With every action you take, your knees not only flex and align however also bear the weight of your body. The knees usually accomplish these jobs without symptoms; however this is not constantly the case. Pain provoked by correcting your knee can arise from acute injuries or chronic disorders impacting many structures in and around the joint, consisting of cartilage, tendons, ligaments, bursae, muscles, bones or the synovial membrane.
What Causes Knee Pain When You Straighten Your Leg
Each knee consists of 2 small pieces of rubbery cartilage called menisci situated deep within the joint. They serve as shock absorbers between the two main bones of the knee– the thigh, or thighbone, and the tibia, or shinbone. The medial meniscus lives on the inner side of the knee, and the lateral meniscus on the external side. Meniscus tears are common injuries, particularly throughout sporting activities. They also happen in older people, as the menisci thin and damage with time. Pain while aligning the knee is frequently present with a meniscus tear. Knee swelling may occur, particularly with tears triggered by a severe injury. Part of the torn meniscus in some cases catches in between the bones, causing locking of the knee.
Articular Cartilage Damage
Articular cartilage covers the surface of the thigh and tibia, making it possible for the bones to move smoothly throughout knee movements. Throughout decades, duplicated knee movements that accompany daily activities might ultimately damage the articular cartilage and result in osteoarthritis. As the cartilage deteriorates, the underlying bones enter into direct contact, causing pain and a grinding sound or feeling with knee movement. Joint swelling and stiffness happen due to accompanying inflammation. Knee defect typically develops with severe osteoarthritis.
Articular cartilage also covers the back of the kneecap or patella, and the trochlear groove, the anxiety at the lower end of the femur through which the patella travels as the knee flexes and aligns. Chondromalacia patella, or runner’s knee, takes place when the patellar cartilage is harmed. This condition frequently occurs in amateur and professional athletes due to recurring knee movements. It is more common in women, runners and people with patellar misalignment that avoids the kneecap from relocating the center of the trochlear groove. Pain accompanies knee motions, consisting of aligning, and after prolonged sitting with the knee bent.
Tendons are strong bands of fibrous tissue that link the ends of muscles to bone. The quadriceps tendon connects the quadriceps muscles in the front of the thigh to the upper part of the patella. Damage to the tendon can occur with recurring knee movements, mainly jumping and climbing up stairs. Chronic injury and inflammation produce quadriceps tendinitis, or jumper’s knee, which sets off the pain when correcting the knee. Less often, the quadriceps tendon partially or entirely ruptures, triggering sudden severe pain. With a complete rupture, the knee cannot be corrected without assistance.
The patellar tendon joins the lower part of the patella to the tibia. Regardless of its name, the patellar tendon is technically a ligament since it signs up with two bones. Repetitive knee motions can irritate the patellar tendon, leading to patellar tendinitis and pain when straightening the knee. The term jumper’s knee may likewise be used for this condition, as the same movements produce it as quadriceps tendinitis. Rarely, the patellar tendon ruptures partially or entirely, like the quadriceps tendon.
Ligaments are tight bands of fibrous tissue between bones that keep joints in proper alignment. Four ligaments support the knee. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are located deep within the knee joint. The median security ligament and lateral security ligament reside on either side of the knee joint.
Knee ligaments can be overstretched, resulting in a small sprain or actual tear. This is typically caused by an acute injury, such as an unexpected knee motion or a direct blow to the knee. Less commonly, sprains or tears are caused by wear and tear from repeated knee motions, particularly in older adults. Damage to knee ligaments might produce pain with knee straightening, especially if there is accompanying knee swelling. Instability, with the knee paving the way, takes place commonly with ligament injuries. A pop or snap may be heard or felt when a knee ligament tears. Significant swelling usually establishes quickly after ACL and PCL tears due to bleeding within the knee joint.
Bursitis and Baker Cyst
Bursae are sacs containing a percentage of fluid that different movable structures like tendons, ligaments, and muscles from each other or surrounding bones. They cushion portable structures, protecting them from excessive pressure when in movement. With repetitive motions, the amount of fluid in a bursa increases and inflammation occurs, leading to bursitis. Eleven bursae reside around the knee. Some, like the deep infrapatellar bursa situated underneath the patellar tendon, cause pain during knee correcting when they are inflamed.
A Baker cyst is a fluid-filled sac behind the knee. The bursa typically forms it in between the gastrocnemius muscle of the calf and the semimembranous muscle at the back of the thigh. However, it may likewise arise as an outpouching from the fluid-filled knee joint itself. Big Baker cysts often accompany severe knee arthritis and produce pain when the knee is corrected or completely bent.
Muscle, Bone and Synovial Membrane Disorders
Stress or tears of muscles that run behind the knee, such as the hamstrings or popliteus, frequently provoke pain when they are stretched during knee straightening. A fractured patella produces pain, swelling and bruising around the patella, and tries to correct the alignment of the knee can get worse the pain. This injury is usually brought on by a direct blow to the kneecap. A fracture at the upper end of the tibia that extends into the joint– a tibial plateau fracture– can also cause pain with knee straightening and other knee movements, along with standing. Knee swelling can be severe with this injury, as bleeding takes place inside the joint.
Inflammation of the synovial membrane — the tissue lining the knee joint– is particular of inflammatory arthritis, such as rheumatoid arthritis or gout, or infection in the joint. These conditions produce continuous knee pain that typically aggravates with knee movements. Knee swelling and other signs of inflammation or infection, such as redness and warmth, are generally present.
You might still be able to bear weight and walk gradually and thoroughly without assistance, however will probably require support to raise your lower leg and fully extend your injured knee. Patella fractures, quadriceps tendon tears, and patellar tendon tears all tend to be associated with an inability to align the leg.
We will carry out a detailed health examination and ask you a series of concerns about your symptoms and medical history This will assist us identify the condition that is affecting your knee. It is frequently challenging to diagnose meniscal tears based entirely on a physical exam and we might require to carry out a knee arthroscopy to look inside the knee.
MD will ask you a number of questions about your knee pain and how it developed. We will likewise ask you if you have problem moving your knee. Concerns we normally ask consist of:
- Does your knee catch or lock, or is your knee challenging to correct after it has been bent for a while?
- When do you experience reduced mobility or pain?
- Does your knee swell?
- Does your knee give way and make you fall or lose your balance?
We will examine your knee. Throughout the evaluation we try to find signs and symptoms that may indicate a meniscal tear. These signs include:
- Problem moving the knee throughout different maneuvers
- Clicking noises when we move your knee
- Tenderness in particular areas of the knee
Imaging research studies
In a lot of cases, we might need to order extra tests, including imaging studies such as X-rays, to search for any arthritis in the knee or fractures of the bones. We might purchase an MRI to examine your knee if the diagnosis is uncertain or if surgery is an option.
If we believe you have an extreme meniscal tear that needs to be fixed, we may require to look inside your knee utilizing a special scope called an arthroscope. We use arthroscopy to diagnose and possibly deal with the problem.
Throughout an arthroscopy, we place a mini video camera into your knee through a little cut so that we can see the structures within your knee. We can often fix or cut the tear at the very same time.
We will go over treatment options with you. Treatments vary according to the seriousness of your tear and how active you are. The most efficient therapeutic techniques treat the tear and enhance the muscles that support your knee to avoid the meniscus from tearing again.
We typically advise that you attempt nonsurgical treatments first if your tear is not acute and you are still able to stand and stroll. Nonsurgical treatments are most proper if the following criteria use to you:
- Your symptoms established gradually over 1 to 2 days rather than instantly.
- You do not have problem standing or walking on your knee.
- Your swelling is minor.
- You can move your knee completely.
- We do not discover any instability of your knee.
Nonsurgical treatments consist of rest, icing the knee, using a crutch, physical treatment, and injections.
Rest. We will recommend you to avoid doing things that put pressure on your knee. Avoid squatting, kneeling, twisting, turning, or repetitive flexing like walking upstairs. Prevent using a manual transmission automobile with a clutch if you have actually left knee pain.
Avoid jogging, running, bicycling, or swimming utilizing frog kicks (breaststroke). We might encourage you to raise your leg as much as possible to assist the swelling decrease.
Ice. Ice your knee for 15 minutes every 4 to 6 hours.
Helpful gadgets. If you remain in severe pain, we might recommend that you use a crutch to keep your weight off your injured knee. We may recommend a brace if your kneecap is displaced or your knee muscles are weak and your knee is giving way frequently.
Injections. We may suggest a cortisone injection if the knee symptoms are significant sufficient to impact your activities. This helps in reducing swelling around the meniscus and enhance your pain and function.
Physical treatment. We might suggest physical therapy. Our physical therapists can establish a workout program for you to strengthen the muscles of the thigh and leg that stabilize your knee. Continuing these workouts in the house will help you prevent additional injury to your knee.
If your meniscus tore as an outcome of an injury and you have severe pain and can’t stand or stroll on the leg, surgery might be an option. If your tear established gradually and nonsurgical treatments are not helping we might likewise consider surgery.
If your tear is on the outside of the meniscus, it has a great chance of healing well after surgery because this area has a good supply of blood. In this case, we may attempt to repair the meniscus, or stitch the torn piece together. The type of tear determines if this is possible.
If your tear is on the inside of the meniscus, which does not have a good supply of blood, we might not try a repair work since this area is not able to heal well. If that holds true we might simply remove the torn tissue, instead of repairing it. Surgery to remove all or part of the meniscus is called a meniscectomy. This is normal for meniscus tears that have occurred slowly over time and some intense tears.
Many knee surgical treatments, including meniscus repair and meniscectomy, are carried out using an arthroscopic treatment. This is an outpatient surgery that does not need an overnight stay in the health center.
Throughout this treatment, we make small incisions in your knee. In one cut, we insert a fiber optic scope with an electronic camera attached to assist us see plainly inside your knee joint. In 2 other cuts, we insert small surgical instruments.
If we are fixing your meniscus, we utilize the surgical instruments to sew the meniscus back together utilizing dissolvable stitches or anchors. If we are removing part, or all, of your meniscus we will utilize the instruments to trim away the tissue and then extract it from the knee joint.
Although it is not always possible to prevent hurting your knee, there are a number of things you can do to reduce your risk of developing knee problems. It is also crucial to follow these standards to protect your knee if you have actually had surgery to fix or trim a damaged meniscus.
A couple of things that you can do are:
- Maintain a healthy weight. Extra pounds place extra stress on your knee. Speak to us about weight management resources and classes.
- Exercise. Regular exercise will keep your muscles strong and your ligaments versatile. Attempt workouts that do not stress your knee like swimming, fixed cycling, elliptical machines, or water aerobics.
- Wear shoes that support and cushion your feet.
- Prevent falls in your home by keeping your home well-illuminated, using hand rails on staircases, and utilizing durable ladders or foot stools if you require to reach for products in high shelves. Do not utilize a chair or step on the counters.
- Avoid extended and repeated kneeling, squatting, or frequent knee flexes.
- Use strolling sticks if you need to walk up and downhill.
Cautions and Precautions
If you experience repeating pain when attempting to align your knee, see your medical professional to identify the cause and appropriate treatment. Look for urgent medical attention if your knee is warm and red, specifically if you likewise have a fever as this may show an infected joint. If you sustain a severe injury to your knee, seek instant healthcare if you are unable to walk, can not flex or straighten your knee, or have severe pain, a deep wound or substantial bleeding. Likewise, seek immediate medical care if you discover a pop or breeze during the injury, or your knee appears very swollen or warped.
What doctor do you go to for the primary knee examination?
I will recommend you go first to orthopedic traumatologist if you unsure about cause of pain in your knee.