KNEE OVERVIEW

by DR KIRAN ADAM

What am I?

KNEE- The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia) the smaller bone that runs alongside the tibia (fibula) and the knee cap (patella) are the other bones that make the knee joint.

Two ligaments are located on the outside of the knee joint. These ligaments connect the femur to the tibia and fibula. They help manage side to side movements in the knee.

Two additional ligaments (cruciate ligament) inside the knee stretch between the femur and tibia. These ligaments help control the forward and backward movements of the tibia in relation to the femur.

The patella is a triangular bone at the front of the knee. It is attached by tendons to the quadriceps muscles of the thigh and allows the knee to straighten.

The bone surface of the femur and tibia has a smooth durable cover of the articular cartilage that cushions the ends of the bones and enables them to move easily.

THE HUMAN KNEE

What do I Do?

The largest joint in the body is the knee. It act as a hinge that allows your lower leg and foot to swing easily forward or back as you walk, run, or kick. The knee slightly rotates and moves from side to side.

What is knee pain?

Pain is a common knee problem that can originate in any of the bony structures compromising the knee joint. Knee pain can be aggravated by physical activity, as well as obesity, affected by the surrounding muscles and their movements and be triggered by other problems such as foot injury, knee pain can affect of all ages.

What are the knee pain symptoms and signs?

• Difficulty weight bearing or walking due to instability.
• Limping due to discomfort.
• Difficulty waking up or down steps.
• Locking of the knee (unable to bend the knee).
• Redness and swelling
• Inability to extend the knee, and shifting weight to the opposite knee and foot.

What causes knee pain?

Acute injury, broken bone, torn ligament or meniscal tear. Autoimmune conditions; Like Rheumatoid Arthritis, Osteoarthritis, Gout, Spondyloarthropathy Chronic use / overuse conditions; Osteoarthritis, Chondromalacia, IT band syndrome, patellar Syndromes, tendinitis, bursitis.

We will be focusing on Autoimmune conditions

1. History-Taking proper history, persons general health (Health Assessment Questionnaire), nature of knee pain (how long, how severe, does anything make it feel better or worse swelling, etc.).Rheumatoid Arthritis (RA) -RA is a chronic autoimmune disease that typically impacts multiple joints. Young female predominance, it may eventually attack the knee joint, causing pain and swelling.
2. Osteoarthritis (OA) - Osteoarthritis is a degenerative disease caused by wear and tear, is mostly in older age group and is usually localized to a specific joint. Over time, knee cartilage wears away, causing bone-on-bone rubbing and pain.
3. Spondyloarthropathy – Spondyloarthropathy are a family of long term disease of joints. They include Ankylosing Spondylitis, Reactive Arthritis, Psoriatic Arthritis, joint problems linked to Inflammatory bowel disease. Usually involve the attachments between your low back and the pelvis (sacroiliac joint) , affects joints predominantly Large joints such as knee, ankle associated with Psoriasis , Ulcerative colitis, Crohn's disease.
4. Gout-This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.

Diagnosis of knee pain?

• History-Taking proper history, persons general health (Health Assessment Questionnaire), nature of knee pain (how long, how severe, does anything make it feel better or worse swelling, etc.).
• Examinations - Physical examination inspect your knee for pain, range of motion grinding sound, swelling, warmth any deformity.
• Radiological tests X-rays are typically ordered to detect bone or joint damage, and help differentiate forms of arthritis. New bone formation may be common to both types of arthritis, but RA will also show erosion. MRI is used to evaluate the soft tissue of knee for ligaments tears or cartilage and muscle injuries.
• Blood test - Rheumatoid factor and cyclic citrullinated peptide (CCP) antibody tests are often used to confirm RA. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests may also be ordered to measure the level of inflammation in the body and severity of illness.
• Arthrocentesis (Removal of joints fluid) some conditions are best diagnosed by removal of a small amount of fluid form the knee joint small needle is placed into your joints and fluid is withdrawn this is done in sterile method, then fluid is sent to the laboratory for evaluation. This procedure is helpful suspected or to distinguish gout form different forms of arthritis.

TREATMENT-

• Medications - Disease – modifying Antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, and hydroxychloroquine, are commonly prescribed to slow the progression of RA. NSAIDS (Nonsteroidal anti-inflammatory drugs) to reduce the pain and inflammation such as Naprosyn, Diclofenacetc, Osteoarthritis knees Chondroitin agents like Glucosamine sulphate, Diacerin may slow cartilage breakdown and even stimulate cartilage growth under Rheumatologist supervision
• Physiotherapy - Strengthening the muscles around your knee will make it more stable. Your doctor may recommend physical therapy or different types of strengthening exercises based on the specific condition that is causing your pain. Arch supports, sometimes with wedges on one side of the heel, can help shift pressure away from the side of the knee most affected by osteoarthritis. In certain conditions, different types of braces may be used to help protect and support the knee joint. Don't be shy about using a walking aid, walking stick, walker, chair commode, knee braces, splints can also help you stay stable, non-weight bearing exercise (health cycle, swimming).
• Injections - some cases your doctor may suggest injecting medication or other substances directly into your joints example include corticosteroids in the form of triamcinolone acetonide injections into your knee joints may help to reduce symptoms of arthritis flare and provide pain relief which last for months, hyaluronic acid A thick fluid naturally lubricant joints improve, mobility, pain and ease which last for around 6 months.
• Lifestyle Modification - A proper diet, weight loss, and getting plenty of sleep can help alleviate some of the physical pain and emotional distress around knee RA, if you are overweight, losing weight reduces the stress on your knee). Footwear (shoe soft cushions), stop smoking & alcohol, do not sit cross leg.
• Keep extra pounds off. - Maintain a healthy weight; it's one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
• Surgery - If RA or OA progresses to bone-on bone pain and causes disability that's not relieved. with medication, surgery may be advised.