“Ooohhh… my aching knee!!!” Insider Secrets on How You Can Get Relief Quickly and Easily!
By Nathan Wei
When your knee hurts, getting relief is all that’s on your mind.
Getting the right relief, though, depends on knowing what’s wrong. The
correct diagnosis will lead to the correct treatment.
Know Your Knee!
knee is the largest joint in the body. It’s also one of the most
complicated. The knee joint is made up of four bones that are connected
by muscles, ligaments, and tendons. The femur (large thigh bone)
interacts with the two shin bones, the tibia (the larger one) located
towards the inside and the fibula (the smaller one) located towards the
outside. Where the femur meets the tibia is termed the joint line. The
patella, (the knee cap) is the bone that sits in the front of the knee.
It slides up and down in a groove in the lower part of the femur (the
femoral groove) as the knee bends and straightens.
the strong rope-like structures that help connect bones and provide
stability. In the knee, there are four major ligaments. On the inner
(medial) aspect of the knee is the medial collateral ligament (MCL) and
on the outer (lateral) aspect of the knee is the lateral collateral
ligament (LCL). The other two main ligaments are found in the center of
the knee. These ligaments are called the anterior cruciate ligament
(ACL) and the posterior cruciate ligament (PCL). They are called
cruciate ligaments because the ACL crosses in front of the PCL. Other
smaller ligaments help hold the patella in place in the center of the
Two structures called menisci sit between the
femur and the tibia. These structures act as cushions or shock
absorbers. They also help provide stability for the knee. The menisci
are made of a tough material called fibrocartilage. There is a medial
meniscus and a lateral meniscus. When either meniscus is damaged it is
called a "torn cartilage".
There is another type of cartilage in
the knee called hyaline cartilage. This cartilage is a smooth shiny
material that covers the bones in the knee joint. In the knee, hyaline
cartilage covers the ends of the femur, the femoral groove, the top of
the tibia and the underside of the patella. Hyaline cartilage allows
the knee bones to move easily as the knee bends and straightens.
connect muscles to bone. The large quadriceps muscles on the front of
the thigh attach to the top of the patella via the quadriceps tendon.
This tendon inserts on the patella and then continues down to form the
rope-like patellar tendon. The patellar tendon in turn, attaches to the
front of the tibia. The hamstring muscles on the back of the thigh
attach to the tibia at the back of the knee. The quadriceps muscles are
the muscles that straighten the knee. The hamstring muscles are the
main muscles that bend the knee.
Bursae are small fluid filled
sacs that decrease the friction between two tissues. Bursae also
protect bony structures. There are many different bursae around the
knee but the ones that are most important are the prepatellar bursa in
front of the knee cap, the infrapatellar bursa just below the kneecap,
the anserine bursa, just below the joint line and to the inner side of
the tibia, and the semimembranous bursa in the back of the knee.
Normally, a bursa has very little fluid in it but if it becomes
irritated it can fill with fluid and become very large.
Is it bursitis... or tendonitis...or arthritis?
generally affects either the quadriceps tendon or patellar tendon.
Repetitive jumping or trauma may set off tendonitis. The pain is felt
in the front of the knee and there is tenderness as well as swelling
involving the tendon. With patellar tendonitis, the infrapatellar bursa
will often be inflamed also. Treatment involves rest, ice, and
anti-inflammatory medication. Injections are rarely used. Physical
therapy with ultrasound and iontopheresis may help.
is common. The prepatellar bursa may become inflamed particularly in
patients who spend a lot of time on their knees (carpet layers). The
bursa will become swollen. The major concern here is to make sure the
bursa is not infected. The bursa should be aspirated (fluid withdrawn
by needle) by a specialist. The fluid should be cultured. If there is
no infection, the bursitis may be treated with anti-jnflammatory
medicines, ice, and physical therapy. Knee pads should be worn to
prevent a recurrence once the initial bursitis is cleared up.
bursitis often occurs in overweight people who also have osteoarthritis
of the knee. Pain and some swelling is noted in the anserine bursa.
Treatment consists of steroid injection, ice, physical therapy, and
The semimembranous bursa can be affected when a
patient has fluid in the knee (a knee effusion). The fluid will push
backwards and the bursa will become filled with fluid and cause a
sensation of fullness and tightness in the back of the knee. This is
called a Baker’s cyst. If the bursa ruptures, the fluid will dissect
down into the calf. The danger here is that it may look like a blood
clot in the calf. A venogram and ultrasound test will help
differentiate a ruptured Baker’s cyst from a blood clot. The Baker’s
cyst is treated with aspiration of the fluid from the knee along with
steroid injection, ice, and elevation of the leg.
Knock out knee
arthritis... simple steps you can take!
Younger people who have pain in the front of the knee have what is
called patellofemoral syndrome (PFS). Two major conditions cause PFS.
The first is chondromalacia patella. This is a condition where the
cartilage on the underside of the knee cap softens and is particularly
common in young women. Another cause of pain behind the knee cap in
younger people may be a patella that doesn’t track normally in the
femoral groove. For both chondromalacia as well as a poorly tracking
patella, special exercises, taping, and anti-inflammatory medicines may
be helpful. If the patellar tracking becomes a significant problem
despite conservative measures, surgery is need.
many types of arthritis may affect the knee, osteoarthritis is the most
common. Osteoarthritis usually affects the joint between the femur and
tibia in the medial (inner) compartment of the knee. Osteoarthritis may
also involve the joint between the femur and tibia on the outer side of
the knee as well as the joint between the femur and patella. Why
osteoarthritis develops is still being scrutinized carefully. It seems
to consist of a complex interaction of genetics, mechanical factors,
and immune system involvement. The immune system attacks the joint
through a combination of degradative enzymes and inflammatory chemical
messengers called cytokines.
Patients will sometimes feel a
sensation of rubbing or grinding. The knee will become stiff if the
patient sits for any length of time. With local inflammation, the
patient may experience pain at night and get relief from sleeping with
a pillow between the knees. Occasionally, locking and clicking may be
noticed. Patients with osteoarthritis may also tear the fibrocartilage
cushions (menisci) in the knee more easily than people without
So how is the arthritis treated? An obvious place to start is weight reduction for patients who carry around too many pounds.
exercises for the knee are also useful for many people. These should be
done under the supervision of a physician or physical therapist.
therapies include ice, anti inflammatory medicines, and occasionally
steroid injections. Glucosamine and chondroitin supplements may be
helpful. A word of caution... make sure the preparation you buy is pure
and contains what the label says it does. The supplement industry is
unregulated... so buyer beware!
of the knee with viscosupplements – lubricants- are particularly useful
for many patients. Special braces may help to unload the part of the
joint that is affected.
Arthroscopic techniques may be beneficial
in special circumstances. Occasionally, a surgical procedure called an
osteotomy, where a wedge of bone is removed from the tibia to “even
things out,” may be recommended. Joint replacement surgery is required
for end stage knee arthritis.
Research is being done to develop
medicines that will slow down the rate of cartilage loss. Targets for
these new therapies include the destructive enzymes and/or cytokines
that degrade cartilage. It is hoped that by inhibiting these enzymes
and cytokines and by boosting the ability of cartilage to repair
itself, that therapies designed to actually reverse osteoarthritis may
be created. These are referred to as disease-modifying osteoarthritis
drugs or “DMOADs.” Genetic markers may identify high risk patients who
need more aggressive therapies.
Newer compounds that are injected
into the knee and provide healing as well as lubrication are also being
developed. And finally, less invasive surgical techniques are also
being looked at. Recent technological advances in “mini” knee
replacement look very promising.
Wei (pronounced “way”) is a board-certified rheumatologist and Clinical
Director of the nationally respected Arthritis and Osteoporosis Center
of Maryland. He is a Clinical Assistant Professor of Medicine at the
University of Maryland School of Medicine and has served as a
consultant to the Arthritis Branch of the National Institutes of
Health. He is a Fellow of the American College of Rheumatology and the
American College of Physicians. Dr. Wei is the editor of the arthritis-treatment-and-relief.com website.
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