Are you experiencing knee pain? When did it start? Do you remember falling or feeling a pop? Did it come on gradually or did it just start hurting? How bad is the pain on a scale from 1 to 10? Has this ever happened before? Are you an athlete? When you go to see the doctor for your pain, these are just some of the questions you should be prepared to answer. Not all knee pain is alike, but knee pain is very common. The knee joint has the largest area of moving parts of all the joints in your body, and it endures a great deal of stress. Depending on the activity, your knee joint can support up to 5 times the weight of your body. This may explain why as many as 25% of adults complain of chronic pain bad enough to slow them down. However, you are not sentenced to a life of pain just because your knee hurts today. Being evaluated by a board-certified specialist in orthopedic surgery is the best way to get to the root of the problem and to begin effective treatment. Knee pain has many causes, and an orthopedic expert will find your answers.
Pain Caused by Acute Trauma
If you had a recent fall or injury exercising or playing a sport, your knee pain may be caused by acute trauma. It’s usually pretty easy to determine if you have an acute injury because you will likely remember exactly when it occurred. Incidents that result in acute knee injury include collisions between players, skiing accidents, falls from a height, jumping, landing, quick direction changes, squatting, slipping, and sprinting. A prior traumatic injury will also make you more at risk for new injuries in the same area. Whenever this type of trauma occurs, it is likely that you will not be able to resume your activity and you may also experience swelling. There are many potential injuries due to trauma, but some are more common than others.
Medial Collateral (MCL) Tear
The MCL is a strong band that attaches the inner part of the long bone of the thigh (the femur) to the tibia bone of the lower leg. This ligament is the most commonly injured knee ligament, especially in athletes. It is often injured in contact sports and those that require a lot of twisting of the lower extremity. Most heal with conservative treatment such as rest, ice, compression, and elevation (RICE) as well as physical therapy. However, surgery is sometimes needed for a full recovery.
Anterior Cruciate Ligament (ACL) Tear
The ACL is one of the four ligaments in the knee and is crucial for stabilizing the joint. It attaches the lower leg bones to the thigh bone and prevents forward or backward motion. You can tear this ligament partially or completely, but can also damage other parts of the knee as this ligament gives way as well. In addition to contact sports, this injury can also occur with running, jumping, and quick direction changes. Symptoms of an ACL injury include feeling a “pop” and feeling like your knee is giving out or unstable. Swelling and bleeding in the knee will occur. Even after symptoms subside, a feeling of instability will remain. Surgery and postop rehab are almost always recommended unless the tear is minimal, or you are older with bad arthritis already, or you have no plans to participate in sports that could reinjure the ligament. Even without surgery, rehabilitation will still be necessary for recovery.
The meniscus is a cushion of cartilage between the thigh and shin bone. While a tear is often common during sports, this is also an injury that can occur over time as someone gets older. If you suddenly experience knee pain, swelling, locking, or a feeling like your knee catches when you straighten it, you may want to consider a meniscal consultation. You may also experience stiffness and a feeling that your knee might give out and not support you. Many meniscal tears can be treated conservatively with RICE. Using crutches may be necessary if you’re having a lot of pain, and a knee brace might be recommended. Your doctor may recommend pain medicine or anti-inflammatory medicine and give you an exercise prescription or send you to physical therapy. In instances where the tear is severe, surgery may be necessary to repair it or remove the damaged portion.
The patella is a bone in the knee joint that is attached between the quadriceps tendon and the patellar tendon and increases your strength when straightening the knee. The quadriceps muscle is your thigh muscle that helps extend your leg and supplies the power to do so. There are a number of ways that the patella can be injured, and all should be evaluated by an orthopedic surgeon. A patellar dislocation is one of the most common patellar injuries. They often occur with young athletes in sports like gymnastics, soccer, ice hockey dance, and weightlifting. Symptoms include a feeling of the knee giving way or the kneecap shifting to the side followed by severe pain, swelling, and tenderness. In contrast, a patellar fracture often occurs as a result of direct trauma to the knee such as a fall or hitting a dashboard during a car accident. Symptoms would include tenderness, swelling, and an inability to extend the knee against gravity. X-rays will confirm the diagnosis. The patellar tendon attaches the bottom of the patella to the top of the shin bone. Patellar Tendon Ruptures are less common than other patellar injuries but should be considered with significant knee pain, swelling, and an inability to straighten the knee. Treatment for these injuries will be tailored to your specific injury and overall health. Conservative treatment may work for some injuries, and surgery may be necessary for others. Your orthopedic surgeon will recommend the best course of action for you.
Intra-articular fractures of the knee can occur when the end of the femur (the thigh bone) is broken. This often happens in younger people with very traumatic injuries such as those in car accidents, or in older people whose bones are more brittle. When this part of the femur breaks into multiple pieces, their attachment to the rest of the knee joint is compromised and the joint surface is damaged. Muscles from the front and back of the thigh may pull the femur away from the joint causing more damage. Symptoms include pain with weight-bearing, bruising, swelling, and even a deformed appearance of the leg. After tests to determine the extent of the injury, your orthopedic surgeon will suggest a treatment which in most cases will require surgery. Other treatments include traction and casting.
Your muscles are the tissues in your body that make you move. Healthy muscles are not only required for sports and physical activities, but for simple tasks like getting out of the chair or standing to cook dinner. Injury to muscles can put a real damper on your lifestyle. A muscle strain happens when a muscle gets stretched too much, too hard, or too quickly, sometimes even causing small tears. Muscle strains in your thighs can definitely cause knee pain, tightness, and weakness. RICE is the best form of treatment and allowing yourself enough time to heal. If your doctor agrees, you could take over the counter medications to help with the pain and swelling. The best way to prevent this type of injury is to warm up and stretch before exercising.
Pain Associated with Physical Activity
Another reason for knee pain that involves physical activity, but not necessarily an acute injury, is called overuse trauma. These syndromes develop over time with repetitive and stressful movements.
Patellofemoral pain is a very common overuse injury of the knee. It is very common in athletes, especially runners, and is more common in women than in men. There is usually no identifiable trauma associated with the pain and the pain can come on suddenly or overtime. Usually, pain is worse when you squat, run, sit for a long time or go up and downstairs. It can be an achy or sharp pain, and sometimes it is hard to pinpoint exactly where the pain originates. Once any other more serious ailments are eliminated, treatment usually includes rest, avoiding the aggravating activities, ice, and anti-inflammatory medications as advised by your doctor. Physical therapy to help strengthen muscles that support the knee is also recommended.
The bursa of your knee is a fluid-filled sac that surrounds the joint and its tendons and decreases friction. It acts as a cushion during movement. Chronic bursitis is caused by long periods of repetitive use or motion. For instance, kneeling for long periods of time, marching, running, or even walking unevenly because you are favoring an injury on the other leg. Eventually, the bursa becomes inflamed which causes pain. You may actually be able to see the swelling around your knee, and this pain and swelling may limit your knee movement. Treatment will include rest, avoiding aggravating activities, and ice or heat. Your doctor may recommend NSAIDs (nonsteroidal anti-inflammatory drugs) but be sure to check with them because not everyone should take these medications. You may also be able to get a therapeutic injection in your knee for relief.
Tendons attach muscle to bone. The more you use your muscles, the more stress you place on your tendons. Patellar tendonitis is another overuse injury caused by repetitive activities involving the knee. Sports that involve running and jumping may contribute to this injury. Patellar tendonitis can take months to resolve so following your treatment plan is very important. Activity modification, rest, anti-inflammatories, ice or heat, weight training, stretching, and massage are all used in the treatment that is best overseen by a physical therapist
Pain from Arthritis
There are many types of arthritis and it affects millions of Americans at some point in their lives. Osteoarthritis is also known as degenerative arthritis because it happens over time, causing inflammation from wear and tear of the joints. Knees are one of the most common places for osteoarthritis to occur. Pain is generally worse after lying or sitting for a period of time but generally improves once you get moving, and can get worse again after longer distances too. Physical therapy, ice or heat, over the counter pain medication, and even injections into the knee can help most people with the pain of osteoarthritis. However, if it becomes severe enough, your orthopedic surgeon may recommend knee replacement surgery.
Inflammatory arthritis such as rheumatoid, psoriatic, or lupus is all diseases of the immune system. This usually protective system in your body attacks joints along with other organs. Symptoms will include pain, swelling, and warmth of the affected joints. Medications called disease-modifying antirheumatic drugs are often needed to control this type of arthritis. If it becomes severe enough in the knee, surgery may be necessary just like with regular wear-and-tear arthritis.
Gout is another form of arthritis that is caused by crystallized deposits of uric acid in the joints. This type of arthritis is characterized by remissions and flares. The affected knee will usually be warm, swollen, and very tender. This arthritis is treated by prescription medications. First, anti-inflammatory medications are used to deal with the flare. Then medications to control uric acid in your body are taken regularly.
Other Causes of Knee Pain
The human body is amazing and so many things in it are connected. Knee pain can be caused by other parts of your body. A bad hip can cause knee pain. Problems with your lower back can cause knee pain. Dangerous things like deep vein thrombosis (DVT) can cause swelling and knee pain. Baker’s Cyst behind the knee can cause knee pain. Diabetic neuropathy can cause pain in your lower legs that may make you think your knee is giving you pain. Because knee pain can mean so many things, some more dangerous than others, it is important to not ignore it. While knee problems can originate somewhere else, most are a result of an orthopedic problem. For this reason, the best place to have your knee pain evaluated is with a board-certified orthopedic surgeon.
Knee Replacement Surgeon in Raleigh, Apex, and Durham, NC
If you are experiencing knee pain, discomfort, swelling, or a feeling of it giving out, Dr. Brett Gilbert will be happy to review your history with you and give you a thorough examination. If you need additional tests, he will order them to provide you with the answers you are looking for. Our friendly team is here to answer your questions about knee injuries or any other problems with your bones or joints and our goal is to get you the treatment that will get you on the road to recovery. Call the offices of Dr. Brett Gilbert in Raleigh, Durham, Apex, or Cary at (919) 788-8797 or you can request an appointment with Dr. Gilbert using our appointment request form, or you can self-schedule your appointment here.