the joint itself, intra-articular fluid and connective tissues are drawn into the pathological state, which can have serious consequences - the development of arthritic diseases. A general understanding of the anatomical structure of the knee joint will help you understand which element can cause pain and what steps should be taken to eliminate the pain.

Anatomical structure

The anterior area of the joint is formed by the patella, in simpler language: the patella. It is connected to the quadriceps (fascicular) muscle of the thigh, which continues into the patellar ligament and, in general combination, forms a ligament apparatus, which consists of the following types of fascia:

• Lateral branches of the tibia (small and large);
• posterior support nodes - sickle-shaped, dorsal, median and lateral;
• transverse and cruciate joint ligaments of the knee.

Cruciate ligaments are the most susceptible to injury: a sharp movement, a large degree of rotation, a fall with subluxation lead to rupture of the interminimal joints.

Ligaments are divided into two types:

1. Front - have the function of stabilizing the ankle joint, in particular preventing excessive forward movement. They originate from the posterior part of the large femur, intersect with the posterior ligaments in the knee cavity, and attach to the notch between the anterior protrusions of the tibia.
2. Rear: Prevents the lower leg from moving backward. They start from the upper anterior part of the femur, pass through the joint cavity and end between the dorsal protrusions of the tibia.

On the surface of the joint bones is cartilage. At the junction of the tibia and femur, are the menisci, a kind of joint lining that plays a role in shock absorption and stabilization.

There are several synovial bursae (three to five) in the knee joint that provide natural lubrication:

• over the kneecap;
• deep popliteal;
• between the tendons of the long muscle of the thigh;
• hypodermic patella;
• in the recess below the knee joint.

Thanks to the knee, a person can perform a step, a flexion, an extension within the limits indicated by the ligaments.

Causes of pain

Inflammation can develop in the following structures:

• cartilage;
• joint sheath;
• synovial fluid;
• bones of the tibia;
• muscles and tendons surrounding the joint;
• ligament apparatus;
• blood vessels, veins, arteries;
• Subcutaneous fat;
• epidermis.

The most common causes of knee pain are:

1. Osteoarthritis is the cause of over 50% of knee pain cases. It is characterized by a slow and gradual destruction of the hyaline cartilage. For a long time, it can be asymptomatic and sharply aggravate in the second stage. Pain in the knee joint occurs due to the growth of osteophytes affecting the nerve endings;
2. Arthritis is an inflammatory disease that occurs in an acute form. It can be an independent disease - spondylitis or a complication of other joint pathologies - arthrosis, rheumatism, etc. Arthritis is characterized by intense pain, accompanied by swelling and redness;
3. Osteochondritis: articular cartilage becomes inflamed over time with degenerative arthrosis, mechanical injuries;
4. Periarthritis is a disease that occurs against the background of obesity (more often in women). The pathology affects the tendons, muscles, and subsequently passes to the shell of the knee joint. The pain is moderate, pulling (as in a sprain).
5. Chondromatosis is the formation of knots on the hyaline cartilage tissue, which eventually spread throughout the capsule of the knee joint. In this case, pinching of soft tissues with a large number of nerve cells occurs. Because of this, the knee constantly hurts, even during the rest period.
6. Bursitis - the synovial capsule of the knee joint rarely becomes inflamed, only due to injury or complications of collateral joint disease, hence the pain.
7. Cellulite - subcutaneous fatty tissue can cause pain only in the case of close foci of concomitant diseases. Purulent arthritis, soft tissue abscess can cause inflammatory and painful processes in the protective layer.
8. Dermatitis - the epidermis is affected in case of infectious pathologies (eczema, erysipelas, psoriasis) or allergic reactions to external stimuli.
9. Osteomyelitis: The bone marrow becomes inflamed due to bacteria that have entered the gelatinous body along with the lymphatic flow. It can also be the result of open injuries or a complication of surgical operations.
10. synovitis: the capsule of the knee joint is most often affected in elderly people over the age of 55, due to rheumatism or other chronic conditions. At a young age, you can get sick from a serious injury.

Types of pain depending on the location

Diseases provoking the development of negative processes also form the type of pain:

• Intense and stabbing pain - reactive arthritis, torn menisci and tendons, bursitis in the acute stage;
• Tolerable, but constant pain - synovitis, bursitis in the initial degree;
• Itching pain - gonarthrosis, arthrosis;
• Vibrating - degenerative osteoarthritis, in the phase of joint deformation;
• Sharp and burning pain - compression of the sciatic nerve, bone tuberculosis;
• Burning - osteoporosis, progression of inflammation of the synovial bursa, exacerbation of chronic meniscus injury;
• Cramps - inflammation of the soft tissues of the knee joint, muscles and tendons;
• Shooting pain - damage to the nerve roots.

Diagnostic measures

If you experience severe pain in the knee joints, you should not postpone a visit to the doctor, hoping that "everything will pass". Early diagnosis guarantees the success of treatment and prevents the development of more serious processes that can cause irreparable damage to health and quality of life. For an initial consultation, you should contact a therapist. After a standard examination, he decides to prescribe a treatment (which happens in 70% of cases of knee pain complaints) or prescribe a complete laboratory and hardware examination, with the involvement of highly specialized specialists.

Running and suspicious pains are studied in different directions:

• Traumatology: If osteoarthritis, congenital or acquired dysplasia, joint fracture, dislocation, displacement, X-ray, MRI, ultrasound, fluid biopsy in the synovial sac is prescribed to find out where the pain in the knee joint is coming from.
• Surgery: cyst under the patella, thrombosis, arthritis with purulent formations, ruptures of tendons, menisci, ligaments, stones within the joint, hemarthrosis, abscesses diagnosed by ultrasound, fluoroscopy, CT or MRI, blood tests, general factor and rheumatoid, hyaline puncture cartilage in the knee joint, etc.
• Rheumatology: the exclusion of systemic diseases (lupus erythematosus, rheumatoid arthritis, gout) is carried out with the help of laboratory tests. Complete blood count, hematology, rheumatoid proteins, DNA test, uric acid level.
• Neurology and psychiatry: The pinched sciatic nerve does not require a lengthy diagnosis. Already on ultrasound, muscle tone and sites of inflammation will be visible. In the case of mental disorders, when the pain in the knee joint is not confirmed by a single fact, but the patient continues to experience torment (so-called somatic pain), specific studies are prescribed for mental abnormalities.

Basic diagnostic methods

The most popular ways to quickly and accurately diagnose knee pain are:

• X-ray - allows you to see the knee joint in different projections and determine the location of the injury. The images show lesions already in the initial stages, in particular changes in the bone, synovial bursa or the appearance of osteophytes.
• Ultrasound examination: a modern and high-precision examination determines the thickness of the joint shell, the state of the ligament structure, the presence of inflammation of any type and general alterations of the knee.
• Dopplerography - Examination of veins and arteries for aneurysms, plaques and blockages. It quickly and effectively determines the possible risks and the state of the internal walls of blood vessels in percentage terms.
• MRI is currently the most accurate way of diagnosis. It allows you to see a clear and three-dimensional image of the knee joint, pathological changes in the synovial fluid, even a slight deformation of the bone tissue, etc. It is rarely prescribed, due to the high, for many, costs and contraindications. It is forbidden to undergo examinations for patients with implants, metal prostheses and weighing more than 150 kg.
• TC - the principle of operation is based on X-rays, only in a more modern way. The images are taken in a circular projection, which allows a more accurate image of the knee joint to be obtained and thus to determine the nature and extent of the injury.
• Angiography is a method of examining the patency of blood vessels by injecting a contrast fluid. It determines the functionality of metabolic processes and allows you to diagnose joint failure in the early stages.
• Complete blood count - is prescribed to identify inflammation and pain. The totality of indicators can also lead to the trail of specific diseases and determine joint pathologies only at the beginning of the progression.
• Blood for rheumatoid antibodies - also indicates the presence of inflammation, but of a specific, systemic or hereditary nature. For example, to establish a diagnosis of rheumatoid arthritis, this analysis is taken as a basis.
• Uric acid is an important test for determining the causes of pain and the stage of exacerbation of gout or infectious arthritis. A high level indicates the accumulation of salt deposits in the joints.
• Wasserman's reaction - is prescribed for suspected sexual infections, syphilis, gonorrhea, chlamydia, etc. The development of joint diseases against the background of specific diseases or as their complications are very common. Thus, a positive test will allow to prescribe the correct treatment, taking into account the type of infection.
• Tumor markers: These help identify special substances in the blood that are secreted by a cancerous neoplasm or its metastases. Thus, for sarcoma of the synovial bursa, the presence of markers of vimentin, external cellular antigen and pancytokeratin is characteristic.

Treatment of knee joint pain

Knee pain can be divided into those that require emergency medical attention. And those that are pre-diagnosed. Urgent conditions include all injuries, fractures, dislocations, abscesses, purulent inflammation, hemarthrosis (bleeding in the joint). The symptoms in all cases are identical: unbearable pain, swelling, redness, inability to move, fever in the knee joint and a feverish state.

Treatment is limited to the provision of primary care until the ambulance arrives:

• the leg should be raised - put a rolled roller or a hard pillow;
• put an ice bandage on the knee and change it every 5-10 minutes;
• take an available pain reliever.

In all other cases, the treatment is carried out after conducting thorough studies and establishing the causes. According to the anamnesis, drug therapy, physiotherapy, physical therapy, massages, homeopathic treatments, local applications, spa holidays and, in extreme cases, surgery are prescribed.

Conservative therapy

Traditional drug treatment of pain includes the following drug groups:

1. Anesthetics. To ease the initial symptoms and relieve the painful condition, you can take simple over-the-counter pain relievers. Severe cases associated with loss of mobility and unbearable pain require more severe medications that are only prescribed by a doctor and are available by prescription.
2. NSAIDs. Helps relieve inflammation and swelling quickly.
3. Chondroprotectors. Modern drugs, despite the long course of administration, provide the regeneration of cartilage tissue. The effect is cumulative and long-lasting (up to 10 years, joint pain may not bother after a six-month course, subject to treatment in the early stages).
4. Glucocorticosteroids. Indicated for patients with autoimmune diseases to reduce the production of the hormone cortisol and stop the progress of the disease. Doses and regimen are prescribed by the doctor on a strictly individual basis.
5. Immunosuppressants. They suppress the abnormal action of the defense system, thus stabilizing the progress of dangerous diseases such as rheumatoid arthritis, lupus erythematosus and vasculitis. They are rarely prescribed, only in the case of an accurate diagnosis and the inability to eliminate knee pain in other ways.
6. Injections of hyaluronic acid. They are injected directly into the knee joint cavity and eliminate pain and synovial fluid deficiency. They also contribute to the restoration of hyaline cartilage, thus restoring the mobility of the knee.

Folk recipes

Most people who begin to have pain in the knee joint try to eliminate the discomfort by folk methods. You can make lotions, compresses and night applications based on homemade ointments or tinctures. A decoction of herbs, topical alcohol tinctures will help prevent a period of exacerbation and relieve obsessive pain.

The following plants and substances have anti-inflammatory effects:

• Coltsfoot;
• St. John's wort;
• oak bark;
• burdock root;
• Bay leaf;
• chamomile flowers;
• Calendula;
• White and black kaolin clay;
• A solution of salt and soda;
• Honey based products.

For example, mix 10 previously crushed aspirin tablets and a glass of liquid honey. Apply a thick layer on the knee in the pain localization area. Cover with plastic wrap and wrap with wool material (scarf), preferably left overnight. The pain is eliminated after the first application.

Similarly, you can apply a clay application where pain appears. A little olive oil is added to the mixture of clay and water to prevent hardening and severe hardening of the skin.

An effective recipe, which includes honey, salt and soda. Mix 1 teaspoon of salt and soda with honey, in enough quantity to abundantly cover the knee joint. This method performs three actions at once: it removes excess fluid, relieves inflammation and pain, is enriched with nutrients.

Oak bark in the form of a decoction or alcoholic tincture well strengthens blood vessels, promotes normal blood circulation. For a decoction, pour 1 tablespoon of dried bark with 1 cup of boiled water, cook in a water bath for 20 minutes. Soak the gauze with the decoction and apply to the knee in a warm (not hot) form for 30-50 minutes to eliminate pain in the knee joint. For alcohol tincture, use the same proportions, replace only water with vodka. Insist in a cool dark place for 10-14 days. Apply in the same way.

By alternating various means and methods, you can preserve the disease for a long time, forget about pain and swelling. The effectiveness of alternative medicine has not been proven, despite the elimination of the primary symptoms - pain in the knees.

Massage and therapeutic exercises for knee joint pain

Full traditional treatment necessarily includes physical therapy and massage. The exercises are recommended for all people who have had, or have, knee injuries, diagnosed with arthritis, osteoarthritis and other joint diseases, who lead an inactive lifestyle (sedentary static work, 1-2 group disabilities, housewives , etc. ).

Gymnastics can be done independently, at a slow pace and in a doable mode. Gradually increase the number of exercises or, conversely, reduce, depending on how you feel.

1. From a lying position or sitting on a chair, slowly bend and straighten your legs, until a state of mild fatigue appears.
2. Bending the leg at the knee, perform rotational movements in a small amplitude, repeat the same on the second leg.
3. Lying on your back, gently pull your legs bent at the knees towards your stomach.
4. Put a cushion on the chair and sit so that the legs "hang", make circular movements clockwise and vice versa.
5. Sitting on a chair, slowly stretch your leg and hold this position for 2-5 seconds, just as slowly lower it, repeat on the second leg.
6. Stand straight, straighten your back, slowly bend your leg at the knee and linger in the "heron" position for several seconds. If possible, increase the delay time every 2 days.
7. If there are no contraindications and health allows, you can complicate the complex. Put the gymnastic stick at the maximum level, which is reached with one leg bent at the knee. Throw your leg over the "barrier" 10-15 times, then change your position.
8. A small complex for stretching the lower leg also contributes to the rapid recovery of the knee joint. Place your palms on the wall, bend your right leg at the knee, bring your left leg back. The feet rest completely on the floor. Hold the pose for 30 seconds. Switch legs.

Regular performance of simple gymnastics, accessible to any person, will give visible results in a month: pain in the knee joint will cease to disturb, joint mobility will improve, swelling will disappear.

The effectiveness of gymnastics will significantly increase if you combine it with a massage course. It can be both a traditional method of exposure and manual pain therapy. It should only be remembered that only experienced professionals with good recommendations should be reliable for carrying out such procedures. Otherwise, manual manipulations, at best, will not have the slightest effect, at worst they will cause a joint displacement and aggravate the pathological condition. The massage should be done periodically, no more than 10 sessions, 25-30 minutes per month. Daily procedures are strictly contraindicated. During the session, there should be no pain in the knee. If any discomfort is felt, the procedure should be stopped.

Home treatment

Treatment of knee pain at home is a prerequisite for outpatient therapy. The patient with all permissible methods should help himself to relieve pain and recover as quickly as possible.

Therefore, for these purposes, it is necessary to adhere to certain rules for the treatment of all types of pain:

• Follow all the recommendations of the attending physician: do not miss the intake of prescribed drugs, do gymnastics feasible, arrive in time for physiotherapy.
• Review your diet. Add plenty of fresh vegetables, herbs, and fruits to your diet. Exclude fatty, fried and semi-finished meats.
• If necessary, use aids to relieve the load from the knee joint: cane, crutch and other special devices.
• Do not use, without prior consultation with a doctor, recipes of traditional medicine, even tested and close ones. What helps one person may be categorically contraindicated for another.
• During the treatment period, if possible, avoid physical activity and ensure bed rest so that the pain does not return (therapeutic exercises are an exception).
• Provide a comfortable place to sleep and rest: orthopedic mattresses, comfortable chairs and armchairs, preferably with small supports so that you can comfortably lift your aching legs.
• A light self-massage is allowed. Stroking, rubbing promotes blood circulation, thus enriching the tissues with oxygen. Thus, the muscle spasm is removed and the pain becomes less intense.

Preventive measures

It is almost impossible to fully insure against injury, sprains or dislocations of the most loaded joint in the body. Everyday life forces you to do housework, go to work, etc. In the course of normal activities, it is quite possible to receive an unexpected injury. But reducing the risk of developing joint disease is quite in every person's power. Leading rheumatologists have developed a number of recommendations that will help protect you from dangerous pathologies:

• Establish and strictly adhere to a rational regime: work-rest. This is especially true for people whose activities are associated with increased physical activity (athletes, builders, sellers, metallurgists, miners, etc. ).
• Treat promptly and undergo rehabilitation after any infectious diseases. This rule also applies to "harmless" ones such as acute respiratory infections or seasonal SARS.
• Avoid exposure to low temperatures, drafts. Dress for the time to prevent hypothermia.
• Upon reaching the age of 35, it is desirable to undergo a course of treatment with chondroprotectors.
• Monitor your weight carefully. Increasing body weight will inevitably increase the load on the knees, it is worth remembering when eating another sandwich.
• To maintain normal weight, stick to the principles of a healthy diet. More vegetables and dairy - less sweet, spicy, salty, fatty and starchy foods.
• Reconsider your lifestyle: Quitting smoking, drinking alcohol and other toxic addictions will have a positive impact not only on your knee joints, but also on life in general. To overcome addictions, you can ask your relatives for help - the difficult stage will pass much faster and easier.

Every person has experienced pain in the knee joints, regardless of age, gender, or social status. From the very first steps, the joint is subjected to all kinds of tests: falls, bruises, injuries, sports, hypothermia. Despite this, many people manage to maintain the mobility, health and functionality of the main complex until old age.