The knee is a large joint connecting the thigh bone (the femur) to the large shin bone (the tibia). The kneecap (the patella) joins the femur to form a joint, called the patellofemoral joint. The knee functions to allow movement of the leg and is critical to normal walking.
The meniscus is a thickened pad between the femur and tibia. The meniscus acts as a smooth surface for the joint to move on.
The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments).
Below the kneecap, there is a large tendon (patellar tendon) which attaches to the front of the tibia bone.
Knee pain refers to any type of pain or discomfort in your knees. This pain could be caused by an injury, like a sprain, or by a medical condition, such as arthritis.
Knee pain can also be accompanied by black-and-blue mark, burning, feeling of instability, Joint deformity, Stiffness or swelling & giveaway.
Knee pain is very inconvenient as the knee is responsible for carrying nearly the whole-body weight. Whenever there is pain in the knee, it is very difficult and sometimes impossible for the patient to even walk normally.
Knee pain can be felt on the inside of the knee, the outside, or along the patellar tendon.
The pain felt by the patient could be mild, moderate or severe, depending on the cause of pain. Mild pain can be treated at home with some rest and above the counter pain killers or anti-inflammatory medications. On the other hand, moderate to severe knee pain may take a lot of time to resolve particularly if an injury was the cause of pain.
Knee pain can be caused by one or more disorder; these include:
1.Torn ligament, tendon or meniscus:
May result in unstable knee, gives way when you try to stand, unable to straighten, may hear a popping sound during injury.
2.Patellar Tendinitis(tendinosis):
inflammation of the tendon between the knee cap and the shin often caused by repetitive running or jumping
-Patellar Tendinitis is often easily treated with home rest, simple pain killers and changing the patient’s exercise routine. With some of the cases, the condition may persist or cause tendon rupture in which case surgery may be required.
-Patellar tendinosis my end up with having a complete tear.
3.Sprains & Strains:
-Pain after overstretching, overusing or twisting, often during exercise
-Sometimes the ligament joining the knee joint can be sprained causing swelling and pain.
-Knee sprains require rest and in some cases the use of pain killers and refraining from strenuous activities and exercise. In other cases when the condition persists, the patient must consider medical treatment.
4.Knee Fracture:
A fractured or broken knee is a condition where one or more of the knee bones have been broken. These are most commonly those of the Tibia and Femur that usually break due to an accident or a sports injury. This causes ankle pain and swelling that hinders the patient’s ability to walk or perform daily movements or sports involving the knee. Breaking knee bones is diagnosed with an x-ray and requires placing a cast on the knee or surgery.
5.Dislocated knee cap
Kneecap changes shape and position after a collision or sudden change in direction or twisting, especially when playing or dancing.
6.Knee Arthritis:
Knee Arthritis is a general term for a group of more than 100 diseases. When it affects the knee joint it can produce swelling and pain, and may eventually result in deformity, loss of joint function, and decreased ability to walk.
Osteoarthritis is considered a “wear and tear” disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.
Sometimes osteoarthritis develops as a result of abnormal knee mechanics causes less stability in the ligaments, resulting in excessive strain on the joints, which can cause arthritis.
Similar symptoms may be caused by another form of arthritis, rheumatoid arthritis.
-Rheumatoid Arthritis: Patients having this condition are more susceptible to developing knee arthritis as the rheumatoid causes joint inflammation and cartilage damage. This disease is often associated with pain and a numbing or tingling sensation in the knee joint.
7.Bakers Cyst
A Baker’s cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee. The pain can get worse when you fully flex or extend your knee or when you’re active.
A Baker’s cyst, is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker’s cyst.
Although a Baker’s cyst may cause swelling and make you uncomfortable, treating the probable underlying problem usually provides relief.
1.Medication:
-Using anti inflammatory medications which provides varying results from one patient to the other and typically gives short term relief and is ineffective with others.
2.Physiotherapy:
-Performing some physiotherapy exercises with a specialist. This may provide a relief of pain after many sessions. This could be ineffective and some patients do not prefer this type of long course treatment.
3.Pain Killers and Exercise:
-This approach relies on using painkillers combined with stretching exercises and waiting for the pain to improve. This may show an effect within 1 to 6 months.
4.Surgical Intervention:
-When Is Surgery Needed?
When osteoarthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function.
-Some patients resort to surgery to end the severe pain. This approach has varying results according to the cause and severity of the pain and carries the common risks associated with any surgery or undergoing general anesthesia.
– Some types of fractures
5.Localized pain management injection without image guidance:
-This technique relies on injecting certain medication to the pain area at a doctor’s clinic (not radiologist) to relieve the pain. This approach may result in many complications due to the fact that the doctor can’t see where he injected the medication, so he may inject the wrong spot without any benefit and sometimes-even causes even more pain and discomfort to the patient. Statistic accurate localization of painful spot is about 10-30%.
6.Localized pain management injection with ultrasound guidance (our preferred method of administrating the medication):
-This is a modern, advanced, non-surgical treatment technique that relies on injecting specific medication accurately into the area of inflammation under ultrasound guidance. Using an accurate, effective, safe and non-invasive technique, make us achieve better results in terms of pain relief/management. Statistic accuracy rate is about 95-99%.
This technique uses FDA approved medication, which is injected, directly into the pain area under ultrasound guidance. This technique has the following benefits:
-Helps the radiologist to accurately identify the inflamed tendon or bursa, which is important to confirm the clinical examination.
-Allows the radiologist to accurately localize and effectively administer the medicine to one or more compartments of the painful area “if necessary” resulting in better and faster pain relief.
-The patient benefits the most by having the medication in the right spot without pain or complications.
-The patient is injected a numbing local anesthetic. A mild burning sensation can be felt due to the numbing anesthetic.
-The radiologist then uses an ultrasound probe to guide the needle to the painful area.
-The medication is then injected in the exact location.
-The injection needle is then removed.
-The patient can leave immediately after the injection. Some patients may be asked to wait for re assessment.
-After the procedure the patient may experience complete relief of pain.
-The maximum effect of the medications may take up to 2 weeks to show the maximum effect.
-The patient is instructed to use painkillers during the first few days if needed.
Different patients respond differently to the same. So one may have a total relief and others may have residual pain and would benefit from another injection.
Most patients report the following after the procedure:
-A great reduction or total elimination of the pain for a period of several weeks after which they may need to have another injection to maintain the results.
-A great reduction or elimination of the pain for several months.
-A great reduction or elimination of pain for years after the procedure especially if complimented with physiotherapy.
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