Knee pain – a widespread symptom, indicating the difficulty in the body – the case of diseases of the joints, or simply an increase in load of work on the legs.
Difficult to find a man, never experiencing knee pain at some period of his life. The discomfort, whiplash or pain of varying intensity of the knee joint occur between adults and children because of many reasons. The older a person becomes, the greater is the probability of the onset of various diseases, the first symptom is knee pain. This happens due to the characteristics of the age of the body: slowing down of metabolic processes, wear and tear of the cartilage of the joints, the membership of other muscle-skeletal problems, blood vessels, nerves.
Due to the complex anatomical structure, a plurality of structures and found significant loads, and often overloads, knee joints are very vulnerable. Damage to any item of the structure, for example, of the bag, leads to disorders of motor function of the knee and, as a result the pain syndrome. Ligaments and menisci are considered the most vulnerable, are injured in 80-85% of cases.
The anatomical structure of the knee
The knee is formed by the articulation of the knee, the distal end of the femur has two condyles, and sottocondili, tibial tubular bones, muscles, nerves, blood vessels, ligaments of the apparatus, places of interest, such as the patella (places of interest, such as a knee), structured handbags, and menisci.
The knee joint is one of the main joints of the body. On top of it suitable thigh. The articular surfaces of its lateral (outer) and medial (internal) condyles articulate with the places of interest such as the patella bone and tibial. Meniscus, which represent the connective tissue, cartilage, serve as shock absorbers to the joint. Thanks to them, occurs the rational distribution of the weight of a person on the tibial plateau and increases joint stability. Thin, biceps, paliperidonesee and other muscles synchronize incidence of ligamentous structure, by providing the motor activity of the knee.
The elements of the knee are connected by a lot of bales. Within the municipality there are two posterior cruciate ligament and front. Podmyshalsky bedernau bones are connected with the fibula and tibia bones warranty bundles. Oblique ligament popliteus is located in the back of the bag of the knee. From a series of cavities in the joints show home – the synovial capsule, it does not communicate with the joint. The blood supply of the elements of the knee occurs through the network of blood vessels, and innervation – nerve fibers.
The causes of knee pain
There are many causes of pain in the joints of the knees, which can be divided into several groups.
Traumatic injury of the elements of the knee:
- The injury to the knee. Following the rupture of the blood vessels local bleeding in the soft tissues of the joint. Redness, swelling, defeat nerve endings and causes pain, difficulty of movement.
- Full or partial rupture of the ligaments. Most often diagnosed partial violation of the internal integrity of the collateral ligament resulting from excessive eversion leg to the outside.
The external ligament is torn less than the domestic market. This happens due to a strong deviation of the shin on the inside, when the exposure of legs for example. Rupture ligament injury is inevitably accompanied by a hemarthrosis.
Complete rupture of both ligaments is often combined with lesion of the joint capsule, the liberation from the internal meniscus. Such a trauma causes an excess of mobility of the knee, accompanied by a sharp pain, the intensity of which depends on the degree of rupture.
- Hemarthrosis of the knee , rupture of the blood in the joint cavity. It is traumatic and non-traumatic character. Traumatic hemarthrosis occurs when retinal tears of the meniscus, a partial or total retinal tears of the ligaments, intra-articular fractures, contusions the knee area. Non-traumatic option is one of the symptoms of diseases characterized by increased fragility of the walls of the blood vessels or a violation of the coagulation system of the blood. These include hemophilia, scurvy, a severe form of bleeding diathesis. Accumulated in the joint cavity the blood compresses the tissue, thus interrupting the circulation. A pigment – special emosederina – negatively affects the ligament, hyaline cartilage, bag the synovial fluid, with consequent loss of elasticity. The result of a lesion of the articular bursa is swelling its villi and reinforced the production of synovial fluid. The result of repeated hemorrhages, becomes degeneration and joint destruction.
- Patella miniscope – violation of the integrity of the menisci of the knee. When side forms a damaged outer meniscus, when the medial inside. This is one of the most common, but difficult-to-diagnose knee injuries. In the risk area of the disease are not only athletes involved in intense training, but also to common people. Meniscus tear can occur from an unusual movement during the rotation of the trunk, the exhibition legs, a strong blow to the knee.
- Dislocation of the places of interest such as the patella – the pathological displacement of the places of interest such as the patella. The trauma is diagnosed not more than 0.7% of cases by the total number of contortions. Most often occurs the external dislocation, at least – the internal, very rarely – vertical or torsion bar. When incomplete places of interest such as patella luxation, determined on a protective coverings-sterile (outer) condyles, with the full – out from the lateral condyle.
- Closed or open fractures of the knee, the upper phase the tibia or the lower of the department bedernau bones. These injuries are often combined with injuries of the soft tissues of the knee, causing a massive hemorrhage, the excessive mobility in the knee area, its deformation.
Inflammatory and degenerative-dystrophic diseases of the articulated elements of the knee:
- Arthritis inflammatory defeat of the knee joint. A similar mechanism of development of the malocclusions observed in osteoarthritis, ankylosing Spondylitis, rheumatoid arthritis, gout (the deposition of urate in the joints).
- Osteoarthritis (gonarthrosis) with the defeat of the knee non-inflammatory character, which affects all of its facilities and that leads to serious-to the degenerative changes.
- Bursitis with synovial inflammation bourse causes pain when the flexion-extensor movements of the knee.
- Consists of the tendons of the knee – inflammation of the capsule of the goose leg, the hock, as well as the muscles and ligaments that surround the joint. When the pain occurs mainly during the descent of the stairs, especially with a heavy load, and focuses on the inner surface of the knee.
- The chondropathy places of interest such as a knee – degenerative-necrotic alterations of the articular cartilage (rear) of the surface of the places of interest such as the patella. The degree of destruction can be different phases, the light softening to cracking and full of abrasion.
- Chondromatous – serious chronic disease, due to a dysplastic process with islet rebirth phases of the synovial membrane shell in the cartilage – gondrom. It is not excluded, ossification of the individual cartilage phone
- Cysts Baker – the formation of thick stroke rounded tumor formation in the popliteal fossa, located on the opposite side of the places of interest such as the patella. The cyst is clearly visible in the condition of the flattened knee. Causes discomfort, pain to the thigh field. If of considerable size, compresses the blood vessels and nerves, resulting in the violation of innervation and the circulation.
- The disease Hoff – disease, accompanied by a defeat and a further degeneration of the fatty tissue that is located around the knee. Pinched, swelling and other damage of the fat cells – adipocytes – ending replacement of dense fibrous tissue. The end-of-buffer function "abbiategrasso pillow" is broken, per se, the adipose tissue becomes able to perform the role of shock absorber.
- Osgood–Schlatter disease – malocclusion, characterized by necrosis irregular of the tibia. Diagnosed children aged 10 to 18 years, dealing with sports. Under the places of interest such as the patella appears painful pigna, in the absence of treatment related to the limitation of the movement of the foot, or complete immobilization, and also loss of muscle mass.
Diseases in which it is possible irradiation of pain in the knee area:
- Were the hip – chronic defeat of the hip, accompanied by a progressive degeneration and degenerative changes in it. Often the pain extends downward on the outer surface of the thigh up to the knee or below.
- The neuropathy of the sciatic nerve – the non-inflammatory defeat of the nerve due to a compression of be crushed or spazmirovannah of the blood vessels. This nerve is on foot, starting in the lumbar region and passing through the coccyx and the pelvis. The block at any point along the path leads to the rupture of sensitivity or pain pounding.
- Fibromyalgia – extra-articular defeat of the soft tissues in non-inflammatory character, with a combination of symptoms such as arthralgia, muscle weakness, depression, etc.
Some systemic diseases, which can lead to knee pain:
- Osteoporosis is a disease of the bone, chronically progressive current, which alter the mineral composition and bone density. "Washout" of calcium from the bones leads to their fragility. The process is accompanied by pain or aching pain in the limbs.
- Tuberculosis of the bones. Tuberculosis defeat phase bone leads to a constant severe headache.
- Osteomyelitis is an infectious disease-inflammatory in nature which affects all the structural elements of the bones. The specific result, for example, tuberculosis, and nonspecific, this coccal, osteomyelitis becomes a reddening of the skin, swelling, local acute pain in the bones and muscles, feverish temperature.
- Some infectious diseases. Reiter's syndrome, in addition to involving in the process of the urogenital tract and the mucous membranes of the eyes, affects the joints. One of the manifestations of Lyme disease is arthralgia.
The types of knee pain
Depending on the etiology and the nature and intensity of the pain can be different.
- Sore. When arthritis, osteoarthritis.
- Strong, strong. Fractures of the elements of the knee, torn ligaments, bursitis, acute injury to the knee, exacerbation miniscope, deforming osteoarthrosis.
- Throbbing. During the execution the deformation arthrosis, lesions of the meniscus.
- Drill. In osteomyelitis.
- Stupid. When bursitis, chronic the Law.
- Burning. During the compression of the sciatic nerve, tuberculosis process nuts.
- The recovery. When jamming breakdown of the trunk.
- The pain when you walk. Cysts, Baker, bursitis, rheumatoid arthritis, gonarthrosis, periarthritis.
- The rest pain. In the case of gout, arthritis.
The diagnosis of disorders that cause pain in the knee
Fizikalna the exam:
- medical history and complaints;
- a visual examination through palpation of the knee.
Laboratory studies:
- biochemical and clinical examinations of the blood;
- serological tests of the blood;
- immunological analysis of the blood;
- rheumatology test;
- bacteriological analysis of synovial fluid.
The Invasive instrumental techniques:
- arthroscopy;
- the puncture of the joint capsule;
- puncture biopsy of the bone.
Non-invasive diagnostic up:
- x-ray of the knee;
- densitometry;
- ultrasound of joints;
- An mri or CT scan.
Treatment of knee pain
If the pain in one or both of the knee non-traumatic nature occur, you must first contact the physician, who, on the basis of complaints of the patient and of the results the objective of the inspection, it will send a small one orthopedic specialist, rheumatologist, recital or a neurologist. For any knee injury, it is necessary to consult a surgeon or orthopedic trauma.
The treatment in each case, the various, depends on the cause of the pain, that is, from the type of injury or illness. For every disease there is the treatment plan. But, to begin with, the patient should comply with some general rules:
- greatly reduce the duration of the trek and be on your feet all day;
- the athletes temporarily (until the healing) to drop out of workouts, and the common people from running or jumping;
- the amplification of the pain to completely abandon the movement, to impose on the knee fixing bandage gauze elastic;
- wearing a bandage or a bandage for the immobilization of the knee;
- when the lesion cold in-place traumatic impact.
Arthritis, psoriatic arthritis, crash of autoimmune disease serious-the need to complete treatment, conducted in the course of many months. Therapy baseline consists of immunosuppressive drugs, nonsteroidal anti-inflammatory drugs and hormonal drugs, drugs, gold, etc.
During the treatment for bursitis is used for pain and anti-inflammatory medications. If it is an infection, antibiotics. Therapeutic puncture bags is performed step by step to remove the excess fluid from the synovial cavity and/or the introduction of a corticosteroid. From chronic inflammation of the bursa helps to get rid of a surgical excision of the bag.
When deformation osteoarthritis effective intra-articular injections of corticosteroids, long-term use of NSAIDS and chondroprotectors. To relieve the pain topical prescribed compresses with dimexide or bishofit in, ointments and gels for the anti-inflammatory action. Helps massage, physiotherapy, medical gymnastics. The heavy defeat of the knee require surgery – total prosthesis of the knee.
Treatment of osteoporosis is ongoing intake of bisphosphonates, calcitonin, preparations of calcium, vitamin D, etc.
Treatment of rupture of the meniscus can be conservative or surgical. Conservative therapy consists of the use of analgesics, NSAIDS, hyaluronic acid, chondroprotectors. But initially, produce reposition the joint.
Types of intervention:
- meniscectomia;
- partial (part-time) meniscectomia;
- the transplantation of meniscus;
- arthroscopy;
- arthroscopic stitching meniscus tear.
In any knee injury after the treatment is very important period of rehabilitation, which should pass under the control of the rehabilitation or orthopedic. The doctor will be the best program of recovery of the joint function. The main methods of post-operative rehabilitation are considered massage and medical gymnastics. Also effective lessons of special equipment for the fitness, gradually developing the articulation of the knee.