Knee Joint bones? Knee joint ligaments? Knee joint pain causes? Knee joint pain treatment? Knee joint physical therapy?

 

                                    Knee Joint

INTRODUCTION:

 Bony anatomy:

Knee joint is a uniaxial synovial joint hinge joint. It is formed by two articulations

1.     The articulation tibia and femur bone forming tibio-femoral joint

2.     The articulation between patella and patellar grove on femur forming patella-femoral joint.

Ligaments:

There are 4 major ligaments in knee joint, namely

1. Medial collateral ligament (MCL) or tibial collateral ligament: It is present on the medial (inner) side of the knee, connects the femur with tibia. It supports the medial side of the knee.
2. Lateral collateral ligament (LCL) or fibular collateral ligament: It is present on the lateral (outer) side of the knee, connects the femur to the fibula. It supports the lateral side of the knee.
3. Anterior cruciate ligaments (ACL): It is located at the front of the knee. It plays a role in limiting anterior translation of femur over tibia, resist tibial rotation, provides valgus-varus stability when knee is fully extended, and to a lesser extent, it controls extension and hyperextension along with PCL.
4. Posterior cruciate ligaments (PCL): It is located at the back of the ACL, at posterior knee joint. t plays a role in limiting posterior translation of femur over tibia, prevent excessive rotation of the knee, controls extension and hyper-extension of the knee.

 COMMON CAUSES OF KNEE PAIN:                                           

1.    Knee pain caused by arthritis:

·       Arthritis is derived from two words, “Arthro” means joint and “it is” means inflammation, so arthritis means inflammation or swelling of joints.

·       There are three types of arthritis:

Osteoarthritis: It is a degenerative joint disease, in which the tissues in the joint break down over time.

 Rheumatoid arthritis: It is a chronic inflammatory condition that affects a wide variety of systems of the body, including the joints, skin, eyes, lungs, heart, and blood vessels.

Gout arthritis: It is a painful form of inflammatory arthritis that usually affects the big toe, but can develop in any joint, including one or both of the knees. It is caused due to excessive accumulation of uric acid in blood.

·       Arthritis is caused by a number of factors including, wear and tear due to overuse (this is also called osteoarthritis), age, obesity, auto-immune disease (in case of rheumatoid arthritis), muscle weakness etc.

 

2.    Knee pain caused by Baker’s cyst:

·       Baker's cysts, also known as popliteal cysts, it is a fluid-filled growth behind the knee. It causes a bulge and a feeling of tightness.

·       Baker's cysts typically result from a problem inside the knee joint, such as osteoarthritis/ arthritis or a meniscus tear

·       In response to this inflammation, the knee produces excess synovial fluid, which travels behind the knee and accumulates in the popliteal bursa. The bursa then swells and bulges, forming a Baker's cyst.

3.    Knee Pain caused by cancer (osteosarcoma):

·       It is usually due to a primary tumor of the osseous structures or soft tissues of the knee joint.

·       Osteosarcoma is an aggressive bone cancer. This type of cancer occurs when a bone-forming cell starts growing out of control, making a malignant (cancerous) tumor in the bone. Cancers that start elsewhere in the body and then metastasize (spread) to bone are much more common than tumors that actually start in bone.

·       It is common in individuals ranging from 10-30 years (teenage growth spurts), Being tall for a specific age, Previous treatment with radiation for another cancer, especially at a young age or with high doses of radiation, Presence of certain benign (noncancerous) bone diseases etc.

4.    Knee pain caused by Osgood Schlatter disease:

·       Osgood-Schlatter disease is a condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the shinbone (tibia), a spot called the tibial tuberosity,

·       Children and adolescents get Osgood-Schlatter disease when they play sports that put repeated stress on the patellar tendon, it can lead to tenderness at the point where the patellar tendon attaches to the top of the tibia.

5.    Knee pain caused by Infection:

·       A common example of knee infection is septic arthritis.

·       Septic arthritis is a painful infection in a joint that can come from germs that travel through your bloodstream from another part of your body. Septic arthritis can also occur when a penetrating injury, such as an animal bite or trauma, delivers germs directly into the joint.

6.    Iliotibial band syndrome:

·       IT band syndrome is a common overuse injury, causing pain at the outside of the knee.

·       It occurs when the iliotibial band gets irritated or swollen from rubbing against your hip or knee bones.

SYMPTOMS OF KNEE INJURY:

Common symptoms faced by patients suffering from knee injury include:

•  Knee pain, from daily activities like walking, bending, standing and lifting
• Selling of knee joint
• Stiffness and decreased or loss of range of motion
• Redness and warmth to touch
• Popping or crepitus sounds

Knee pain does not happen unless there is any serious pathology or initial stages of pathology, a person with knee pain must consult a doctor as soon as possible to prevent complications and disabilities, here are some conditions when to see your doctor.

WHEN TO SEE THE DOCTOR ABOUT YOUR KNEE PAIN:

• Can't bear weight on your knee or feel as if your knee is unstable or gives out
• Have marked knee swelling
• Are unable to fully extend or flex your knee
• See an obvious deformity in your leg or knee
• Have a fever, in addition to redness, pain and swelling in your knee
• Have severe knee pain that is associated with an injury.

TREATMENT OF KNEE INJURY:

1.    Medications:

The doctor may assign medications to relieve pain, reduce inflammation and relax muscles. Rheumatoid arthritis require special medications to be used during daily living to prevent flare ups.

2.    Physical therapy treatment:

·       PRICE therapy (Protection, rest, icing, compression and elevation) during the initial stages of injury.

·       Using of modalities like hot pack, short wave diathermy, TENS, Infra-red lamps and ultrasound to relax muscles.

·       Patellar mobilization, knee distraction techniques and knee mobilization may be used to mobilize the knee joint to gain range of motion and reduce pain.

·       Knee Range of motion exercises to gain ranges if compromised.

·       Strengthening exercises of the muscles around the knee joint, including the quadriceps, hamstrings, tensor fascia latae, calf muscles, abductors and adductors, through knee isometrics.

·       Stretching of muscles that affect knee joint with their tightness.

·       Kineso-taping for lowering load on the joint and better healing purpose, bracing can also be considered.

3.    Injections:

In some cases, your doctor may suggest injecting medications or other substances directly into your joint. Examples include:

·       Corticosteroids: Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that may last a few months. These injections aren't effective in all cases.

·       Hyaluronic acid: A thick fluid, similar to the fluid that naturally lubricates joints, hyaluronic acid can be injected into your knee to improve mobility and ease pain. Although study results have been mixed about the effectiveness of this treatment, relief from one or a series of shots may last as long as six months.

·       Platelet-rich plasma (PRP): PRP contains a concentration of many different growth factors that appear to reduce inflammation and promote healing. Some studies have found that PRP may benefit certain people with osteoarthritis.

 

4.    Surgery:

Under extreme cases, when knee injury or pain cannot be treated using conservative treatments, Surgery may be preferred. Different types of surgeries are as follows:

• Partial knee replacement surgery: In this procedure, the surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed through small incisions, so it mostly heals up quickly
• Total knee replacement: In this procedure, the surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.
• Osteotomy: This procedure involves removing bone from the thighbone or shinbone to better align the knee and relieve arthritis pain. This surgery may help you delay or avoid total knee replacement surgery.