Knee pain

The knee joint consists of an articulation between four bones: the femur, tibia, fibula and patella. There are four compartments to the knee. These are the medial and lateral tibiofemoral compartments, the patellofemoral compartment and the superior tibiofibular joint. The components of each of these compartments can suffer from repetitive strain, injury or disease.

Knee pain
Human knee
SpecialtyOrthopedics

Knee pain is pain in or around the knee.

Running long distance can cause pain to the knee joint, as it is high-impact exercise.

Causes

Injuries

Some common injuries include:

Fractures

Diseases

Some of the diseases of cause of knee pain include the following:

Inflammations

Deformities

Common deformities of the knee include:

Syndromes

Dislocations

Cold temperature

Knee pain is more common among people working in the cold than in those in normal temperature.[3] Cold-induced knee pain may also be due to tenosynovitis of the tendons around the knee, in which cold exposure has a specific role, either as a causative or a contributing factor.[3] Frank arthritis has been reported in children due to frostbite from extreme cold causing direct chondrocyte injury.[4]

There is also a hereditary disease, familial cold autoinflammatory syndrome (FCAS), which often features knee pain, in addition to hives, fever and pain in other joints, following general exposure to cold.[5]

Knee pain due to less physical movement

A lower level of physical activity and a work environment where one is required to sit in a chair during the work day is one reason for developing knee joint pain, as the lower degree of physical movement tends to weaken the knee muscles. Blood vessels also can be affected, leading to development of painful conditions.

As age progresses the movement of the knee joint involves higher friction with adjacent tissue and cartilages.

Other causes

Referred knee pain

Referred pain is that pain perceived at a site different from its point of origin but innervated by the same spinal segment.[6] Sometimes knee pain may be related to another area from body. For example, knee pain can come from ankle, foot, hip joints or lumbar spine.

Diagnosis

Knee MRIs should be avoided for knee pain without symptoms or effusion, unless there are non-successful results from a functional rehabilitation program.[7]

In some diagnosis, such as in knee osteoarthritis, magnetic resonance imaging does not prove to be clear for its determination [8]

Management

Although surgery has a role in repairing traumatic injuries and broken bones, surgeries such as arthroscopic lavage do not provide significant or lasting improvements to either pain or function to people with knee pain, and therefore should almost never be performed.[9] Knee pain is pain caused by wear and tear, such as osteoarthritis or a meniscal tear. Effective treatments for knee pain include physical therapy exercises,[10] pain-reducing drugs such as ibuprofen, joint stretching[11][12], knee replacement surgery, and weight loss in people who are overweight.[9]

Acupuncture has also been found to be a potential treatment for those with knee pain.[13][14][15] There is evidence that acupuncture can be useful in reducing acute pain after a total knee arthroplasty, reducing the need for certain prescription drugs such as opioids.[15] For those suffering from chronic knee pain, defined as pain lasting more than 3 months, acupuncture was found to be effective in reducing pain up to 12 weeks after acupuncture treatment.[14]

Overall, a combination of interventions seems to be the best choice when treating knee pain. Interventions such as exercises that target both the knee and the hip, foot bracing, and patellar taping are all recommended for use with patients suffering from knee pain.[16]

Current evidence suggests that psychological factors are elevated in individuals with patellofemoral pain.[17] Non-physical factors such as anxiety, depression, fear of movement, and catastrophizing are thought to have a linear correlation with increased pain experience and decreased physical function.[17] Catastrophizing is defined as imagining the worst possible outcome of an action or event.[18] Furthermore, psychosocial factors may have either a positive or negative impact on adherence to rehabilitation programs for managing knee pain.[17]

Epidemiology

About 25% of people over the age of 50 experience knee pain from degenerative knee diseases.[9]

Society and culture

In the United States, more than US $3 billion is spent each year on arthroscopic knee surgeries that are known to be ineffective in people with degenerative knee pain.[9]

References
  1. van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M (January 2015). "Exercise for treating patellofemoral pain syndrome". The Cochrane Database of Systematic Reviews. 1: CD010387. doi:10.1002/14651858.CD010387.pub2. PMID 25603546.
  2. Darlene Hertling and Randolph M.Kessler. Management of Common Musculoskeletal Disorders. Third Edition. ISBN 0-397-55150-9
  3. Pienimäki T (May 2002). "Cold exposure and musculoskeletal disorders and diseases. A review". International Journal of Circumpolar Health. 61 (2): 173–82. doi:10.3402/ijch.v61i2.17450. PMID 12078965.
  4. Carrera GF, Kozin F, McCarty DJ (October 1979). "Arthritis after frostbite injury in children". Arthritis and Rheumatism. 22 (10): 1082–7. doi:10.1002/art.1780221006. PMID 486219.
  5. Clinical trial number NCT00887939 for "Pathogenesis of Physical Induced Urticarial Syndromes" at ClinicalTrials.gov
  6. Carol Mattson Porth. Pathophysiology:concepts of altered health states. Publisher:Lippincott. Third Edition. Page 853. ISBN 0-397-54723-4
  7. American Medical Society for Sports Medicine (24 April 2014), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Medical Society for Sports Medicine, retrieved 29 July 2014
  8. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM (June 2018). "Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis". British Journal of Sports Medicine. 53 (20): bjsports–2018–099257. doi:10.1136/bjsports-2018-099257. PMC 6837253. PMID 29886437.
  9. Siemieniuk RA, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, Buchbinder R, Englund M, Lytvyn L, Quinlan C, Helsingen L, Knutsen G, Olsen NR, Macdonald H, Hailey L, Wilson HM, Lydiatt A, Kristiansen A (May 2017). "Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline". BMJ. 357: j1982. doi:10.1136/bmj.j1982. PMC 5426368. PMID 28490431.
  10. Lack S, Neal B, De Oliveira Silva D, Barton C (July 2018). "How to manage patellofemoral pain - Understanding the multifactorial nature and treatment options". Physical Therapy in Sport. 32: 155–166. doi:10.1016/j.ptsp.2018.04.010. hdl:11449/171014. PMID 29793124.
  11. Knee Reviver
  12. Kniedistractie
  13. MacPherson H, Vickers A, Bland M, Torgerson D, Corbett M, Spackman E, Saramago P, Woods B, Weatherly H, Sculpher M, Manca A, Richmond S, Hopton A, Eldred J, Watt I (2017). "Acupuncture for chronic pain and depression in primary care: a programme of research". Programme Grants for Applied Research. 5 (3): 1–316. doi:10.3310/pgfar05030. PMID 28121095.
  14. Zhang Q, Yue J, Golianu B, Sun Z, Lu Y (December 2017). "Updated systematic review and meta-analysis of acupuncture for chronic knee pain". Acupuncture in Medicine. 35 (6): 392–403. doi:10.1136/acupmed-2016-011306. PMID 29117967.
  15. Tedesco D, Gori D, Desai KR, Asch S, Carroll IR, Curtin C, McDonald KM, Fantini MP, Hernandez-Boussard T (October 2017). "Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis". JAMA Surgery. 152 (10): e172872. doi:10.1001/jamasurg.2017.2872. PMC 5831469. PMID 28813550.
  16. Crossley KM, van Middelkoop M, Callaghan MJ, Collins NJ, Rathleff MS, Barton CJ (July 2016). "2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)". British Journal of Sports Medicine. 50 (14): 844–52. doi:10.1136/bjsports-2016-096268. PMC 4975825. PMID 27247098.
  17. Maclachlan LR, Collins NJ, Matthews ML, Hodges PW, Vicenzino B (May 2017). "The psychological features of patellofemoral pain: a systematic review". British Journal of Sports Medicine. 51 (9): 732–742. doi:10.1136/bjsports-2016-096705. PMID 28320733.
  18. "Definition of CATASTROPHIZE". www.merriam-webster.com. Retrieved 2019-03-12.
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