MANUAL MINORS
Knee pain is a common symptom that can arise from a variety of causes, including traumatic injuries, degenerative diseases, inflammatory conditions, and mechanical overload. Depending on the cause, the pain may be localised to different areas of the knee (anterior, posterior, medial, or lateral) and may be accompanied by other symptoms such as swelling, stiffness, instability, or limited movement. The causes of knee pain can affect people of all ages and activity levels.
Diagnosis
Diagnosis begins with a detailed medical history and physical examination focusing on the location of the pain, the type of activity that aggravates or alleviates it, and joint mobility. Imaging tests such as X-rays, magnetic resonance imaging (MRI), or ultrasounds are useful to confirm the diagnosis and assess structural damage. In some cases, blood tests may be necessary to rule out inflammatory or infectious causes.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Patellar Tendinitis (Jumper’s Knee) | Pain in the anterior, below the kneecap, worsens with physical activity, especially jumping |
Patellofemoral Pain Syndrome | Anterior pain when climbing stairs, caused by cartilage wear behind the kneecap |
Knee Osteoarthritis | Chronic pain, stiffness, especially in the morning or after inactivity, radiological signs of wear |
Anterior Cruciate Ligament Injury | Instability, joint effusion, and pain after twisting or trauma, positive Lachman test |
Meniscal Injury | Knee locking or clicking, pain along the joint line, pain when rotating the knee |
Iliotibial Band Syndrome | Lateral knee pain, especially during running, caused by friction overload |
Bursitis | Swelling and localised pain in the affected area (prepatellar, infrapatellar, anserine) |
Gout | Acute pain, swelling, redness, and local heat in recurrent episodes, usually affecting the knee or big toe |
Rheumatoid Arthritis | Inflammatory pain, prolonged morning stiffness, affects multiple joints, accompanied by systemic signs |
Patellar Fracture | Severe pain, inability to extend the leg, evident deformity on X-rays |
Emergency Management
In emergencies, the management of knee pain focuses on relieving symptoms, stabilising the joint if necessary, and ruling out serious injuries. The RICE protocol (rest, ice, compression, elevation) is recommended to reduce inflammation and pain.
Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain management. In cases of acute trauma or instability, it may be necessary to immobilise the knee until a more precise diagnosis is made and to refer the patient to a specialist.
Definitive Treatment
Definitive treatment depends on the underlying cause. Traumatic or mechanical injuries, such as ligament or meniscal tears, may require surgery. For inflammatory or degenerative diseases, treatment includes physiotherapy, pain control, and conservative measures such as weight loss and muscle strengthening. Systemic inflammatory conditions, such as rheumatoid arthritis or gout, require specific medical treatment with immunomodulators or medications to reduce uric acid.
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