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| Underlying diagnosis: |
Comments: |
| septic arthritis |
red, hot, swollen knee; mostly Staph. aureus, also streptococcal and gonococcal |
| inflammatory arthritis |
gout, osteoarthritis, RA, AS, psoriatic |
| knee trauma |
strain/sprain, meniscal tear, ACL tear, ligamentous tear, bone/cartilage injury |
| bursitis |
carpenter's knee, Baker's cyst, prepatellar bursitis, Anserine bursitis |
| growing pains |
in children during growth spurts |
| Osgood-Schlatter disease |
in athletically minded adolescents |
| avascular necrosis |
at medial compartment of knee in elderly females |
| congenital knee problems |
hypermobility, congenital plicae |
| alignment problems |
bowlegs, knock knees |
| malignant bone tumors |
osteosarcoma and others |
Common Causes Of Knee Pain
Introduction:
The knee is very exposed and therefore easily injured. It is weight bearing
and for his reason is at a higher risk when the patient is overweight.The
knee is a complex structure with a medial (inside)
and lateral (outside) compartment as well as a patellofemoral
joint.
All of these strucutures are held together with ligaments, a joint capsule and muscle tendons that are providing significant support to the knee. Knee pain can develop when any of these structures get injured. When there is pain in the knee, the patient usually starts limping as weight bearing may be painful and the range of motion is reduced. With inflammation the synovial pouches, called bursae, can contain fluid (called an "effusion") as does the knee joint. This makes the knee cap disappear and the normal contours of the knee are blunted. Knee pain can also be referred from the lower back, the hip, pelvis and in an adolescent even from a slip in the femoral growth plate ("slipped femoral epiphysis").
In the following I will describe each of these conditions in more detail, how to diagnose and how to treat it.
Inflammatory Arthritis
These traditional forms of arthritis tend to lead to synovitis, which is swelling of the synovial lining of the knee joint. Tests to diagnose and treatments to deal with these conditions vary according to the underlying diagnosis. The following links can be used to get more details regarding each of these forms of arthritis:
Growing Pains
They are harmless, but can be very hard on the parent's mind: they occur in the middle of the night in children who are in the middle of a growth spurt. The legs (and also the arms) are very painful, but this disappears very quickly upon treatment with massage. In the morning there is absolutely no pain and no loss of function. Excamination a the doctor's office is normal. Usually within a few weeks even the nightly aches and pains are disappeared (Ref. 2).
Avascular necrosis (also called "osteochondritis dissecans")
This conditiontends to happen suddely and occurs on one side, usually the medial aspect of a knee. There are predisposing risk factors such as prior treatment with systemic corticosteroids, a history of lupus, alcohol abuse, history of sickle cell anemia or the hormone changes of pregnancy. Also, a history of deep sea diving with exposure to increased barometric pressure can often be found. Part of the bone and hyaline cartilage of the medial femoral condyle is cut off the circultaion and dies off, but then gets regenerated. Technetium-99 bone scan or MRI scan can help in the diagnosis. Treatment consists of high tibial osteotomy or total knee arthroplasty (knee replacement), both of which would require a referral to an orthopedic surgeon (Ref. 4).
Alignment problems
The two major alignment problems are the bowleg (genu varus) andthe knock-knee (genu valgus).
Bowleg (genu varus)
For a period of time it is normal for a toddler to have bowlegedness.
However, by about 18 months this normalizes on its own. If it
persists, rickets (Vit. D deficiency) has to be ruled out. An
orthopedic surgeon should be consulted as uncorrected genu
valgus leads to premature osteoarthritis and the need
for total knee replacement later in life, which can be prevented
by intervening at a young age. Bracing usually helps to normalize
it, if not, correctve surgery might be needed in order to prevent
premature osteoarthritis.
Knock-knee (genu valgus)
Thisis not as common and usually peaks at age 3, then outgrows itself by age 9. It is more common in girls. If it persists, a referral to an orthopedic surgeon should be made as uncorrected genu valgus leads to premature osteoarthritis and the need for total knee replacement later in life, which can be prevented by intervening at a young age. There is a surgical stapling method available that can straighten out the malalignment (Ref. 3,p.2404).
Malignant
bone tumors: there are a number
of malignant bone tumors, the most common around the knee are
the osteosarcoma
and the malignant
giant cell tumor (X-ray here shown of a distal radius).
These are dealt with under this link: bone
cancer, where diagnostic tests and treatment are
also discussed.
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