Thursday, 4 April 2013

Knee pain: What you need to know

Many people suffer from pain in their knee joints. One out of three patients that see an orthopaedic doctor do so for knee-related problems. It affects both the young and the old.  Most of us would- know someone with this problem. Your knee pain could be only a mild discomfort that occurs now and then, but may be severe enough to interfere with your work and lifestyle.  In the extreme, knee pain can be a crippling condition whereby performing the activities of daily living is impossible.

I know people who are wheel-chair bound because of knee problems. We also know that a lot of sports people have their career terminated because of knee pain. It can be a serious problem in many cases. So, it is important you talk to your doctor early about your knee pain because treatments are now available for most of these conditions.

Some people think their knee pain is caused by black or bad blood. To some people, any pain is either arthritis or rheumatism. Sometimes, people are told they have arthritis even when x- ray pictures do not suggest the diagnosis. An unwary doctor may not think of other possibilities as cause of pain. Treatment would not work unless you have an accurate diagnosis.

Causes of knee pain
There are many things that can cause the knee to hurt. Awareness and knowledge of the causes of knee pain lead to a more accurate diagnosis. Knee pain can be either ‘referred pain’ or related to the knee joint itself. Referred pain means it is due to problems elsewhere, such as the hip, ankle or the back. You need to tell your doctor if you have problems in those areas.

The cause of knee problems may depend on your age. Although this discussion cannot exhaust the causes of the joint pain, I will try to explain the common ones. In adults and elderly, osteoarthritis is the commonest cause. Osteoarthritis is due to wear and tear at the end of the bones that make the joint. The cartilage that covers the end of the bones wears off and pain results when bone grinds on bone. That is why it is often called wear-and-tear arthritis.   Osteoarthritis is the result of advancing in age and most people above the age of 70 would be affected.  When Osteoarthritis occurs in younger individuals, previous knee injury is the usual cause.  Osteoarthritis gradually worsens with time, and no cure exists. But treatments can slow the progression of the disease, relieve pain and improve your joint function.

Inflammatory conditions like rheumatoid disease and gout can cause knee pain also.  Rheumatoid arthritis occurs when, for unknown reasons, the body attacks itself and part of the damage caused is the destruction of joints. It is a bad disease. Many joints of the body are affected, but its effect is most obvious in the hands, causing pain and deformity.

Gout is another cause of joint pain. It occurs when crystals are deposited in the joints. The joint of the big toe is the commonest site it affects. The knee joint is affected in some cases.  Conditions like gonorrhoea may also cause knee joint problem, resulting in pain. Such patients have history of discharge from their private parts or/and the eyes. Inflammation of the skin or the bursa sac (lining) around the knee may also cause pain.

Young people and sportsmen
Injury to the knee is the commonest cause in this category.  There may be fracture (break in bone) or dislocation. Dislocation of the knee cap may cause tendon or ligament injury. It may also cause bone fragments or cartilage to chip off, with the piece floating around in the joint. This is called loose body and could cause pain if caught between the bones.

There are other problems around the knee cap that would cause the knee to hurt.
Injury can cause a tear of the meniscus (the cartilage that serves as a cushion and shock absorber in the knee). Ligaments (the tough structures that make the knee stable) problems are also common. You might have heard of the anterior cruciate ligament or collateral ligament injury before.

In children and adolescents, septic arthritis is common when an infection by bacteria and other micro-organisms cause fever, joint swelling and pain. The child is not able to stand or move the knee. An urgent orthopaedic consultation is necessary to save the knee of such a child.  Septic arthritis may also occur in an adult due to previous injection into the knee, penetration of a foreign object into the knee or trauma to the knee.

Other causes in the young include rheumatic fever. The heart and the kidneys will also need evaluation. Haemophilia is a condition that causes people to bleed excessively, sometimes without an injury. Repeated bleeding into knee joints causes pain and stiffness.

I cannot mention all the causes in this write-up without boring you. A good description of your symptom and a careful evaluation by your orthopaedic doctor will help him to know the exact cause(s) of your knee pain.

Tests like X-rays and MRI scan may be necessary for complete assessment. Modern treatments like knee replacement and arthroscopy would provide excellent treatment in most cases. These operations are about the most successful of all time and are now available in some hospitals in Nigeria.
In subsequent articles, I would tell you more about arthroscopy and joint replacement.
culled from Punch:Author, Christopher Amuwa (Consultant Orthopaedic Surgeon)

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