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Knee Pain

What are the causes of knee pain?

The causes of knee pain are osteoarthrosis, patellafemoral pain syndrome, ligament lesions, meniscus tears, arthritis (rheumatoid arthritis, hemophilic arthritis, pyogenic arthritis, gout arthritis), seronegative polyarthritis, periodic arthritis syndromes (Behcet’s Disease, intermittent hydrartrosis, palindromic rheumatism), neuropathic arthropathy, aseptic necrosis (Osgood-Schlatter disease, osteochondritis dissecans), bursitis, congenital and acquired deformities, Sudeck atrophy, pigmented villonodular synovitis, erythema nodosum, synovial chondromalacia, low back and hip pain.

Knee osteoarthritis (gonarthrosis, calcification)

Knee arthrosis comes after the spine within the joint disorders. The first complaint of a patient with knee osteoarthritis is pain. Pain increases with activity, usually disappears at rest. Knee pain increases as you climb up and down the stairs and sit up. Pain may also increase with load bearing and walking, and the patient may have to sit and rest because of the pain. Meteorological changes are also among the factors that increase pain. The second complaint but less frequent one besides pain is joint stiffness. It disappears with activity in a short time. Patients may also complain of crunching noises coming from their joints as a result of movement, swelling, and also the swelling in their joints. The diagnosis of osteoarthrosis is confirmed with radiography and its degree is determined.

In acute exacerbations, osteoarthritic knee rest is required. Canes can be given temporarily until pain and swelling are reduced. The elderly and those with persistent pain should be advised to use canes constantly. Cane and crutch can assure the resting, and also reduce the burden on the knee and help elderly patients to maintain their balance. Most patients with osteoarthritic knee are obese. It should be explained to the patient that excess weight will increase the load on the knee joint and this will cause pain. Patients should work on the sofa rather than standing and should avoid squatting and kneeling. Exercises are used to increase muscle strength and prevent the muscles around the joints from wasting. Physical therapy improves joint mobility and reduces pain. PRP and ozone therapy should be considered in these patients. Surgical treatment is applied to patients who do not respond to these treatments, cannot do their daily work and have deformity.

Patellofemoral pain syndrome

Patella is the knee cap bone. Patellofemoral pain is caused by disorders between the kneecap and other bones. Patients are in the young age group. Patellofemoral pain syndrome is characterized by pain and crackling in the anterior aspect of the knee. After sitting for a long time, it is characteristic that there is pain when climbing the stairs and especially when descending. It is uncomfortable for the patient to sit for an hour with the knees bent at 90°. Complaints fade with the correction of the knee. Patients say that they hear a cracking sound during activities such as standing up from the chair and climbing stairs. In the therapy, they should avoid kneeling and exercises should be regulated. Painkillers are used for a short time. Physical therapy is applied.

Meniscus tear

Meniscus are pieces of cartilage that provide bone harmony in the joints. Pain in meniscus tears is usually severe and sudden. The patient is forced to stop activity. Knee swells and it sometimes is locked. Knee radiographs, arthroscopy and MRI are diagnostic methods. Local ice application and ozone can be applied first in order to reduce the swelling. The liquid can then be aspirated or hot can be applied. In this period, it can be ensured that the tissue repair itself by the administration of PRP and prolotherapy. Patients should be prevented from stepping on the knee with meniscus tear by means of crutches. If there is no swelling in the knee, physical therapy can be performed. If the symptoms improve over time, the patient may gradually return to activities, unless there is pain. If symptoms persist or increase, arthroscopy and surgical indications arise.

Ligament Lesions

There are many ligaments that provide knee stability. The main knee ligaments are cross and lateral ligaments. Wear and tear may occur with traumas such as falling, crashing and strain. If there is no complete rupture, surgery is not necessary. In physical therapy, both electrical treatments and exercise are applied. Prolotherapy and PRP strengthens the ligaments. The patient may need to use a knee brace for a while.

Hemophilic arthritis

The prevalence of hemophilia was calculated as one in ten thousand births. Hemophilia occurs only in boys. Acute hemarthrosis, that is, bleeding and swelling of the joint, occurs after the child begins to walk. Swelling develops with severe pain following mild trauma of the joints, especially the knees, ankles and elbows. Recurrent acute hemarthrosis results in chronic hemophilic arthritis. Usually the knee joints are swollen and painful. Drugs that increase bleeding tendency such as aspirin should be avoided in treatment. Factor VIII and factor IX treatments are conducted. Aspiration is unnecessary unless it is too much and painful. Joints should be taken to rest. Exercise should be done to prevent muscle loss. In chronic hemophilic arthritis, a more intensive physical therapy program can be applied.

Behcet’s disease

It was first described in 1937 by Hulusi Behcet, a Turkish dermatologist. The places where the disease is more common are Mediterranean countries, and especially Turkey, Iran and Japan. Behçet's Disease involves young adults. The disease progresses with attacks and extinctions, and activity decreases with age. Men are more likely to develop the disease. Approximately every patient has oral ulcers, and this is usually the first lesion. Ulcers are mainly seen in the mucosa of the lips, gums, cheeks and tongue. It is usually numerous, repeats at different intervals and heals without a trace within a week or two. Genital ulcers look like oral ulcers. They are less recurrent than mouth ulcers and are more painful in men than women. Approximately half of the patients have recurrent uveitis attacks that can go down to visual loss. Eye involvement occurs within 2-3 years. Half of the patients develop arthritis in the large joints. It usually involves the knees, ankles, elbows and wrists. Arthritis disappears within a few weeks. In Bechet’s disease, veins, central nervous system and gastrointestinal system can be involved. No specific treatment is available. Men and adolescents should be treated more carefully because it is severe. Colchicine is effective on mucocutaneous and joint symptoms, especially in women. Arthritis usually resolves spontaneously. Azathioprine, sulfasalazine and interferon-α can be used in chronic and recurrent cases.

Cyst around the knee

Synovial cysts are the hernia or herniation of the synovial membrane through the joint capsule into the surrounding tissue. They are not real cysts. They are associated with a joint disease such as trauma, osteoarthrosis, crystal arthropathy and rheumatoid arthritis. Although it can be seen in every joint, it is most commonly seen on the posterior side of the knee, often with osteoarthrosis. In terms of prevalence, knee is followed by the shoulder and hip. Synovial cyst may be present with symptoms of joint pain, swelling, and limitation of joint movement. Treatment varies according to localization and accompanying symptoms. Pain relief rheumatism medications are given. If the cyst is large or there is no response to the medications, the fluid is drained, and corticosteroid or ozone is injected and bandaged. Sometimes surgery is required.