Pain in the knee joint: causes, effective treatment, diagnosis

Every person experiences knee joint pain from time to time. This may be the result of a sudden movement or a symptom of progressive pathology. The knee joint is the largest and anatomically complex element of the musculoskeletal system. It represents up to 80% of physical weight, which leads to increased physical activity and risk of injury. A large number of capillaries, nerve fibers and muscle tissues make every injury, even the smallest, extremely painful. Injured nerves provoke an infectious-inflammatory process, which is accompanied by swelling, skin discoloration and increased local temperature.

As it progresses, the joint itself, intra-articular fluid and connective tissues enter a pathological state, which can lead to serious consequences - the development of arthritic diseases. A general understanding of the anatomical structure of the knee joint will help you understand what element can cause pain and what measures should be taken to eliminate pain.

anatomical structure

The anterior zone of the joint is formed by the patella, in simpler language: the patella. It is connected with the quadriceps (fascicular) muscle of the thigh, which continues into the patellar ligament and, in general combination, forms a ligamentous apparatus, consisting of the following types of fascia:

• lateral branches of the tibia (small and large);
• rear support nodes - sickle-shaped, dorsal, median and lateral;
• Transverse and cruciate articular ligaments of the knee.

The cruciate ligaments are the most susceptible to injury: a sudden movement, a high degree of rotation, a fall with subluxation lead to ruptures of the interminimal joints.

Ligaments are divided into two types:

1. Anterior: they have the function of stabilizing the ankle joint, in particular, preventing excessive forward displacement. They originate from the back of the large femur, intersect with the posterior ligaments in the knee socket, and attach to the notch between the anterior knobs of the tibia.
2. Rear: Keep your lower leg from rolling back. They begin at the upper anterior part of the femur, cross the joint cavity, and end between the dorsal protuberances of the tibia.

On the surface of the articular bones there is cartilage. At the junction of the tibia and femur, there are menisci, a kind of lining of the joint that plays a shock-absorbing and stabilizing role.

There are several bursae (three to five) in the knee joint that provide natural lubrication:

• above the patella;
• deep popliteus;
• between the tendons in the long muscle of the thigh;
• hypodermic patella;
• in the recess below the knee joint.

Thanks to the knee, a person can perform a step, flexion, extension within the limits indicated by the ligaments.

Causes of pain

Inflammation can develop in the following structures:

• cartilage;
• joint sheath;
• synovial fluid;
• tibia bones;
• muscles and tendons surrounding the joint;
• ligament apparatus;
• blood vessels, veins, arteries;
• subcutaneous fat;
• epidermis.

The most common causes of knee pain are:

1. Osteoarthritis is the cause of more than 50% of cases of knee pain. It is characterized by the slow and gradual destruction of hyaline cartilage. For a long time, it can be asymptomatic and sharply aggravated in the second stage. Pain in the knee joint occurs due to the growth of osteophytes that affect the nerve endings;
2. Arthritis is an inflammatory disease that occurs acutely. It can be an independent disease, spondylitis, or a complication of other joint pathologies: osteoarthritis, rheumatism, etc. Arthritis is characterized by intense pain, accompanied by swelling and redness;
3. Osteochondritis - articular cartilage becomes inflamed over time with degenerative arthrosis, mechanical injuries;
4. Periarthritis is a disease that occurs against the background of obesity (more often in women). Pathology affects the tendons, muscles, and subsequently passes to the shell of the knee joint. The pain is moderate, pulling (as in a sprain).
5. Chondromatosis is the formation of nodules in the hyaline cartilage tissue, which eventually spread throughout the capsule of the knee joint. In this case, pinching of soft tissues with a large number of nerve cells occurs. Because of this, the knee constantly hurts, even during the rest period.
6. Bursitis: The synovial capsule of the knee joint is rarely inflamed, only as a result of injuries or complications of collateral joint diseases, hence the pain.
7. Cellulite - subcutaneous adipose tissue can cause pain only in the case of closely spaced foci of concomitant diseases. Purulent arthritis, soft tissue abscess can cause inflammatory and painful processes in the protective layer.
8. Dermatitis: the epidermis is affected in case of infectious pathologies (eczema, erysipelas, psoriasis) or allergic reactions to external stimuli.
9. Osteomyelitis: The bone marrow becomes inflamed due to bacteria that have entered the corpus gelatinosum along with the lymphatic flow. It can also be the result of open injuries or a complication of surgical operations.
10. Synovitis: The capsule of the knee joint is most often affected in people over 55 years of age, as a result of rheumatism or other chronic pathologies. At a young age, you can get sick from a serious injury.

Types of pain according to location

Diseases that provoke the development of negative processes also form the type of pain:

• Severe excruciating pain: reactive arthritis, torn menisci and tendons, bursitis in the acute stage;
• Tolerable but constant pain: synovitis, bursitis in the initial degree;
• Stabbing pain - gonarthrosis, arthrosis;
• Vibrant - degenerative arthrosis, at the stage of joint deformation;
• Sharp burning pain: compression of the sciatic nerve, bone tuberculosis;
• Itching: osteoporosis, progression of inflammation of the synovial bursa, exacerbation of chronic meniscus injury;
• Cramps - inflammation in the soft tissues of the knee joint, muscles and tendons;
• Shooting pain: damage to the nerve roots.

diagnostic measures

If you experience severe pain in the knee joints, you should not postpone a visit to the doctor, hoping that "everything will pass. "Diagnosis at an early stage ensures the success of treatment and prevents the development of more serious processes that can cause irreparable damage to health and quality of life. For an initial consultation, you need to contact a therapist. After a standard examination, he decides to prescribe treatment (which happens in 70% of cases of knee pain complaints) or prescribes a full laboratory and hardware examination, with the participation of highly specialized specialists.

Running, suspicious pains are studied in different directions:

• Traumatology: if osteoarthritis, congenital or acquired dysplasia, joint fracture, dislocation, displacement, radiography, magnetic resonance imaging, ultrasound are suspected, a biopsy of fluid in the synovial sac is prescribed to find out where the pain in the knee joint comes from.
• Surgery: cyst under the patella, thrombosis, arthritis with purulent formations, tears in the tendons, menisci, ligaments, stones inside the joint, hemarthrosis, abscesses are diagnosed by ultrasound, fluoroscopy, computed tomography or magnetic resonance imaging, analysis of blood, general and rheumatoid factor, hyaline puncture cartilage in knee joint, etc.
• Rheumatology - the exclusion of systemic diseases (lupus erythematosus, rheumatoid arthritis, gout) is carried out with the help of laboratory tests. Complete blood count, hematology, rheumatoid protein, DNA test, uric acid level.
• Neurology and psychiatry: pinched sciatic nerve does not require a long diagnosis. Already on ultrasound, muscle tone and sites of inflammation will be visible. In the case of mental disorders, when the pain in the knee joint is not confirmed by a single fact, but the patient continues to experience torment (the so-called somatic pain), specific studies for mental abnormalities are prescribed.

Basic diagnostic methods

The most popular ways to quickly and accurately diagnose knee pain are:

• X-ray - allows you to view the knee joint in various projections and determine the location of the injury. The images show lesions already in the initial stages, in particular changes in the bone, synovial bursa or the appearance of osteophytes.
• Ultrasound examination - a modern, high-precision examination determines the thickness of the joint cover, the state of the ligamentous structure, the presence of inflammation of any kind, and general changes in the knee.
• Dopplerography: Examination of veins and arteries for aneurysms, plaques, and blockages. It quickly and efficiently determines the possible risks and the state of the internal walls of the blood vessels in percentage terms.
• Magnetic resonance imaging is currently the most accurate form of diagnosis. It allows you to see a clear three-dimensional image of the knee joint, pathological changes in the synovial fluid, even a slight deformation of the bone tissue, etc. It is rarely prescribed, due to high, for many, cost and contraindications. Patients with implants, metal prostheses and weighing more than 150 kg are prohibited from undergoing examination.
• CT - the principle of operation is based on X-rays, only in a more modern way. The images are taken in circular projection, which allows you to obtain a more accurate image of the knee joint, and thus determine the nature and extent of the injury.
• Angiography is a method of examining the patency of blood vessels by injecting a contrast liquid. It determines the functionality of the metabolic processes and allows to diagnose joint insufficiency in early stages.
• Complete blood count: It is prescribed to identify inflammation and pain. The totality of the indicators can even lead to the trace of specific diseases and determine joint pathologies only at the very beginning of the progression.
• Blood for rheumatoid antibodies: also indicates the presence of inflammation, but of a specific, systemic, or hereditary nature. For example, to establish a diagnosis of rheumatoid arthritis, this analysis is taken as a basis.
• Uric acid is an important test to determine the causes of pain and the stage of exacerbation of gout or infectious arthritis. An elevated level indicates the accumulation of salt deposits in the joints.
• Wasserman reaction: It is prescribed for suspected sexual infections, syphilis, gonorrhea, chlamydia, etc. The development of joint diseases in the context of specific diseases or as their complications are very common. Therefore, a positive test will allow the correct treatment to be prescribed, taking into account the type of infection.
• Tumor markers - help identify special substances in the blood that are secreted by a cancerous neoplasm or its metastases. Thus, for sarcoma of the synovial bursa, the presence of markers for vimentin, foreign cell antigen, and pancytokeratin is characteristic.

Treatment of pain in the knee joints.

Knee pain can be divided into those that require emergency medical attention. And those who are pre-diagnosed. Urgent conditions include all injuries, fractures, dislocations, abscesses, purulent inflammation, hemarthrosis (bleeding into the joint). The symptoms in all cases are identical: excruciating pain, swelling, redness, inability to move, fever in the knee joint, and a feverish state.

Treatment is limited to providing primary care until the ambulance arrives:

• the leg should be raised - put a rolled roller or a hard pillow;
• put an ice bandage on the knee and change it every 5-10 minutes;
• take an available pain reliever.

In all other cases, treatment is carried out after conducting full studies and establishing the causes. According to the anamnesis, drug therapy, physiotherapy, exercise therapy, massage, homeopathic treatment, local applications, spa vacations, and in extreme cases, surgery are prescribed.

conservative therapy

Traditional drug treatment of pain includes the following groups of drugs:

1. anestheticsTo alleviate the initial symptoms and ease the painful condition, you can take simple over-the-counter pain relievers. Severe cases associated with loss of mobility and excruciating pain require more serious medications that are prescribed only by a doctor and are available by prescription.
2. NSAIDs. Helps quickly relieve inflammation and swelling.
3. Chondroprotectors. Modern drugs, despite the long course of administration, provide regeneration of cartilage tissue. The effect is cumulative and long-lasting (up to 10 years, joint pain may not bother after a course of six months, subject to treatment in the early stages).
4. Glucocorticosteroids. Indicated for patients with autoimmune pathologies to reduce the production of the hormone cortisol and slow down the progression of the disease. Dosage and regimen are prescribed by the doctor strictly individually.
5. Immunosuppressants. They suppress the abnormal action of the defense system, thus stabilizing the progress of such dangerous diseases as rheumatoid arthritis, lupus erythematosus and vasculitis. They are rarely prescribed, only in the case of an accurate diagnosis and the inability to get rid of knee pain in other ways.
6. Hyaluronic acid injections. They are injected directly into the cavity of the knee joint and eliminate pain and synovial fluid deficiency. They also contribute to the restoration of hyaline cartilage, thus restoring the mobility of the knee.

popular recipes

Most people who begin to have pain in the knee joint try to eliminate discomfort with folk methods. You can make lotions, compresses and night applications based on homemade ointments or tinctures. A decoction of herbs, alcohol tinctures for topical use will help prevent a period of exacerbation and relieve obsessive pain.

The following plants and substances have anti-inflammatory effects:

• Coltsfoot;
• Grass of San Juan;
• oak bark;
• burdock root;
• bay leaf;
• chamomile flowers;
• Calendula;
• White and black kaolin clay;
• A solution of salt and soda;
• Honey products.

For example, mix 10 aspirin tablets, previously crushed, and a glass of liquid honey. Apply a thick layer on the knee in the area where the pain is located. Cover with transparent film and wrap with woolen fabric (scarf), preferably overnight. The pain is eliminated after the first application.

In the same way, you can apply a clay application where the pain appears. A little olive oil is added to the clay and water mixture to prevent hardening and severe tightening of the skin.

An effective recipe, which includes honey, salt and soda. Mix 1 teaspoon of salt and soda with honey, in sufficient quantity to abundantly cover the knee joint. This method performs three actions at once: removes excess fluid, relieves inflammation and pain, enriches with nutrients.

Oak bark in the form of an alcohol decoction or tincture strengthens blood vessels well and promotes normal blood circulation. For a decoction, pour 1 tablespoon of dried bark with 1 cup of boiled water, cook in a water bath for 20 minutes. Soak gauze in the decoction and apply to the knee warm (not hot) for 30-50 minutes to eliminate pain in the knee joint. For alcohol tincture use the same proportions, just replace the water with vodka. Insist in a dark cool place for 10-14 days. Apply in the same way.

By alternating various means and methods, you can preserve the disease for a long time, forget about pain and swelling. The effectiveness of alternative medicine has not been proven, despite the elimination of the main symptoms - pain in the knees.

Massage and therapeutic exercises for pain in the knee joints.

Comprehensive traditional treatment necessarily includes exercise therapy and massage. The exercises are recommended for all people who have had or have knee injuries, diagnosed with arthritis, osteoarthritis and other joint diseases, who lead an inactive life (sedentary lifestyle, static work, disability of 1-2 groups, housewives, etc. ).

Gymnastics can be performed independently, at a slow pace and in feasible mode. Gradually increase the number of exercises or, conversely, reduce, depending on how you feel.

1. From a lying position or sitting in a chair, slowly bend and unbend your legs, until a state of mild fatigue appears.
2. Bending the leg at the knee, perform rotational movements in a small amplitude, repeat the same on the second leg.
3. Lying on your back, gently pull your legs bent at the knees towards your stomach.
4. Put a pillow on the chair and sit so that the legs "hang", make circular movements clockwise and vice versa.
5. Sitting on a chair, slowly straighten your leg and hold it in this position for 2-5 seconds, slowly lower it, repeat with the second leg.
6. Stand up straight, straighten your back, slowly bend your leg at the knee and stay in the "heron" position for several seconds. If possible, every 2 days, increase the delay time.
7. If there are no contraindications and health allows, you can complicate the complex. Set the gym stick at the maximum level, which can be reached with one leg bent at the knee. Throw your leg over the "barrier" 10-15 times, then switch positions.
8. A small complex for stretching the lower leg also contributes to the rapid recovery of the knee joint. Rest your palms on the wall, bend your right leg at the knee, place your left leg behind you. The feet rest completely on the ground. Hold the pose for 30 seconds. Change legs.

Regular performance of simple gymnastics, accessible to anyone, will give visible results in a month: the pain in the knee joint will cease to bother, joint mobility will improve, swelling will disappear.

The effectiveness of gymnastics will increase significantly if you combine it with a massage course. It can be both a traditional exposure method and manual pain therapy. It should only be remembered that only experienced professionals with good recommendations should be trusted to carry out such procedures. Otherwise, manual manipulations, at best, will not have the slightest effect, at worst, they will lead to displacement of the joint and aggravate the pathological condition. Massage should be done periodically, no more than 10 sessions, 25-30 minutes per month. Daily procedures are strictly contraindicated. During the session, there should be no pain in the knee. If discomfort is felt, the procedure should be stopped.

home treatment

Treatment of knee pain at home is a prerequisite for outpatient therapy. The patient by all permissible methods should be helped to relieve pain and recover as quickly as possible.

Therefore, for these purposes, it is necessary to adhere to some rules for the treatment of all types of pain:

• Follow all the recommendations of the attending physician: do not stop taking prescribed drugs, do feasible gymnastics, be on time for physical therapy.
• Check your diet. Add plenty of fresh vegetables, herbs, and fruits to your diet. Exclude fatty meat, fried foods and semi-finished products.
• If necessary, use aids to relieve the load on the knee joint - cane, crutches and other special devices.
• Do not use, without prior consultation with a doctor, recipes of traditional medicine, even tested by time and neighbors. What helps one person may be categorically contraindicated for another.
• During the treatment period, if possible, avoid physical activity and ensure bed rest so that the pain does not return (therapeutic exercises are an exception).
• Provide a comfortable place to sleep and rest: orthopedic mattresses, comfortable chairs and armchairs, preferably with small supports so that you can comfortably lift sore legs.
• Light self-massage is allowed. Stroking, rubbing promote blood circulation, thereby enriching the tissues with oxygen. Thus, the muscle spasm is eliminated, and the pain becomes less intense.

Preventive measures

It is almost impossible to completely insure against injuries, sprains or dislocations of the body's most heavily loaded joint. Everyday life forces you to do housework, go to work, etc. In the course of normal activities, it is quite possible to receive an unexpected injury. But reducing the risk of developing joint diseases is within everyone's reach. Leading rheumatologists have developed a number of recommendations that will help protect yourself from dangerous pathologies:

• Establish and strictly adhere to a rational regimen: work-rest. This is especially true for people whose activities are associated with increased physical activity (athletes, builders, salespeople, metalworkers, miners, etc. ).
• Timely treat and undergo rehabilitation after any infectious disease. This rule applies even to "harmless" ones like acute respiratory infections or seasonal SARS.
• Avoid exposure to low temperatures, drafts. Dress for the weather to prevent hypothermia.
• Upon reaching the age of 35, it is desirable to undergo a course of treatment with chondroprotectors.
• Carefully monitor your weight. Increasing body weight will inevitably increase the load on the knees, this is worth remembering when eating another bun.
• To maintain normal weight, follow the principles of a healthy diet. More vegetables and dairy products: less sweet, spicy, salty, fatty and starchy foods.
• Reconsider your lifestyle: quitting smoking, alcoholic beverages and other toxic addictions will have a positive impact not only on your knee joints, but also on life in general. To overcome addictions, you can ask your relatives for help - the difficult stage will pass much faster and easier.

All people experienced pain in their knee joints, regardless of age, gender or social status. From the first steps, the joint is subjected to all kinds of tests: falls, bruises, injuries, sports, hypothermia. Despite this, many people manage to maintain the mobility, health and functionality of the main enclosure well into old age.