Acute knee pain

Acute knee pain: Description, Causes and Risk Factors:The knees provide stable support for the body and allow the legs to bend and straighten. Both flexibility and stability are needed for standing and for motions like walking, running, crouching, jumping, and turning. Like any joint, the knee is composed of bones and cartilage, ligaments, tendons, and muscles. Malfunction in any of this can lead to knee pain.Types of Knee Pains:Mechanical Knee Pain: Some knee problems result from injury, such as a direct blow or sudden movements that strain the knee beyond its normal range of movement. Other problems, such as osteoarthritis in the knee, result from wear and tear on its parts.
  • Inflammatory Knee Pain: Inflammation that occurs in certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus, can damage the knee.
Knee pain is a common presenting complaint in primary care. In addition, approximately 1.3 million patients are seen annually in US emergency departments with the problem of acute knee pain. The majority of knee pain is caused by patellofemoral syndrome and osteoarthritis.knee painAcute knee pain is often caused by twisting of the knee. Sports that involve running and jumping such as soccer, basketball, volleyball, tennis, and baseball, as well as contact sports such as football, wrestling, and hockey increase the risk of an acute knee injury and pain.Risk Factors:Knee osteoarthritis.
  • ACL rupture (anterior cruciate ligament rupture).
  • PCL rupture (posterior cruciate ligament rupture).
  • Medial meniscus injury.
  • Lateral meniscus injury.
  • Medial lateral collateral ligament injury.
  • Lateral collateral ligament injury.
  • Acute gouty arthritis.
  • Fracture.
Symptoms:Dull pain around or under the knee cap.
  • Swelling of the knee.
  • Pain worsen with walking downstairs, hills.
  • Also feel pain when climbing stairs.
Diagnosis:Medical history: The patient tells the doctor details about symptoms and aboutany injury, condition, or general health problem that might be causing the pain.Physical examination may include:Visual inspection for dislocations & fractures.
  • Presence and location of swelling (intraarticular, prepatellar bursa, posterior).
  • Presence and location of warmth.
  • Presence and location of crepitus.
  • Foot pulses.
  • Palpate for tenderness (peripatellar, patella, patella tendon, tibial tuberosity, medial and lateral joint lines, medial and lateral collateral ligaments, and pes anserine bursa).
  • Apprehension and pain with lateral displacement of patella for indications of patella subluxation or dislocation.
  • Active range of motion.
  • Passive range of motion.
  • Joint line pain with extension or flexion is compatible with meniscus tear.
  • Meniscal compression tests (McMurray's, Appley's) to evaluate for torn meniscus.
  • Varus/valgus instability (0° & 30° of flexion) for damage to collateral ligaments.
  • Evaluate hip range of motion for underlying hip pathology.
Diagnostic Tests:X-ray of the knee.
  • CAT (computerized axial tomography) scan of the knee.
  • Bone scan.
  • MRI scan.
  • Arthroscopy.
The majority of knee pain is caused by patellofemoral syndrome and osteoarthritis.MRI of the knee has been proven not to be superior to the clinical exam by an experienced examiner in the evaluation of acute knee injuries. MRI may be useful to assess bone pathology underlying chronic knee pain.Differentiating between knee pain without constitutional symptoms, knee pain with constitutional symptoms, and traumatic knee pain is helpful in determining a diagnosis.Patients with knee pain and swelling who have non-bloody aspirates may also have serious knee pathology.Treatment:Many knee conditions will improve with conservative treatment consisting of low impact activities and exercises to improve muscular strength and flexibility. Patellofemoral dysfunction is best treated with vastus medialis strengthening and hamstring and calf stretchingTreatment Options:Non-steroidal anti-inflammatory agents (NSAIDs): Evidence is lacking for impact on outcome of osteoarthritis. May be useful to decrease swelling. Probably the drugs of choice for inflammatory arthritis. Other less toxic agents have been proven to be equally efficacious as analgesics.
  • Rest, Ice: 15-20 minutes every 3-4 hours for first 24-48 hours.
  • Crutches: Should be used if unable to bear full weight without pain or for specific conditions for which non-weight bearing is indicated (e.g., fractures, osteochondritis dissecans). If partial weight bearing is acceptable, encourage range of motion and weight bearing as tolerated.
  • Bracing: Indicated only if injury is unstable and needs immobilization, or for specific support of an injured structure when the diagnosis has been established (e.g., collateral ligament sprains). Routine use of immobilizers is discouraged because resulting stiffness and pain delays recovery.
Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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