Pain in the knee( knee joint) - Causes, symptoms and treatment. MF.

The knee joint is considered to be the most vulnerable joint - first of all, because of its complex structure and the loads imposed on it. Orthopedists and traumatologists daily face a large number of patients complaining of knee pain when stretching, at rest or walking.

Causes of knee pain not caused by disease

Vascular pain in the knees of occurs due to worsening of the circulation of the knee joints. Usually they begin in adolescence, during a period of active growth - as the development of blood vessels in fast-growing adolescents often does not keep up with the accelerated growth of bones. But their intensity after 18-20 years usually decreases( and does not increase with age, as happens with arthrosis), are not accompanied by a decrease in mobility of the knee joints. Pain sensations are usually symmetrical.

Diseases that accompany pain in the knee

Diseases in which there is pain in the knee are very diverse, due to the complexity of the structure and function of the knee area. Knee injury can affect any of the ligaments, tendons or "sacs" filled with fluid( bursitis) that surround the knee joint, as well as bones, cartilages and ligaments that directly form the joint.

The contusion in the knee joint zone is characterized by a limited hemorrhage into the soft tissues in the joint region, edema and local soreness that impedes movement. As a result of a bruise in the tissues, microcirculation is disturbed. Damage to blood vessels and nerve endings causes varying degrees of hemorrhage, edema and soreness.

Traumatic hemarthrosis of the knee joint, or hemorrhage into the joint cavity, develops both with bruises and with more severe joint damage;as a rule, accompanies damage to meniscuses, ligaments, capsules, bone tissue. With hemarthrosis, poured blood acts on the synovial membrane, causing it to swell and edema of synovial villi, which in turn begin to produce an excessive amount of synovial fluid. By the nature of distant exudates, it is possible to judge the localization and severity of damage to intraarticular formations. If the puncture is dominated by blood, we can assume a rupture of the synovium, cruciate ligaments, damage to the inner meniscus in the capsular zone. If the articular cartilage is damaged and the transchondral rupture of the meniscus of blood in the joint is usually not present. To damage the bone tissue is characterized by the presence in the joint of blood with drops of fat. Removal of blood from the joint and rinsing it is recommended for the prevention of chronic serous-fibrinoid synovitis, when there is a lot of fibrin in the exudate that has fallen out in the form of separate threads and clots that can germinate with blood vessels with the formation of semi-free villi.

Rupture of ligaments ( full or partial).Damage to the outer lateral ligament of the knee joint is less frequent than internal, and occurs when the tibia is excessively tilted internally( for example, when the foot is tucked).The rupture is often complete, it can be combined with a tearing fracture of a part of the fibula head. The patient complains of pain in the area of ​​damage, which is amplified by the deviation of the shin to the inside. Movement is limited. The joint is swollen, hemarthrosis is determined. The severity of symptoms depends on the degree of damage to the ligaments of the knee joint. At full rupture revealed looseness( excessive mobility) in the joint.

Damage to the inner lateral ligament of the knee joint occurs more often, however, usually its damage is incomplete. Trauma occurs when the tibia is excessively deviated from the outside. The rupture of the lateral ligaments is often combined with the rupture of the inner meniscus and damage to the capsule of the joint, which can be diagnosed when performing a magnetic resonance imaging of the knee joint. The patient complains of painfulness during palpation, movements, deviation of the lower leg to the outside, the joint is swollen. There is a hemarthrosis. Movement is limited. A complete rupture is accompanied by excessive mobility in the joint.

With , the cruciate ligament rupture of , which is located inside the joint, often causes hemarthrosis. Therefore, the diagnosis of the rupture of these ligaments in the acute period is very difficult, since with hemarthrosis it is almost impossible to investigate the symptom of the "drawer", characteristic for the damage of cruciate ligaments. To study this symptom it is necessary to return in 3-5 days or after puncture of the joint and removal of blood. Treatment of rupture of cruciate ligaments operative.

Meniscus damage ( meniscopathy) is the most common knee injury, sometimes difficult to diagnose. A sharp unusual movement in the joint with a turn of the thigh with a fixed foot and shin sometimes leads to the detachment of a part of the meniscus or to crushing it between the bones. Quickly there is a hemarthrosis;an important symptom of the blockade is determined - the patient can not completely straighten the leg in the knee joint. Such a condition requires immediate referral to a traumatologist to eliminate the blockade. Often, the joint blockade is resolved independently, hemarthrosis also resolves after 5-7 days and the patient, without seeking help, continues to work. Blockades repeat, but with each time pain after infringement of a meniscus and a hemarthrosis become less. However, this is a very serious situation, since repeated infringements of the meniscus with time( within 1 year) lead to the development of deforming arthrosis and then already meniskectomy( removal of the meniscus) is ineffective.
Even with the slightest suspicion of a meniscus rupture, consultation of a traumatologist and radiography of the joint is required. The latter is due to the frequent combination of a meniscus injury with intraarticular fractures.

Chronic dislocation of the patella ( displacement of the patella) is relatively rare( 0.4 to 0.7% of all dislocations), but often recurs in the future. In the case of the development of habitual dislocation in children, as a rule, with age, deformity of the knee joint is formed in the form of valgus( X-shaped) tibial deviation and progressive destruction of limb function. In most cases, there is an external dislocation of the patella, rarely an internal dislocation. Very rarely there is a dislocation of the patella, called torsion, in which the patella turns around its axis. Patients with chronic patellar instability are concerned with pain in the anterior and inner surface of the knee joint. They can complain about a sense of instability, a knobby raspolnannosti. When examining patients by special methods determine the degree of patellar bias. Clarify the diagnosis for radiographic examination.

Inflammation of the tendon( tendinitis). The causes of tendonitis are:
- significant physical stress on the joint for a long period of time.
- injuries;
- infections caused by bacteria, for example, gonorrhea;
- the presence of rheumatic diseases( gout or arthritis);
- an allergic reaction of the body to medicinal preparations;
- anatomical features of the structure of the body: different lengths of limbs contribute to the development of tendonitis of the knee joint;
- weakened tendons or their incorrect development;
- non-observance of correct posture.
The most pronounced symptoms of tendonitis are pain and mobility restriction. Pain sensations in the site of inflammation and nearby areas are stubborn, long-lasting. Pain may appear suddenly, but sometimes soreness increases as the inflammation increases. There is an increased sensitivity when probing the affected tendon.

Bursitis - inflammation of the periarticular bag( bursa), which contains the fluid washing the joint. Common symptoms of bursitis: redness, swelling, pain and sensitivity above the knee cap, limited mobility in the joint. If bursitis is allowed to pass into a state of chronic inflammation, there is a possibility of adhesions, which can only be removed surgically.

Synovitis is an inflammation of the synovial membrane, which from the inside covers the joint cavity. This produces an effusion that accumulates in the joint bag. In addition to injury, synovitis can develop with various autoimmune processes, with metabolic disturbances, against the background of existing diseases( gonarthrosis) of the knee joint, inflammation can be secondary( reactive synovitis of the knee joint).As a rule, the inflammation is aseptic( that is, there is no infection) and is manifested by the formation of serous effusion. If the infection joins, the nature of the synovial fluid changes, pus appears in it and a purulent synovitis develops. Symptoms appear gradually, for hours or even days after the injury. The joint increases in volume. The fluid as it bursts the intra-articular structures, deforms the contours of the knee. Limited function of the joint, but the violation of movement is not always accompanied by a pain syndrome. Nevertheless, the pain is still characteristic of this pathology, but it is not sharp, but dull, medium intensity. The skin above the joint is not hyperemic, the temperature is not increased. is a soft, dense, elastic, tumor-like formation that develops on the posterior surface of the knee joint( in the popliteal fossa).Skin over swelling of normal color, not soldered with underlying tissues. The Baker's cyst is more prominent with an unbent knee. When bending decreases in size or completely disappears. The appearance of Baker's cyst is a consequence of any diseases of the knee joint, among which the most frequent are joint trauma, damage and degenerative changes of the meniscus, joint cartilage damage, chronic synovitis( inflammation of the synovial membrane of the joints), osteoarthritis, patellofemoral arthrosis, osteoarthritis, rheumatoid arthritis. Visually Baker's cyst is a dense, elastic, rounded formation in the popliteal fossa, which can be imperceptible when the knee is bent and quite clearly protrudes with the joint extended. In this popliteal area there may be a feeling of discomfort or pressure( and sometimes - and pain), difficulty or pain when moving in the knee. If the size of the Baker cyst is large, due to the compression of adjacent vessels and / or nerve trunks, coldness of the skin of the leg below the knee, a sensation of numbness, tingling, crawling, swelling and other signs of circulatory and innervation disorders may occur. To the possible complications, Baker's cysts include the development of thrombophlebitis and deep vein thrombosis of the lower leg, the development or aggravation of the already existing varicose veins, as well as the rupture of the cyst wall, which is manifested by severe pain, reddening of the skin of the calf's posterior surface, increased local temperature, swelling.

Hoff's disease is the damage and degeneration of adipose tissue surrounding the knee joint. This is a difficult enough diagnosed condition, which is often confused with a meniscus injury, the so-called "articular mouse" - a fragment of cartilage or bone in the body of the joint. Without competent treatment of the knee with Hoff's disease, the "fat pad" stops performing its buffer function - the disease goes to a chronic stage, which increases the risk of developing knee arthrosis, can provoke constant pain in the knee joint for many years. Most often, with knee injury, damage to the fat lobules occurs, their pinching, hemorrhage, and edema of the tissues. In place of damaged cells, fibrous tissue grows, which can not perform the functions of adipose tissue. In some situations, Goff's disease can develop against the background of knee arthrosis or under the influence of hormonal changes, for example, in women in menopause. In the acute stage of the disease, damage to the fat body can be diagnosed already when examined. In addition to pain in the knee, weakness of the quadriceps muscle, a characteristic sign of palpation is a localized swelling. But the chronic stage is not always easy to determine - you may need MRI, CT or arthroscopy if there is no response to conservative treatment.

Osgood - Schlatter disease ( osteochondropathy of tibial tuberosity).Often occurs after increased physical exertion or trauma, with the tension of the patellar ligament. It affects mainly boys-adolescents aged 13-15 years, engaged in sports. Symptoms are pain, swelling in the region of tuberosity of the tibia.

Arthritis - inflammation of the joint, which most often occurs with such diseases as rheumatoid, reactive, psoriatic arthritis, as well as with Bekhterev's disease, rheumatism, gout. Characteristic features - articular pain, stiffness, limitation of joint mobility, swelling, increase in temperature in the affected area, deformation of the joint.

Soft tissue edema with arthritis

Deforming osteoarthritis is a joint disease characterized by the defeat( thinning and destruction) of the cartilaginous joint tissue with simultaneous deformation and changes in the structure of the bony heads. In the early stages of development, arthrosis manifests itself by symptoms such as pain, usually arising at the onset of motion after a resting state, and these pains soon pass. With further progression of the disease, the pain during movement increases, appear not only during movement, but also at rest, there is a feeling of joint stiffness, a restriction of their mobility. With deforming arthrosis of the knee, there is a significant curvature of the leg, a deviation of its axis from a straight line, which leads to difficulty and total inability to work the joint. Finally, at the last stages of development, deforming arthrosis leads to its complete destruction. To restore the function of the joint, stopping pain, restoring the length of the limb, endoprosthetics of the knee joint are performed.

Severe arthrosis of knee joints with X-shaped deformity of the extremities

Patella chondropathy is a pathological condition characterized by degenerative-necrotic changes in the articular cartilage of the patella. It occurs both directly after a trauma of different intensity, and against a background of chronic traumatization and, especially, with lateral dislocations of the patella. Patients complain of pain in the patella, which increases with physical activity. Kneeling is very painful even for a short time. Finding the lower limb in a bent position, for example, with a long ride in the car, can also lead to pain in the patella area. When moving in the knee joint, you may hear a crack or there may be clicking sounds.

Chondromatosis of the knee joint is a long-term progressive disease of unknown etiology, consisting in the formation of multiple cartilaginous nodes inside the synovial membrane of the joint bag. Cartilaginous nodes can measure from a few millimeters to several centimeters, and their number varies from a few individual formations to several tens. With a significant number of cartilaginous nodes or with the formation of large-sized nodes, moderate pain sensations appear, there is a crunch and limb limb movement in the affected joint, swelling, and with the formation of the "articular mouse" - infringement. There can come a sharp disfigurement and a significant restriction of the function of the joint.

König disease or dissecting osteochondrosis( osteochondrosis) is a disease in which a patch of cartilage covering the bones gradually flakes and can even completely separate from the bone. In the knee joint, it affects only the condyles of the femur or patella( knee cap).Symptoms depend on the stage of the disease. At the beginning of the disease the patient complains of discomfort in the joint, minor pain. With the progression of the process, there is an increase in pain in the joint, a synovitis appears. There may be incomplete separation of necrotic areas of cartilage, joint blockage is possible( arises due to detachment of a piece of cartilage, leads to disruption of the joint).Further, the necrosis of the cartilage is completely separated from the bone, blockade of the joint, progression of pain and synovitis is possible. If the disease proceeds for a long time, the lameness leads to a decrease in the amplitude of movements in the knee joint and atrophy of the quadriceps femoris muscle.

With osteoporosis , a change in the structure of bone tissue occurs, which leads to an increase in their fragility and a tendency to fracture. Osteoporosis is characterized by the appearance of pain in the joints and bones, leg cramps, more often at night, aching back pain( spine), fractures.

Infectious diseases , including urogenital( such as chlamydia, gonorrhea, ureaplasmosis, etc.) and intestinal( dysentery, yersineosis, salmonellosis), flowing secretly, can lead to reactive arthritis of the knee joints. In this case, pain in the knee joints often occur not only when walking. Reactive arthritis of the knee joint is bad in that it affects the joint in addition to the tendon usually around. In addition, the inflammation of the knee joints are often associated with inflammation of a number of other joints and eyes, as well as unpleasant sensations in the genital area. Patients may note the association of arthritis with an anterior urogenital or intestinal infection.

Bone Tuberculosis .The disease begins either with the melting of the bone substance of the bone, or with the necrosis of significant areas of the skin, and this process eventually spreads to an ever larger and larger area. Regardless of the initial manifestations, tuberculosis of bones and joints causes the formation of a purulent fistula or a cavity that opens outward. It should be noted that after a few weeks the inflammatory process can stabilize, and the patient has a persistent remission.

Bone osteomyelitis is a purulent necrotic process that develops in the bone and bone marrow, as well as in surrounding soft tissues, caused by bacteria. At the beginning of the disease a person can complain of weakness, pain in the muscles. Then the temperature rises sharply to 39-40 degrees. Pain, clearly localized in the affected area of ​​the bone, occurs almost immediately. Sharp, boring or bursting from within, intensifying with the slightest movement - such pain is difficult with anything to mix up. The affected knee is edematous, the skin acquires a stagnant red color, the veins are dilated.

Neuropathy of the sciatic nerve - manifestations depend on the level and volume of nerve damage. For example, if L4 is damaged( 4 lumbar vertebrae), patients complain of pain in the anterior parts of the hip, along the inner surface of the knee and lower leg, violation of skin sensitivity along the front surface of the thigh and lower leg, weakness of the shin flexors and thigh reduction, knee reflex decreases.

Other causes of pain in the knee, such as bone and soft tissue tumors, are much less common.

Examination for knee pain

There are a great number of diseases of the knee joint: some are associated with ligament injuries, the second - with deformation of the cartilaginous tissues, the third - with dystrophic changes of the bone itself or inflammatory processes. The formulation of the correct diagnosis always begins with the patient's questioning and manual palpation. Depending on certain signs of the disease, the doctor may prescribe additional methods of examination.

1. General blood test( anemia, leukocytosis, increased ESR in rheumatoid arthritis, Bekhterev's disease);
2. Biochemical blood test: increase in uric acid with gout;
3. Microbiological examination( eg scraping from the urethra on Chlamydia if suspected of reactive arthritis);
4. X-ray examination - one of the main methods of examination for pain in the knee joint. Specific changes specific to a particular pathology will be seen;
5. Serological analysis: rheumatoid factor in rheumatoid arthritis;
6. Puncture bone biopsy for suspected bone tuberculosis and osteomyelitis: a sowing material is obtained by aspiration of pus from bone or soft tissues or bone biopsies are performed;
7. Joint puncture: the needle is inserted into the articular cavity and a part of the exudate is taken for examination for transparency, protein and blood cell content, and microorganisms are sown.
8. Arthroscopy - is carried out both for diagnostic and therapeutic purposes, for example, with a meniscus injury, cruciate ligaments, etc.
9. Densitometry - measurement of bone density in osteoporosis.
10. Ultrasound examination of the knee joint with suspected osteoarthritis, traumatic injuries and meniscus diseases, etc.
11. Magnetic resonance imaging and computed tomography( for example, with suspicion of chondromatosis).

Treatment of knee pain

There is no single universal way of treating all knee diseases. What treatment is needed in each case depends on the precise definition of the cause of the pain, because all of the diseases listed above require a different approach to their treatment. However, it is necessary to follow certain rules when there is pain in the knee.

1. Reduce the load to such an extent that there are no unpleasant sensations. With acute pain, completely eliminate the load and apply a fixing bandage, in order to ensure the knee immobility.
2. Wearing a bandage or bandage with an elastic bandage to stabilize the joint.
3. On the recommendation of a doctor, use of hot compresses for heating the knee. This is done to improve the microcirculation of tissues. You can use warming up ointments( for example, finalgon).
For acute pain in the first two days - a cold compress( plastic bag with ice or a bottle of ice water).Cold compresses should be applied for 15 minutes, and then take a break for an hour in order to restore normal circulation in the leg.
4. Use of anti-inflammatory drugs( paracetamol, ibuprofen).
5. Careful warm-up of the joint before running and other workouts with a gradual increase in load, starting from the minimum.
6. The use of drugs chondroprotektorov. Such drugs successfully protect cartilage tissue, but they need to be taken by courses. One of the most effective chondroprotectors is glucosamine. It is a part of almost all drugs from osteoarthritis. However, not all forms of glucosamine are equally useful. For example, glucosamine hydrochloride is a substance with unproven efficacy, and is produced primarily as a dietary supplement. While stable crystalline glucosamine sulfate is the only form of glucosamine that has successfully undergone clinical trials. For example, based on the stable form of glucosamine, the drug Don has been developed, which not only removes symptoms, but also slows the progression of the disease, which significantly improves the patient's quality of life and postpones the need for endoprosthetics.

If, despite all the measures taken, pain in the knee does not pass, it is possible that the knee injury was more complicated than you thought at the beginning. In this case, you should always contact a specialist trauma specialist. The doctor should also consult if the pain has arisen spontaneously, for no apparent reason, with a strong, permanent and long-lasting pain, visible joint deformity, knee redness, a discoloration of the leg below the knee, and impaired sensitivity. Remember that often the health and mobility of your knee depends on the timeliness of the treatment started.

To which doctor will treat with pain in the knee

Depending on whether there was a trauma, this is a therapist or traumatologist. You may need to consult doctors of the following specialties: orthopedist, osteopath, rheumatologist, neurologist.

Physician therapist Kletkina Yu. V.