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Knee pain can stem from a degenerative (arthritic) condition, a systemic condition, or from a trauma. It is important to understand the cause of one's specific type of knee pain in order to make a correct diagnosis of knee arthritis. This video explains what causes knee pain, the symptoms that indicate knee arthritis, and how knee arthritis pain is diagnosed.
There are many causes of knee pain. In people over the age of 50, by far the most common cause of knee pain is knee osteoarthritis, which is wear and tear of the knee. In younger people, there are more musculoskeletal injuries or repetitive stress injuries. Everyone can develop knee meniscus tears, muscle injuries that refer into the knee, patellar tendinitis, patellofemoral syndrome - the way the patella tracks within the knee, bursitis, ligament strain, all sorts of musculoskeletal injuries can lead to knee pain. In addition, knee pain can be a presenting symptom for a more systemic problem such as lyme disease or rheumatoid arthritis. This is why it’s so important if you have knee pain to go to a doctor and get checked out so that the underlying cause can be identified and promptly treated.
What are the Symptoms of Knee Pain that Indicate Arthritis?
When knee pain is caused by arthritis, people are generally presented with dull, achy pain in the knee. It is often stiff in the morning and feels a little better as you get moving. If you walk for too long, the knee will often be painful. Depending on whether or not the arthritis is in the medial or lateral components, the anterior or front of the knee, it may be more painful with going up steps or going down steps. Down steps indicates more that it is behind the knee cap, and going up steps is more consistent with arthritis in the medial or lateral components of the knee.
In general it may be dull and achy, it may start to lock or catch. There may be episodic flares of knee pain where it gets swollen and then gets better, and it fluctuates as time goes on. Often colder weather or fluctuations in the pressure outside will affect the way that someone experiences knee pain. It is important to recognize that there is no one specific symptom that you will have with arthritis, but rather a constellation of them that will be put into the overall clinical picture.
How is Knee Pain from Arthritis Diagnosed?
The diagnosis of knee pain from arthritis begins with a history and physical examination. During the history, people with knee pain from arthritis will often have dull achy pain, often it’s a little more stiff in the morning and it feels a little better as you get going. If you go for a long walk there may exacerbation of the pain. Going up and down stairs depending on where the arthritis is may also make that more painful. Sometimes when people sit for a long time, they feel like they have to stretch their leg out because the knee will get stiff and achy and there may be episodic flares of knee pain as well.
During the physical examination, you may notice some crepitus and crunching as you move the knee around. And there will be some different provocative maneuvers. A lot of the physical examination will be about ruling out other causes of knee pain and to make sure there is no acute meniscal tear, ligament strain, or other more acute kinds of injuries. X-rays, MRIs, and other imaging studies will typically show arthritis in the knee, but it’s important to realize that images showing arthritis does not necessarily mean that arthritis is causing the symptoms.
So it’s important to always put imaging studies in proper context. That context is that imaging is one piece of the diagnostic puzzle but not the entire diagnostic puzzle. It’s not uncommon to see a patient who has pain on one knee, but X-rays of both knees shows the same amount of arthritis on both knees. The difference is that in one knee, there has been an inflammatory response to the arthritis and now that knee is symptomatic. So that’s the knee that we need to address. That is just one example of why it’s important to take your imaging studies in that appropriate context.