Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis

WALTER L. CALMBACH, M.D., AND MARK HUTCHENS, M.D.

Am Fam Physician. 2003;68(5):917-922

This is part II of a two-part article on knee pain. Part I, “History, Physical Examination, Radiographs, and Laboratory Tests,” appears on page 907 in this issue.

A more recent article on evaluation of knee pain in adults is available.

Knee pain is a common presenting complaint with many possible causes. An awareness of certain patterns can help the family physician identify the underlying cause more efficiently. Teenage girls and young women are more likely to have patellar tracking problems such as patellar subluxation and patellofemoral pain syndrome, whereas teenage boys and young men are more likely to have knee extensor mechanism problems such as tibial apophysitis (Osgood-Schlatter lesion) and patellar tendonitis. Referred pain resulting from hip joint pathology, such as slipped capital femoral epiphysis, also may cause knee pain. Active patients are more likely to have acute ligamentous sprains and overuse injuries such as pes anserine bursitis and medial plica syndrome. Trauma may result in acute ligamentous rupture or fracture, leading to acute knee joint swelling and hemarthrosis. Septic arthritis may develop in patients of any age, but crystal-induced inflammatory arthropathy is more likely in adults. Osteoarthritis of the knee joint is common in older adults.

Determining the underlying cause of knee pain can be difficult, in part because of the extensive differential diagnosis. As discussed in part I of this two-part article,¹ the family physician should be familiar with knee anatomy and common mechanisms of injury, and a detailed history and focused physical examination can narrow possible causes. The patient’s age and the anatomic site of the pain are two factors that can be important in achieving an accurate diagnosis (Tables 1 and 2).

Children and Adolescents

Children and adolescents who present with knee pain are likely to have one of three common conditions: patellar subluxation, tibial apophysitis, or patellar tendonitis. Additional diagnoses to consider in children include slipped capital femoral epiphysis and septic arthritis.

PATELLAR SUBLUXATION

Patellar subluxation is the most likely diagnosis in a teenage girl who presents with giving-way episodes of the knee.² This injury occurs more often in girls and young women because of an increased quadriceps angle (Q angle), usually greater than 15 degrees.

Patellar apprehension is elicited by subluxing the patella laterally, and a mild effusion is usually present. Moderate to severe knee swelling may indicate hemarthrosis, which suggests patellar dislocation with osteochondral fracture and bleeding.

TIBIAL APOPHYSITIS

A teenage boy who presents with anterior knee pain localized to the tibial tuberosity is likely to have tibial apophysitis, or Osgood-Schlatter lesion^3,4(Figure 1).⁵ The typical patient is a 13- or 14-year-old boy (or a 10- or 11-year-old girl) who has recently gone through a growth spurt.

The patient with tibial apophysitis generally reports waxing and waning of knee pain for a period of months. The pain worsens with squatting, walking up or down stairs, or forceful contractions of the quadriceps muscle. This overuse apophysitis is exacerbated by jumping and hurdling, because repetitive hard landings place excessive stress on the insertion of the patellar tendon.

On physical examination, the tibial tuberosity is tender and swollen, and may feel warm. The knee pain is reproduced with resisted active extension or passive hyperflexion of the knee. No effusion is present. Radiographs are usually negative; rarely, they show avulsion of the apophysis at the tibial tuberosity. However, the physician must not mistake the normal appearance of the tibial apophysis for an avulsion fracture.

PATELLAR TENDONITIS

Jumper’s knee (irritation and inflammation of the patellar tendon) most commonly occurs in teenage boys, particularly during a growth spurt²(Figure 1). ⁵ The patient reports vague anterior knee pain that has persisted for months and worsens after activities such as walking down stairs or running.

On physical examination, the patellar tendon is tender, and the pain is reproduced by resisted knee extension. There is usually no effusion. Radiographs are not indicated.

SLIPPED CAPITAL FEMORAL EPIPHYSIS

A number of pathologic conditions result in referral of pain to the knee. For example, the possibility of slipped capital femoral epiphysis must be considered in children and teenagers who present with knee pain.⁶ The patient with this condition usually reports poorly localized knee pain and no history of knee trauma.

The typical patient with slipped capital femoral epiphysis is overweight and sits on the examination table with the affected hip slightly flexed and externally rotated. The knee examination is normal, but hip pain is elicited with passive internal rotation or extension of the affected hip.

Radiographs typically show displacement of the epiphysis of the femoral head. However, negative radiographs do not rule out the diagnosis in patients with typical clinical findings. Computed tomographic (CT) scanning is indicated in these patients.

OSTEOCHONDRITIS DISSECANS

Osteochondritis dissecans is an intra-articular osteochondrosis of unknown etiology that is characterized by degeneration and re-calcification of articular cartilage and underlying bone. In the knee, the medial femoral condyle is most commonly affected.⁷

The patient reports vague, poorly localized knee pain, as well as morning stiffness or recurrent effusion. If a loose body is present, mechanical symptoms of locking or catching of the knee joint also may be reported. On physical examination, the patient may demonstrate quadriceps atrophy or tenderness along the involved chondral surface. A mild joint effusion may be present.⁷

Plain-film radiographs may demonstrate the osteochondral lesion or a loose body in the knee joint. If osteochondritis dissecans is suspected, recommended radiographs include anteroposterior, posteroanterior tunnel, lateral, and Merchant’s views. Osteochondral lesions at the lateral aspect of the medial femoral condyle may be visible only on the posteroanterior tunnel view. Magnetic resonance imaging (MRI) is highly sensitive in detecting these abnormalities and is indicated in patients with a suspected osteochondral lesion.⁷

Adults

OVERUSE SYNDROMES

Anterior Knee Pain

Patients with patello-femoral pain syndrome (chondromalacia patellae) typically present with a vague history of mild to moderate anterior knee pain that usually occurs after prolonged periods of sitting (the so-called “theater sign”).⁸ Patello-femoral pain syndrome is a common cause of anterior knee pain in women.

On physical examination, a slight effusion may be present, along with patellar crepitus on range of motion. The patient’s pain may be reproduced by applying direct pressure at the anterior aspect of the patella. Patellar tenderness may be elicited by subluxing the patella medially or laterally and palpating the superior and inferior facets of the patella. Radiographs usually are not indicated.

Medial Knee Pain

One frequently overlooked diagnosis is medial plica syndrome. The plica, a redundancy of the joint synovium medially, can become inflamed with repetitive overuse.^4,9 The patient presents with acute onset of medial knee pain after a marked increase of usual activities. On physical examination, a tender, mobile nodularity is present at the medial aspect of the knee, just anterior to the joint line. There is no joint effusion, and the remainder of the knee examination is normal. Radiographs are not indicated.

Pes anserine bursitis is another possible cause of medial knee pain. The tendinous insertion of the sartorius, gracilis, and semi-tendinosus muscles at the anteromedial aspect of the proximal tibia forms the pes anserine bursa.⁹ The bursa can become inflamed as a result of overuse or a direct contusion. Pes anserine bursitis can be confused easily with a medial collateral ligament sprain or, less commonly, osteoarthritis of the medial compartment of the knee.

The patient with pes anserine bursitis reports pain at the medial aspect of the knee. This pain may be worsened by repetitive flexion and extension. On physical examination, tenderness is present at the medial aspect of the knee, just posterior and distal to the medial joint line. No knee joint effusion is present, but there may be slight swelling at the insertion of the medial hamstring muscles. Valgus stress testing in the supine position or resisted knee flexion in the prone position may reproduce the pain. Radiographs are usually not indicated.

Lateral Knee Pain

Excessive friction between the iliotibial band and the lateral femoral condyle can lead to iliotibial band tendonitis.⁹ This overuse syndrome commonly occurs in runners and cyclists, although it may develop in any person subsequent to activity involving repetitive knee flexion. Tightness of the iliotibial band, excessive foot pronation, genu varum, and tibial torsion are predisposing factors.

The patient with iliotibial band tendonitis reports pain at the lateral aspect of the knee joint. The pain is aggravated by activity, particularly running downhill and climbing stairs. On physical examination, tenderness is present at the lateral epicondyle of the femur, approximately 3 cm proximal to the joint line. Soft tissue swelling and crepitus also may be present, but there is no joint effusion. Radiographs are not indicated.

Noble’s test is used to reproduce the pain in iliotibial band tendonitis. With the patient in a supine position, the physician places a thumb over the lateral femoral epicondyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion.

Popliteus tendonitis is another possible cause of lateral knee pain. However, this condition is fairly rare. ¹⁰

TRAUMA

Anterior Cruciate Ligament Sprain

Injury to the anterior cruciate ligament usually occurs because of noncontact deceleration forces, as when a runner plants one foot and sharply turns in the opposite direction. Resultant valgus stress on the knee leads to anterior displacement of the tibia and sprain or rupture of the ligament.¹¹ The patient usually reports hearing or feeling a “pop” at the time of the injury, and must cease activity or competition immediately. Swelling of the knee within two hours after the injury indicates rupture of the ligament and consequent hemarthrosis.

On physical examination, the patient has a moderate to severe joint effusion that limits range of motion. The anterior drawer test may be positive, but can be negative because of hemarthrosis and guarding by the hamstring muscles. The Lachman test should be positive and is more reliable than the anterior drawer test (see text and Figure 3 in part I of this article¹).

Radiographs are indicated to detect possible tibial spine avulsion fracture. MRI of the knee is indicated as part of a presurgical evaluation.

Medial Collateral Ligament Sprain

Injury to the medial collateral ligament is fairly common and is usually the result of acute trauma. The patient reports a misstep or collision that places valgus stress on the knee, followed by immediate onset of pain and swelling at the medial aspect of the knee.¹¹

On physical examination, the patient with medial collateral ligament injury has point tenderness at the medial joint line. Valgus stress testing of the knee flexed to 30 degrees reproduces the pain (see text and Figure 4 in part I of this article¹). A clearly defined end point on valgus stress testing indicates a grade 1 or grade 2 sprain, whereas complete medial instability indicates full rupture of the ligament (grade 3 sprain).

Lateral Collateral Ligament Sprain

Injury of the lateral collateral ligament is much less common than injury of the medial collateral ligament. Lateral collateral ligament sprain usually results from varus stress to the knee, as occurs when a runner plants one foot and then turns toward the ipsilateral knee.² The patient reports acute onset of lateral knee pain that requires prompt cessation of activity.

On physical examination, point tenderness is present at the lateral joint line. Instability or pain occurs with varus stress testing of the knee flexed to 30 degrees (see text and Figure 4 in part I of this article¹). Radiographs are not usually indicated.

Meniscal Tear

The meniscus can be torn acutely with a sudden twisting injury of the knee, such as may occur when a runner suddenly changes direction.^11,12 Meniscal tear also may occur in association with a prolonged degenerative process, particularly in a patient with an anterior cruciate ligament–deficient knee. The patient usually reports recurrent knee pain and episodes of catching or locking of the knee joint, especially with squatting or twisting of the knee.

On physical examination, a mild effusion is usually present, and there is tenderness at the medial or lateral joint line. Atrophy of the vastus medialis obliquus portion of the quadriceps muscle also may be noticeable. The McMurray test may be positive (see Figure 5 in part I of this article¹), but a negative test does not eliminate the possibility of a meniscal tear.

Plain-film radiographs usually are negative and seldom are indicated. MRI is the radiologic test of choice because it demonstrates most significant meniscal tears.

INFECTION

Infection of the knee joint may occur in patients of any age but is more common in those whose immune system has been weakened by cancer, diabetes mellitus, alcoholism, acquired immunodeficiency syndrome, or corticosteroid therapy. The patient with septic arthritis reports abrupt onset of pain and swelling of the knee with no antecedent trauma.¹³

On physical examination, the knee is warm, swollen, and exquisitely tender. Even slight motion of the knee joint causes intense pain.

Arthrocentesis reveals turbid synovial fluid. Analysis of the fluid yields a white blood cell count (WBC) higher than 50,000 per mm³ (50 × 10⁹ per L), with more than 75 percent (0.75) polymorphonuclear cells, an elevated protein content (greater than 3 g per dL [30 g per L]), and a low glucose concentration (more than 50 percent lower than the serum glucose concentration).¹⁴ Gram stain of the fluid may demonstrate the causative organism. Common pathogens include Staphylococcus aureus, Streptococcus species, Haemophilus influenzae, and Neisseria gonorrhoeae.

Hematologic studies show an elevated WBC, an increased number of immature polymorphonuclear cells (i.e., a left shift), and an elevated erythrocyte sedimentation rate (usually greater than 50 mm per hour).

Older Adults

OSTEOARTHRITIS

Osteoarthritis of the knee joint is a common problem after 60 years of age. The patient presents with knee pain that is aggravated by weight-bearing activities and relieved by rest.¹⁵ The patient has no systemic symptoms but usually awakens with morning stiffness that dissipates somewhat with activity. In addition to chronic joint stiffness and pain, the patient may report episodes of acute synovitis.

Findings on physical examination include decreased range of motion, crepitus, a mild joint effusion, and palpable osteophytic changes at the knee joint.

When osteoarthritis is suspected, recommended radiographs include weight-bearing anteroposterior and posteroanterior tunnel views, as well as non–weight-bearing Merchant’s and lateral views. Radiographs show joint-space narrowing, subchondral bony sclerosis, cystic changes, and hypertrophic osteophyte formation.

CRYSTAL-INDUCED INFLAMMATORY ARTHROPATHY

Acute inflammation, pain, and swelling in the absence of trauma suggest the possibility of a crystal-induced inflammatory arthropathy such as gout or pseudogout. ^16,17 Gout commonly affects the knee. In this arthropathy, sodium urate crystals precipitate in the knee joint and cause an intense inflammatory response. In pseudogout, calcium pyrophosphate crystals are the causative agents.

On physical examination, the knee joint is erythematous, warm, tender, and swollen. Even minimal range of motion is exquisitely painful.

Arthrocentesis reveals clear or slightly cloudy synovial fluid. Analysis of the fluid yields a WBC count of 2,000 to 75,000 per mm³ (2 to 75 × 10⁹ per L), a high protein content (greater than 32 g per dL [320 g per L]), and a glucose concentration that is approximately 75 percent of the serum glucose concentration.¹⁴ Polarized-light microscopy of the synovial fluid displays negatively birefringent rods in the patient with gout and positively birefringent rhomboids in the patient with pseudogout.

POPLITEAL CYST

The popliteal cyst (Baker’s cyst) is the most common synovial cyst of the knee. It originates from the posteromedial aspect of the knee joint at the level of the gastrocnemio-semimembranous bursa. The patient reports insidious onset of mild to moderate pain in the popliteal area of the knee.

On physical examination, palpable fullness is present at the medial aspect of the popliteal area, at or near the origin of the medial head of the gastrocnemius muscle. The McMurray test may be positive if the medial meniscus is injured. Definitive diagnosis of a popliteal cyst may be made with arthrography, ultrasonography, CT scanning, or, less commonly, MRI.

What is a Hyperextended Knee? Symptoms, Treatments, and More

Written by WebMD Editorial Contributors

In this Article

• How To Know if You Have Knee Hyperextension
• Causes of Knee Hyperextension
• Diagnosing Knee Hyperextension
• Treating Knee Hyperextension Symptoms
• Surgery
• Recovery from Knee Hyperextension

A hyperextended knee — or knee hyperextension — develops when the knee joint bends the wrong way and damages the ligaments near the knee. The condition is common in athletes who play high-impact sports. It can be treated using methods including rest, pain medication, and sometimes, surgery.

Symptoms of a hyperextended knee include the following:

• Knee Pain. You may feel mild to severe pain in your affected knee.
• Poor Movement. You may find straightening or flexing your affected knee to have become difficult.
• Swelling. Swelling and stiffness may develop around your affected knee.
• Poor Stability. Your affected knee may feel weak, making it difficult for you to walk or stand.

In severe cases, you may get a sprained ligament near the knee. The ligaments that could become sprained include the ACL (anterior cruciate ligament) and the PCL (posterior cruciate ligament).

Your knee is said to have hyperextended when your knee joint bends backward and this causes tissue damage and swelling. Most of the damage happens in the ACL and the PCL, which are the two ligaments in the middle of the knee. These ligaments connect the shinbone to the thighbone and help control the movement of your shinbone.

A bad fall or a bad landing after a jump can cause a hyperextended knee. While this condition can affect anyone, athletes are more likely to perform activities that damage their ligaments. This is because knee hyperextension is often triggered by a direct hit to the knee when playing high-impact sports like gymnastics, basketball, and soccer.

Female athletes have a higher chance of getting an ACL injury. Also, people with weak muscles or previous knee injuries or those overweight or obese may also have such knee problems. 

Knee hyperextension can also cause small pieces of bone being broken off the main bone in young children.

To check if you have a hyperextended knee, your doctor will perform a physical exam: the doctor will ask you to bend your knee at different angles as they apply pressure and check for movement. They’ll use a needle to drain your knee if it’s tense or swollen with blood. Your doctor may also ask you to get an x-ray to understand if you’ve broken any bones and an MRI scan to check for injuries to the ligament.

Based on the results of these tests, your doctor may diagnose you as having a sprained ligament. In severe cases, the ligament is either partially torn or split into two pieces. More severe sprained ligaments often require surgery.

You can follow these treatment measures to heal a hyperextended knee:

• Rest. Take a break from sports and physical activities.
• Ice. Ice your hyperextended knee to help reduce swelling.
• Medication. You can take anti-inflammatory medication to reduce pain. 
• Lift the leg. Keep the leg elevated above the heart when possible.
• Compression. Use a compression wrap to reduce swelling.

If you have a severe sprain, you may need ligament repair surgery, where a piece of tendon from somewhere else in your knee or hamstring is taken and used to replace the damaged ligament.

While healing from this surgery, you may need to do physiotherapy exercises to help strengthen the leg muscles. You can also wear a knee brace to improve joint stability as you recover.

In more than 80% of cases, ACL surgery fully restores knee functionality. Your doctor may recommend further ligament surgeries if the first attempt is unsuccessful. But, later surgeries can be more difficult and have poorer long-term results.

Overall, some pain and swelling can remain after this surgery. This may be the case if other knee injuries, like a tear in the cartilage, have happened at the same time as the knee hyperextension.

In some cases, better motion at the knee joint after surgery can have good results. This is because the tendon used to replace the torn ligament will stretch over time. Surgery comes with a small chance of getting an infection, long-term knee stiffness, and blood clots in the leg. 

In any case, even minor knee injuries can increase your chance of getting another knee injury in the future. To lower this risk, you can join injury prevention programs.

Your expected recovery time depends on the severity of your injury, but physiotherapy can help speed things up. Keep in mind that the recovery speed of each person is different.

Mild sprains often feel better after two weeks of normal treatment measures like rest. But, recovery from ligament repair surgery takes around six months. Your doctor will advise you to do physiotherapy exercises during this time, and they may also ask you to use crutches. You might be able to resume sports only after six months.

If you start to use your knee before it’s fully healed, you could cause permanent damage.

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Knee pain – Clinic of Neurology and Orthopedics

Knee pain: the most likely causes and effective treatments for the knee joint

Did you know that…

• Degenerative joint diseases can progress over several decades. Late referral to a specialist is often associated with ignoring the first symptoms.
• Pain and severe discomfort are not normal at any age, and therefore their appearance is a good reason to get examined and take care of your health.

Most often, pain in the joints is associated with the deterioration of the cartilage tissue, which, due to any reason, does not receive proper nutrition and is gradually destroyed, ceasing to function as a natural shock absorber.

One of the most likely causes is the patient’s sedentary lifestyle. It works as follows:

• A network of capillaries is responsible for cartilage nutrition, which is activated during joint movement. Each step is accompanied by the absorption of tissue fluid, which has everything necessary to maintain the “performance” of the cartilage.
• Lack of physical activity leads to deterioration of blood circulation and cartilage nutrition. Oxygen and nutrients cease to enter the joint, which causes the development of arthritis and arthrosis.
• In some cases, pain in the knee joint indicates damage to the hip joint, occurs against the background of extreme load and requires treatment of the underlying disease.

Why does pain occur?

Pain in the knee joint is not a disease, but a symptom indicating the course of a pathological process. Contrary to popular belief, pain can be caused not only by arthritis or arthrosis of the knee, but also by a number of other conditions, including:

• osteoarthritis;

Only an orthopedist can find the real cause of the pain. In order to make a final diagnosis, the specialist will study the history, analyze the symptoms, conduct motor tests, and in some cases send the patient for an X-ray or MRI.

You can make an appointment with an orthopedist by calling +7 (347) 216-00-22

Arthrosis of the knee – a disease of the elderly? Main symptoms

More than half of patients complaining of pain in the knee joint is associated with the progression of arthrosis.

Arthrosis is a degenerative-dystrophic disease of the cartilage, which, in the absence of adequate and timely treatment, leads to the exposure of the bone heads and, as a result, to pain and impaired joint mobility.

What do you need to know about this disease?

• Osteoarthritis of the knee can progress at different rates. From the first symptoms to disability, depending on the patient’s health, lifestyle and the presence / absence of treatment, it takes several years or several decades.
• Osteoarthritis of the knee is one of the most common causes of disability worldwide.
• 20% of people over 55 have this diagnosis, but every year the disease “gets younger”. Today, among the patients there are boys and girls who have barely crossed the border of 25 years. One of the main reasons is a sedentary lifestyle.

This pathology is accompanied by the appearance of one or more symptoms, including decreased mobility in the joint in the morning, pain and discomfort after exercise, crunching when bending and extending the knees, meteosensitivity (increased symptoms in bad weather).

Treatment of the knee: a brief overview of effective conservative methods

Treatment of arthrosis diagnosed at an early stage involves the use of gentle methods of correction of the condition and is more effective. The third stage of the pathology is likely to require surgical intervention, which consists in cutting off part of the bone or in the installation of an endoprosthesis. Whether it is worth contacting an orthopedic doctor or you can get by with the constant use of painkillers, it’s up to you.

Comprehensive conservative treatment of the knee joint

We do everything to delay the operation or completely save the patient from surgical intervention, so treatment begins with the appointment of conservative therapy, which includes:

• The correct mode of exercise and rest.
• Therapeutic diet for overweight patients to reduce stress on the joint.
• Drug treatment of knees with hormonal and non-steroidal anti-inflammatory drugs, analgesics, chondroprotectors.
• Injection of drugs into the joint capsule, including plasmolifting (injection of own platelet-rich plasma) and the introduction of a synovial fluid prosthesis.
• Physiotherapy, massage, acupuncture and remedial gymnastics.

The “Clinic of Neurology and Orthopedics” has everything you need to alleviate the patient’s condition and slow down the progression of the disease. Pain relief, improvement of joint mobility and restoration of cartilage tissue is the result we are striving for.

Next, let’s talk about some of the treatments in a little more detail.

Therapeutic gymnastics

The purpose of performing physical exercises recommended by an orthopedist is to relieve pain during remission, reduce inflammation, slow down cartilage abrasion by strengthening the muscles of the lower leg and thigh, maintaining the elasticity of ligaments and tendons, and preventing muscle atrophy. Physical therapy exercises should be carried out in a continuous course. The first tangible results can be seen after 2 weeks of daily exercise.

Physiotherapy and massage

Orthopedist’s appointment can end with a referral for magnetotherapy, UHF, phono- and electrophoresis. Sulfur and hydrogen sulfide baths have a good effect on the state of the joints.

Wellness massage for knee arthrosis is performed on both legs, the full course is 10-12 sessions. This method of treatment is considered as an auxiliary and is prescribed in conjunction with drug therapy, but is contraindicated during an exacerbation and in the presence of inflammation.

Synovial fluid prosthesis and plasmolifting

The main function of synovial fluid is to ensure smooth sliding of articular surfaces. A lack of fluid or a change in its composition leads to malnutrition of the cartilage and its destruction.

Synovial fluid prosthesis, or, in simple terms, a preparation based on hyaluronic acid, which is injected directly into the joint capsule, helps prevent abrasion and destruction of cartilage. Such an injection allows you to remove pain and restore mobility to the joint. The effect of the procedure lasts up to a year, then the injection should be repeated.

The second innovative method of getting rid of pain in the knee joint is plasmolifting. The patient’s own plasma is purified and enriched with platelets responsible for tissue regeneration, and then injected into the problem joint.

It is scientifically proven that plasmolifting:

• Reduces pain and inflammation.
• Repeatedly accelerates tissue regeneration.
• Slows down the process of bone and cartilage destruction.
• Improves joint mobility.

Whether an injection of plasma or hyaluronic acid will work depends largely on the skill of the person doing it. To obtain a pronounced and lasting result, it is important to choose the right injection site, therefore, all manipulations of such a plan in the “Clinic of Neurology and Orthopedics” are performed by doctors with appropriate qualifications and extensive experience.

The methods of treatment of the knee joint listed in this article have a number of contraindications, so a consultation with an orthopedic doctor is mandatory before any medical manipulation. You can make an appointment with a specialist on the website or by calling +7 (347) 216-00-22. Be healthy!

Knee pain: causes, treatment, which doctor to contact

According to statistics, about 80% of people have experienced knee pain. Moreover, a pronounced pain syndrome may be accompanied by other symptoms: a feeling of weakness (as if the legs give way), clicking when moving, stiffness, inability to straighten the leg.

What causes pain in or under the knee? Is there an effective treatment? Which doctor deals with this problem?

Causes of knee pain

The most common reason for knee pain is an injury:

• A fracture of the knee joint is accompanied by very strong, sharp pain. It becomes more intense if you press on the damaged area. With a fracture, the joint swells, so you won’t be able to bend your knee.

• A dislocation is a displacement of bones. Accompanied by swelling of the knee, severe pain syndrome. A dislocation is not as harmless as it might seem. With an injury of this type, the joint capsule is often torn, tendons, nerves, and ligaments are damaged. If you do not turn to an orthopedic traumatologist in time or completely ignore a visit to a specialist, a habitual dislocation may develop. In this case, the joints and bones can move even with a slight load.

• When ligaments and tendons are torn, a crunch is heard, clicks are clearly distinguished during movement. The joint becomes too mobile. The pain is sharp, as if “shooting”. Theoretically, a person can move around, but when walking, the pain in the knee will be more intense.

• A meniscus tear most often involves a strong blow, as a result of which the knee joint begins to hurt, lose mobility, and swell. A torn meniscus often does not act as an independent injury: it is diagnosed in 75% of cases of knee joint injuries. A torn meniscus often occurs in athletes, dancers, and ballet dancers. But such damage also occurs in everyday life – for example, with a sharp movement, heavy physical exertion or a fall.

By the way, about sports. Runners’ knees often hurt – there is even such a thing as runner’s knee syndrome. Runner’s knee syndrome is a common sports injury in which the cartilage tissue of the patella softens and deforms. The injury occurs as a result of high loads on the knees. By the way, it affects not only runners, but also cyclists, fans of hiking, football players.

Which doctor treats knee pain?

If you are worried about knee pain, the logical question is: which doctor to make an appointment with. In case of pain caused by an injury, you should contact an orthopedic traumatologist as soon as possible.

The doctor will conduct a survey and examination of the patient, to clarify the diagnosis, he will send for examination. By the way, with knee injuries, only x-rays are not always prescribed. For example, when a meniscus is torn, it is not informative, so the patient is referred for an ultrasound of the joint or an MRI of the joints. An MRI will allow you to fully “see” the joint and assess its condition. In case of a fracture and dislocation of the knee, an x-ray is recommended (usually in several projections), in some cases an MRI is prescribed.

In addition, to clarify the diagnosis, the results of laboratory tests are required – most often this is a general and biochemical blood test.

Treatment of knee pain

To prescribe effective treatment, you must first identify the cause of the pain syndrome. For example, when a meniscus is torn, anti-inflammatory drugs are prescribed, the knee is fixed with a bandage. Please note that in the treatment of any knee injury, it is important to ensure that the injured area has complete rest. Splints and splints, which are needed for immobilization, will help reduce the load on the joint. Taping is also actively used – the so-called fixation of the joint with adhesive tapes-teips.

Additionally, the patient is prescribed painkillers that stop the pain syndrome. It can be tablets, ointments or gels.

In some cases, surgery is required. So, with a complete rupture of the ligaments of the knee joint, a low-traumatic operation is performed – arthroscopy.

Massage, reflexology, therapeutic exercises also help to cope with pain, strengthen the knee joint, speed up recovery. These methods “work” due to the fact that they help improve muscle tone, activate blood circulation in the knee joint.

The complex of services in the field of traumatology and orthopedics is provided by experienced specialists of the Scandinavian Health Center. The doctors of our multidisciplinary medical center treat injuries and post-traumatic complications, arthrosis, dislocations, bursitis, etc. In our clinic, you can undergo the necessary examinations, visit a physiotherapist, masseur.