Americans have a 45% lifetime risk of developing knee osteoarthritis.


An Introduction

Knee pain symptoms are among the most commonly experienced symptoms for millions of Americans. In fact, approximately 25% of the adult population reports knee pain that limits function and mobility. Americans have a 45% lifetime risk of developing knee osteoarthritis, the most common cause of knee pain symptoms overall.

Learn more about your knee by watching the video link.

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Common Knee Pain Symptoms

Swelling – Popping

Knee swelling is a very common presentation of joint conditions such as osteoarthritis, rheumatoid arthritis, or ligament injury. The swelling occurs due to a relative increase in the fluid found within the joint capsule. The joint capsule is a closed space, much like a balloon. Normally, this balloon has a small amount of joint fluid to aid in lubrication of the joint surfaces within the knee. After a sustained period of arthritic inflammation or significant injury, the amount of fluid increases. Just as in a water balloon that is over filled, the knee capsule begins to bulge and expand. The results in the commonly reported knee pain symptom of swelling or fullness of the knee.

Popping, snapping, or crunching Sounds coming from your knees are a common complaint for many patients. These unusual sounds and sensations may be related to knee joint degeneration or knee injury. Many patients worry that these sounds indicate a severe knee problem, however that is not often the case.  It is difficult to make a complete diagnosis on the basis of knee pain symptoms such as a sound coming from the knee. What is more important is whether the sounds occur with significant pain, disfunction, or limitation of activity.


Other Knee Symptoms

Stiffness – Decreased Movement

Knee pain with stiffness may be the first sign of trouble for many people. Stiffness in the knee can occur from mechanical problems inside the joint such as increased fluid, damage to the cartilage, or torn soft tissue. Timing of the stiffness can give an idea of the cause. Morning stiffness is among the most reported knee complaints and is most commonly associated with arthritis.

When suffering knee pain, it is often difficult to move, flex, or extend the knee. The limitation of movement may be due to the pain when moving the joint or actual damage to parts of the knee joint complex. Inability to move the knee or stand is a sign of more severe knee pain problem, such as a damaged ligament. If you are having trouble walking due to your knee pain symptoms, you should schedule an evaluation with a pain specialist.

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Functional Knee Problems

Instability – Weakness

In addition to knee pain, the knee may “give out” which is a sign of an unstable joint. Knee instability can occur with or without significant knee pain symptoms. However, an unstable knee will develop problems such as arthritis over time. This is why it is important to have your knee evaluated if you notice it “giving out“ or “buckling” even if you don’t have pain.

Decreased strength in the leg can occur with a painful knee condition. Weakness is seen when significant knee joint swelling occurs as in the case of severe arthritis or ligament injury. Also, a knee ligament or tendon injury could be the cause of your weakness. A cause of knee weakness that may be overlooked is a “pinched nerve” root in the spine that may or may not be associated with lower back pain symptoms. When spinal nerves are compressed, they cause pain and weakness in other areas of the body such as the knees and legs.


Knee instability - physical therapy

Knee Pain Evaluation

History & Physical Exam

The story of when your knee pain started, what provokes it, what helps it, severity rating, what time of day it occurs, and where else it goes are all critical pieces of information. Your joint pain specialist will go over this at your initial office visit to narrow down the causes of your knee pain symptoms.

In addition, your knee pain doctor will perform an exam of your knee. It is most helpful if you wear loose fitting clothes to allow direct examination of BOTH knees. The ability to visually inspect both knees can aid in diagnosis even if only one knee is causing pain. It is important to try to find the specific area of knee pain. Your specialist will perform several movements and touch the knee in order to isolate the source of your pain. It is at this stage that a determination is made regarding which knee images, if any, are needed.


Knee Pain Imaging

X-ray – CT – MRI

X-ray is the most commonly used knee pain diagnostic test. Knee X-rays provide a wealth of information for the joint pain specialist. Key information available from these images include the amount of damage inside the knee joint, thickness of cartilage, or the presence of a fracture. Knee X-rays do have a significant limitation when it comes to the soft tissue of the knee joint, however. This type of imaging focuses on showing the bones within the knee which include the femur, tibia, fibula, and patella. An injury of the meniscus, ligaments, tendons, or other soft tissue is not visible on a knee X-ray.

A CT or CAT scan is a type of X-ray that allows a 360 degree view around the joint. As with X-rays, a knee CAT scan focuses on the hard and bony parts of the knee. It is better suited to finding fractures and arthritis and not as helpful for tears or soft tissue injuries.

MRI of the knee is a commonly performed study in cases of suspected significant soft tissue injury such as an ACL tear and meniscus injury. Surgeons planning for knee replacement with surgical removal of the knee joint will often order these images. Another type of MRI can be done with contrast dye injected into the knee which is called an MRA of the knee. A knee MRA, or knee arthrogram, may be used to more clearly see the joint surfaces and capsular structures within the knee.


New Knee Imaging Techniques

High Frequency Ultrasonography

While technically not “new”, knee ultrasound has advanced dramatically in the last several years providing very valuable and precise information. Major advantages of ultrasound of the painful knee are a patient focused, real-time, low-cost, and functional movement study. In addition, high-frequency ultrasound of the knee shows defects smaller than 1 millimeter better than MRI!

Our joint pain specialists have extensive training and experience in utilizing ultrasound as an advanced technique to diagnose and treat knee pain symptoms. Another advantage of this type of imaging technique is that it is possible to diagnose and then provide treatment at the same visit. We utilize state-of-the-art ultrasound equipment and techniques to deliver the highest level of joint care and knee pain treatment.

The importance of using imaging to guide treatment is well researched and proven in medical studies. In fact, even expert orthopedic surgeons have been found to “miss” the joint in 1 of 5 patients having joint treatments without using imaging. Our knee pain specialists always use image guidance for our treatments in order to provide the highest, most consistent level of knee related care.

Knee ultrasound

Knee Pain Arthritis

Osteoarthritis - Rheumatoid Arthritis - Gout

There are over 100 described forms of knee arthritis and osteoarthritis is the most common form of knee arthritis worldwide. Osteoarthritis of the knee is thought to occur due to “wear and tear” or slow degeneration of the knee joint cartilage. In the healthy knee joint, the joint cartilage is smooth and glides easily back and forth. In osteoarthritis, the knee joint surfaces become damaged with cracks and pits. Ultimately, the result is knee joint inflammation, pain, and swelling that becomes progressively worse over time.

Rheumatoid Arthritis occurs when your immune system attacks joint surfaces in the body including the knees. Common findings in rheumatoid disease of the knee are significant pain, severe swelling, and warmth around the affected joint. There are blood tests that are performed to diagnose patients at risk of having knee pain symptoms from this condition. If your joint pain specialist suspects this condition, they will recommend a plan for evaluation.

Gout is form of inflammatory arthritis that can impact one or both knees. The problem in gout is the development of uric acid crystals within the joint that leads to inflammation, pain, and swelling. Gout typically occurs with short term “flare ups” that can result in severe pain and limitation of activity. Usually, gout will impact more than one join besides the knee and may move from side to side. If gout is suspected, your pain specialist will recommend further evaluation and treatment options.

Osteoarthritis and Rhematoid in a knee

Injury Causing Knee Pain

Knee Tendons

Knee tendon inflammation or injury is most commonly seen in active and athletic individuals, especially volleyball and basketball players. Due to repeated stress on the patellar (knee cap) tendon, small areas of tearing build up over time. When this occurs in athletes, it may be referred to as “jumper’s knee”. Other contributing factors include lower leg muscle weakness, foot-ankle misalignment, poor footwear, running on hard surfaces, and obesity.

Knee Bursitis

Bursitis of the knee can occur in any one of the multiple bursae located around the knee. The most common knee bursa to be affected is the prepatellar bursa over the kneecap in those with jobs that require kneeling frequently. In addition, infrapatellar and pes anserine bursitis are frequent sources of knee pain. Bursitis results from injuries such as falls, infection, inflammatory arthritis, and repetitive stresses.

Knee Meniscus

Meniscus injury is the most common injury of the knee joint cartilage. The role of the meniscus is to act as a cushion and stabilizing structure for the knee. Athletes commonly suffer injuries of the knee meniscus resulting in injuries than can impact knee health over many years. Meniscus tears resulting in knee pain symptoms have been indicated as a key factor in the development of arthritis as people age. Severe tears can be devasting and may lead to significant disability.

Knee Ligaments

Knee ligament injury also occurs frequently in those playing sports. Ligament injuries are often associated with meniscus tears. Of the four main ligaments within the knee, the ACL and the MCL are most commonly injured. Significant knee pain symptoms and instability of the knee should prompt you to have an evaluation to rule out a ligament injury.

Knee Fractures

Fractures of the knee can involve the patella (knee cap), femur (upper leg bone), or the tibia (shin bone). Concern for a fracture is warranted with severe pain and difficulty walking after a trauma to the leg. Simple X-rays can detect the majority of knee fractures.


Knee Pain Symptom Next Steps

The information here provides an overview of knee pain symptoms many of the things to consider when suffering knee joint pain. If you are suffering from knee pain that limits your activity or decreases your quality of life, contact us today. Our knee joint pain specialists have a wide range of advanced surgery-free knee treatments to get you the relief you deserve!

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