The knee joint is the largest joint in the human body and is subjected to the most strain. Therefore there is a considerable risk of knee joint injury or disease.
The causes for knee complaints can vary widely. Generally speaking, one can differentiate between acute and chronic knee pain. Determining the cause of the complaints is important for optimum treatment.
Acute Knee Pain
Acute knee pain occurs mainly due to external force. The combination of bending and twisting is especially risky, and so is stopping suddenly with elevated shear forces. Pain usually occurs immediately in such cases. The common knee injuries include:
- Contusions: An impact, blow or fall causes effusion, usually outside the joint capsule, resulting in typical blue-red skin discolouration after a delay.
- Strain due to overextension: Muscles, ligaments, the capsule and the tendons around the joint are affected. In addition to effusion and pain, affected individuals often experience knee joint instability over an extended period of time.
- Ruptured or torn off muscles and tendons: In healthy individuals, cruciate ligament injuries usually occur only due to extreme force. Cruciate ligament, tendon insertion or patellar tendon ruptures are usually associated with effusion, severe functional limitations and a loss of stability.
- Meniscus ruptures: These frequently occur due to combined bending and twisting in the knee joint. The meniscus can partly or entirely tear off the top of the shinbone as a result. In addition to typical "meniscus pain" and an often bloody joint effusion, the shifting of meniscus material into the joint gap can cause functional disorders and block the movement of the knee joint. The meniscus is affected most frequently on the inside of the joint (medial or interior meniscus).
- Cruciate ligament rupture: Strong shear forces in the knee joint can cause a cruciate ligament rupture. Stopping movements, direction changes and external forces that cannot be absorbed by the surrounding musculature because they are too sudden or too powerful are especially dangerous. The anterior cruciate ligament ruptures in the majority of cases.
Chronic Knee Pain
Chronic knee pain develops continuously. The intensity increases over months or years. Pain is usually felt during or after increased stress. Start-up pain is frequently described, i.e. after a few steps the pain initially gets better but becomes more severe again after increased stress. Chronic knee pain is caused by degeneration (pain) or joint inflammation.
- Primary knee osteoarthritis: This refers to wear of the articular cartilage. The loss of cartilage causes the surfaces to lose their sliding capabilities, leading to constant friction in the joint. This results in joint effusion, pain, blocking of the joint, joint stiffness and restricted mobility. Knee osteoarthritis has a variety of causes. It can occur as a secondary symptom following an injury of the capsular ligaments or as an axial malposition (knock knees or bowed legs). Other causes include disease and inflammation.
- Rheumatoid joint inflammation: With chronic rheumatoid joint inflammation, which usually occurs in phases, immune cells attack the synovial membrane. The resulting inflammatory substances destroy connective tissue and articular cartilage. Symptoms are initially non-specific and cannot always be assigned directly to arthritis. Slight fever, weight loss and fatigue are typical. This phase can start gradually but also abruptly. Classic complaints of the locomotor system, such as morning stiffness, occur later in case of knee arthritis. Then the joints are stiff and painful. This is associated with reddening, swelling and pain.
- Patellofemoral pain syndrome (pain behind the patella): This syndrome is a common cause of anterior knee pain. It mainly affects young women with no structural changes to the articular cartilage. For various mechanical reasons, the patella can painfully shift to the outside with this condition. It is often triggered by excessive strain on the joint, for example due to severe stress in sports, in connection with weak hip muscles or malposition of the foot, and from imbalances of the thigh muscles.
First the doctor asks a few questions about the complaints and accompanying symptoms. Important aspects include how long knee pain has been experienced, where exactly the pain is localised and when it mainly occurs. In order to better isolate the cause of knee pain, possible pre-existing conditions, existing injuries or past accidents are relevant to the diagnosis as well.
A thorough examination of the knee joint follows with the help of various movement tests. The doctor can determine where and how badly the knee is damaged based on the complaints (e.g. knee swelling , joint effusion, limited range of motion).
Additional tests may be required for diagnosis in case of knee pain, depending on the findings. These include X-rays, ultrasound scans, MRT, knee arthroscopy or joint aspiration.
Therapy depends on the cause of the knee complaints. Often it is sufficient to avoid straining the affected knee joint. The doctor may have to operate on the affected knee joint in some cases. After such an intervention, it is usually important to wear a corresponding orthosis and to rebuild the musculature through physiotherapy. A fitting with a support or orthosis offers you a non-surgical treatment option in order to stabilise the knee joint and relieve strain or guide the knee joint and alleviate pain.
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