Knee Pain

An Overview on Knee Pain Causes, Diagnosis & Treatment

Everyone is prone to experience knee pain, whether you are an Olympic champion or a desk-bound clerk with an inactive lifestyle, across all age groups. Knee injuries could be chronically developed or sustained as a consequence of an event such as soccer or rugby games. Knee pain develops gradually over time may be a result of medical conditions like arthritis or gout and/or mechanical problems.

DTAP provides diagnosis, treatment and managing Joint Pain related problems.

Visit their Siglap Branch or call them at +65 6962 2144 / drop them an email at hello@dtapclinic.com.sg for an appointment with their doctor.

Signs and Symptoms

Some signs and symptoms that come along with knee pain include:

• Bolting or “jamming” of the knee
• Rigidity
• Inflammation
• Unable to extend the knee or flex fully
• Redness and swollen skin
• Wobbliness or jelly legs, when changing direction
• Cracking noises when flexing the knee or squatting

Diagnosing the exact cause is important and the degree and location of knee pain may vary as a result.

Anatomy of the Knee

The knee is a complex structure with many parts working together for us to squat, jump, run or holding our weight together. It is the largest joint in the human system and as often it is being used, it is susceptible to damages.

There are three bones in the knee:

• The knee cap or patella, sitting above the tibia and femur
• The shin bone or tibia
• The thigh bone or  femur

Menisci, the two thick crescent-shaped pads of cartilage that reduces friction and absorbs impact, is between the femur and tibia. There is a layer of smooth cartilage at the ends of the bones to reduce friction between them. A joint capsule holds the bones together and has an inner layer secreting synovial fluid to lubricate the knee joint.

Stabilizing and supporting bones of the knee joint are tendons, muscles and several ligaments:

• Anterior and posterior cruciate ligament (ACL & PCL) – Preventing the forward and backward movement of the tibia and found in the centre of the knee joint
• Patellar ligament – attaches the tibia to patella
• Quadriceps tendon – quadriceps (thigh) muscle attached to the patella
• Quadriceps muscles – responsible for unbending the knee and found at the thigh’s front
• Medial and lateral collateral ligament (MCL & LCL) – in the outer and inner parts of the knee
• Hamstring muscles – responsible for flexing the knee and is found at the back of the thigh

What are the common causes of Knee Pain

• Injury
  • Fracture. People who have fragile bones due to osteoporosis may sustain a knee fracture by mis-step or tripping. Previous falls or trauma such as road accidents can cause the bones of the knee to be broken.
  • Osgood-Schlatter Disease (OSD). OSD is caused by inflammation of the patella tendon. OSD is most commonly found in preteen or teenage boys experiencing growth spurts, and especially so if they are active sportspersons.
  • Meniscal injury. Sports can lead to meniscal tears and ligament injuries. The menisci tear when the knee undergoes a twisting motion while it is bent.
  • Tendon injury. Overuse of tendons and repeated stress can lead to tendon injuries such as rupture or tendinitis (inflammation of the tendon).
  • Bursitis. People who play sports such as volleyball and plumbers and gardeners, are at high risk of this condition. Prolonged or frequent kneeling may result in an inflammation of the bursae (small fluid-filled sacs that aid in softening pressure points and reducing friction between the bones and ligaments or tendons).
  • Ligament injury. PCL injury occurs from direct shock to the front of the knee, such as when the knee hits against the dashboard in a car accident. ACL injury may occur as a result of a sudden change in direction or twisting of the knee such as basketball or football.

• Mechanical issues
  • Abnormal gait. Commonly seen on people with leg-length discrepancy, the person make changes to their gait. Consequently, this increased stress to the knee joint leading to pain in the other joints of the lower limb.
  • Loose body. Sometimes, knee injuries causes small fragments of bone or soft tissue to break off into the joint space, which in turn may interfere with joint movement and cause pain.
  • Patella dislocation. An intense pain on movement, this is an injury that results in the kneecap to slip out of place.
  • Iliotibial band (ITB) syndrome. Long distance running, due to the constant repeated stress, can cause the ITB to rub against the outer part of the femur, resulting in sharp, severe knee pain. The ITB is a band of fibrous tissue that stretches from the outer hip to the outer knee.

• Arthritis and other diseases
  • Gout. Caused by excessive buildup of uric acid crystals in the affected joint, this is a condition with intense pain and swelling. Over time, joint erosion results with the repeated attacks to the same joint.
  • Osteoarthritis. The most frequently seen condition of arthritis. It is a chronic degenerative condition characterised by wear and tear of the cartilage and menisci. Deformity, stiffness and severe pain is a result from the bones of the knee joint rubbing directly against each other in the late stage of this condition.
  • Lupus. Lupus is a protracted autoimmune disease, whereby the body’s immune system mistakenly creates antibodies to attack healthy tissues. Other than the knee and other joints, lupus affects many other internal organs within the body.
  • Rheumatoid arthritis. Another chronic autoimmune condition. The immune system attack mistakenly the synovium, a thin membrane that lines our joints. This causes joint pain, deformity, damage and debilitation affecting the knees and any joint in the body.
  • Septic arthritis. This is a condition that requires urgent treatment. Also known as infectious arthritis, this is a result of the spread of bacteria from the bloodstream into the joint. Patients usually have a high fever, and the grueling pain.

• Others
  • Patellofemoral Pain Syndrome (PFPS). PFPS, also known as runner’s knee, is common in the younger population, especially persons who engage in sports like running, cycling and hiking. Usually brought about by changes in the individual’s training regimen and/or intensity, the person may feel pain around and behind the patella.

How to Diagnosis Knee Pain

After a detailed consultation and physical examination of the knee, the following tests may be performed to aid in diagnosis:

• Imaging
  • Computed tomography (CT) scan. This provides three-dimensional views of the knee joint and provides detailed visualisation of the bones and some of the soft tissues.
  • Magnetic resonance imaging (MRI) scan. This test is particularly useful for soft tissue injuries as it shows in great depth the various ligaments, tendons, cartilage and menisci.
  • X-ray. A two-dimensional view of the knee joint and is a dependable and affordable way to diagnose many knee conditions.
• Laboratory tests
  • Blood tests such as full blood count, inflammatory markers, or rheumatoid factor.
  • Knee joint aspiration. Used when there is a swelling of the knee. Joint aspiration helps to provide some small relief. A sample of joint fluid is obtained and sent for testing of uric acid crystals. If so, it is a diagnosis of gout, or bacteria suggesting an ongoing infection.

What are the Treatments Available for Knee Pain?

Treatments will depend on the diagnosis of the knee pain:

Physotarphy

• To reduce pain and  stabilize the knee joint, one can do strengthening exercises for the quadriceps or hamstring muscles.
• To correct alignment issues, exercises, knee braces and foot orthotics helps.

Medications

Prescription of gout or other specific knee conditions medications.

• Topical and oral paracetamol for symptomatic relief
• To reduce inflammation and soft tissue degeneration, one can take oral supplements.
• Intra-articular injections
  • Corticosteroid injections can be performed to provide immediate relief in cases of severe knee pain. The effect is short-term and usually lasts about 3 months.
  • Hyaluronic acid (HA) injections, also known as viscosupplementation, can be administered for more medium-term, 6 to 9 months relief. HA acts as a lubricant for the joint, is a viscous fluid similar to synovial fluid.
• Surgery
  • Depending on the diagnosis, some procedures like arthroscopic surgery e.g. for ligament reconstruction, knee replacement or knee osteotomy (reshaping of bone) can be performed.

How to Prevent Knee Pain

To continue doing our favourite activities and active lifestyle as we grow older, healthy knees is very important. Preventive care is required and here’s a few quick tips:

• Warm up! Before doing any vigorous activities and sports.
• Slow down, or take a break if you feel any knee pain or discomfort while doing an activity. Tailor the intensity of the activity to your own physique level. Everyone is different.
• The lighter the better. Slimming down a few kilograms helps to reduce the weight on the knees.
• Take your time to train up your body before over-exerting as different sports uses different muscle groups and some sports are more strenuous on the knees than others.

DTAP provides diagnosis, treatment and managing Joint Pain related problems.

Visit their Siglap Branch or call them at +65 6962 2144 / drop them an email at hello@dtapclinic.com.sg for an appointment with their doctor.

Dr. Tan & Partners @Siglap

Address:
914 East Coast Road
#01-04 The Domain,
Singapore 459108

Telephone:
+65 6962 2144

Email: hello@dtapclinic.com.sg

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