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Why I don't feel pain when I press the skin on my knee and elbow?

Why I don't feel pain when I press the skin on my knee and elbow?


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Does the muscle on our knee and elbow have some speciality ? Why are we unable to feel any sort of pain when I pinch it ? I also did it with my Mom and Dad and result was same .


There is several types of nerves in the body. Some nerves are specialized in sensing cold or hot temperature, some other to cuts and cell damage and others feel pressure and touch.

The answer to your question is that the nerves in your elbows and knees have less pain detectors and are in fewer number, thus with they are less sensitive.

Here's a funny little poster on BBC: Can you pinch yourself without it hurting?


Knee Pain Kneeling

Knee pain kneeling is a common problem and can really affect daily activities. You might get knee pain as soon as you kneel down, after kneeling for a while, when you get up from kneeling, or later on after having kneeled for a while.

Your knee may just feel a bit sore or you might get a burning, stabbing, stinging or sharp pain when kneeling. 

Here, we look at the most common causes of knee pain kneeling, help you work out which one is causing your pain and then look at what you can do to get rid of it.


What Causes Severe Knee Pain?

In most cases, severe knee pain comes on suddenly. It is typically accompanied by other symptoms such as swelling, instability, hot, red skin or there may be an obvious deformity of the leg, depending on the underlying cause.

Here we will look at the common causes of severe knee pain. We will look at how they present to help you work out what is going on and then what you can do to treat it.

We will also look at what signs to watch out for that indicate there is something serious going on that requires immediate medical attention.


You’re experiencing swelling.

One of the most obvious signs that a knee injury has occurred is excessive swelling that you can see or feel. This “pain freeze” cream has helped many people feel relief from their nagging pain. Based on the reviews, it’s the most effective on the market.

Swelling is most indicative of a serious cartilage or ligament injury to the knee, according to Taylor Brown, M.D., an orthopedic surgeon at Houston Methodist in Texas.

The amount of swelling that is considered “serious” is subjective. A small amount of swelling may not be cause for concern. If you notice a subtle difference between the sizes of your knees, you probably don’t need to sound the alarm just yet. It’s only extreme swelling you need to worry about.

When we talk about extreme swelling, what we mean is when one knee is significantly larger than the other. According to Dr. David Geier, a doctor specializing in orthopedic surgery, significant swelling “could be a sign of a torn ACL or a patella dislocation with a little piece of bone knocked off, and it should be checked out.”

If your knee doesn’t immediately appear swollen and you’re unsure, “feel the injured and normal knee at the same time, with a hand on each knee to compare the two,” he says. “A swollen knee will feel like a large, warm, fluid-filled balloon.”

If you experience any of the above, he recommends using a topical cream or using the RICE principle. Rest with crutches and activity reduction, ice for 20 to 30 minutes several times a day.

Compression with a soft knee sleeve brace (like this top seller) will help, and elevating your knee above the level of the heart. Over-the-counter pain medication can also provide relief until the swelling goes down.

Aaptiv has workouts specifically to help work around your knee injury. Learn more about Aaptiv here.

If your swelling is minor, you might be tempted to reach for the ice and Advil, but research suggests that some amount of swelling could be good for you. A Cleveland Clinic study confirmed that swelling is caused by a rush of cells called macrophages to the affected area.

Macrophages help repair your injury by ingesting damaged cells. This process results in swelling as fluid rushes into the holes in the tissue left by the macrophages, and this is key to muscle regeneration. Pain and swelling are an adaptive body response. While we often view them as an inconvenience, they are natural signals that we need to slow down.

When an injury causes swelling, the pain and stiffness prevent the athlete from using the injured part of their body. This is where the first part of PRICE – protection – comes into play. By protecting your knee from further injury, you have a better chance of minimizing the damage.

In addition to the severity of the swelling, the speed with which the swelling occurs could indicate a serious injury. If the knee immediately blows up and becomes the size of a grapefruit, then you’ve probably sustained a severe injury.

If you’re unsure or you have swelling that doesn’t subside after 72 hours, please consult with your doctor.


Why I don't feel pain when I press the skin on my knee and elbow? - Biology

Treating a patient for a foot or leg injury? Being unable to bear weight due to a sprained or broken ankle, foot injury, knee or lower leg issue, or because a patient is recovering from surgery, often requires a prescription for crutches from the doctor.

An estimated 7+ million people use crutches every year for short and longer term mobility issues, making them one of, if not the most, prescribed orthotic aid. Rates of crutch injuries aren’t well quantified, but a 2014 systematic literature review revealed that over 70% of crutch complications develop from the use of axillary crutches.

Types of Crutches

Axillary - axillary (or underarm) crutches are the most well-known type of crutch mobility aid. Height adjustable, and typically made of wood or aluminum, axillary crutches are placed under the armpit with the top padded part placed against the rib cage and the hand holding the grip below parallel to the top.

Forearm - a forearm (or Lofstrand or elbow crutch) crutch is typically utilized by a patient with longer term ambulatory issues. It features a cuff through which the forearm slides through to a grip the patient holds.

Platform - much less common and more often used for patients with diminished hand grip, platform crutches feature a horizontal platform which a patient’s arm can rest and be stabilized in place with straps.

Strutter - strutter crutches are a variation on the underarm crutch that offer a wide, flat platform base (instead of a tip) that touches the floor as well as an articulating foot. The top portions curve to rest under the arms without rubbing or irritating, like axillary crutches might.

Leg support - this type of mobility aid combines a crutch with a support frame attached or on wheels where the injured leg is bent backwards and set up to rest completely clear of the ground. Best for patients with lower leg injuries that don’t affect the bending of the knee, leg supports may also come in hands-free variations.

Dangers of Crutches

Crutch paralysis - Damage to nerve endings in the armpit (axilla) can result from constant pressure placed on them when using axillary crutches.

Skin irritation - additional irritation and rubbing of the skin when using underarm crutches, especially without padding, can be annoying and painful. Best pads for crutches reviews the best crutch pad options.

Slipping - the smaller point tips of some crutches and the lack of non-slip grip can lead to slipping and falling (especially on slick and uneven surfaces), which may exacerbate an existing weight-bearing injury.

Catching tip and falling - trip hazards on walking surfaces like cords may cause a patient to catch the tip of their crutch and lose their balance leading to a fall. Navigating stairways can also be extremely difficult with crutches.

Joint or muscle pain - less serious joint pain (arthralgia) or muscle pain (myalgia) may occur from the use of crutches as patients engage different muscle groups and incur many more awkward body movements and positions than they otherwise might. Neck, shoulder, back, and even elbow pain may occur.

What Should Clinicians Do

When prescribing crutches, it’s important for clinicians to go over proper gait (way of walking with crutches) as well as key reminders like using crutch pads to avoid nerve damage, how to adjust for height, and proper use of the hand grips to bear weight but avoid injuring the wrists.

For lower leg injuries, discuss crutch alternatives like hands-free leg platforms or knee scooters. Knee scooters are 3 or 4-wheeled devices with a raised leg platform and handlebars for easier maneuvering. Review how to navigate stairways and make recommendations for using help to traverse longer distances or go up and down stairs or inclines.

Avoiding injury from crutch use is possible, but it requires helpful guidance and instruction from clinicians (doctors, nurses, physical therapists, etc) to equip patients with the tools they need to practice good form and avoid falling.

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What are the Symptoms of Knee Nerve Damage? (with pictures)

There can be a number of different symptoms of knee nerve damage, but the most common include pain, numbness and tingling, and feelings of burning on or around the kneecap. Some people may also find that they have a hard time moving the joint, or they may feel stiffness or a dull ache when the leg bends in certain ways. Discoloration around the site of the damage is common, too, particularly if the nerve damage was caused by some sort of trauma. A number of different nerves run through the knees, but diagnosing damage can be somewhat tricky. Symptoms are often really similar to other joint problems, including cartilage damage and issues related to arthritis. In general, medical professionals recommend that anyone who suspects they may be suffering from knee nerve damage get evaluated and treated.

Nerve Damage Basics

The body’s nervous system is a complex series of chemical signals that course along the nerve pathways bringing messages about sensation and pain to and from the brain. Damage can happen almost anywhere, and is usually a result of injury or trauma. Nerves can get pinched, severed, or twisted, and moving joints like the knee provide many different opportunities for this sort of injury. Local nerves can be pinched or squeezed fairly easily between the bones and ligaments that together form the joint.

Some damage is obvious right from the start. This isn’t always true, though, since the damage may not be immediate. Certain knee injuries build on themselves over time. A person may feel as though he or she has healed, but may not realize till later that that healing has actually compromised the nerve structure, for instance or, a person may not even realize that there’s been an injury at all till certain signs of nerve damage begin appearing.

Pain that seems to radiate out of the knee is one of the most common symptoms of localized nerve damage. This often comes in varying degrees, and can alternate between throbbing and mild, dull aching. Sometimes moving the leg or changing the knee’s position can alleviate pressure, but not always. A lot has to do with whether the nerve damage is accompanied by inflammation or swelling at the site, and how seriously the nerves were impacted.

Nerves are usually responsible for carrying signals to indicate pain, and when they’re damaged they can respond in exaggerated ways — in some cases transmitting signals of pain that are disproportionate with the extent of the actual injury. Pathways that have actually been severed, on the other hand, sometimes fail to transmit any signals of pain, even if it would otherwise be warranted.

Numbness and Burning

Anther major sign of knee nerve damage is numbness or a lack of sensitivity. Numbness may be localized in the knee, or it might radiate to the upper or lower leg. Some people also describe the discomfort as a prickly “pins and needles” sensation. Tingling tends to come and go, but is usually most common after periods of inactivity.

People who have suffered these sorts of injuries sometimes also describe a feeling of burning just below the skin. Some of this is just perception, but in certain cases there are actual local skin temperature fluctuations that go hand-in-hand with these sensations. The patient's knee may feel warm to the touch, or in some cases colder than usual.

Restricted Movement

In many cases nerve damage can also restrict a person’s movement. Quick kicks, sharp bends, and other extreme or rapid movements may be delayed or too painful to perform. This is usually a result of muscle constrictions that happen in response to nerve signals indicating damage — which is to say, it isn’t caused directly by the nerves, but it is nonetheless closely related.

Patients with nerve damage to the knee may also experience weakness and immobility. This weakness may involve the knee or the entire leg. In some instances, the leg may buckle under and the patient may feel unsteady or lose his or her balance

Skin Discoloration

It’s also possible for the skin along the top or backside of the knee to become discolored. A bluish tinge surrounding the knee may indicate nerve damage, although the condition does not always cause this. Color changes are most common when the damage has been caused by a trauma that has otherwise left bruising on the skin, and in these cases it can be tough to distinguish between specific causes.

Diagnosis and Treatment Options

Injury to the soft tissue of the knee does not necessarily mean nerve damage has occurred. Ligaments or tendons may have been torn, yet surrounding nerves may be left undamaged. Although a physician or other healthcare expert may recommend a magnetic resonance imaging (MRI) test to determine if there are tears of tendons or ligaments, nerve damage will not always show up on this imaging, and as such still more testing may be required. In most cases these sorts of extreme measures are only taken if there’s no other way to treat a patient’s symptoms.

Care providers often recommend diagnostic tests if symptoms of peripheral neuropathy are present, which are basically more systemic nervous system problems. A test known as an electromyography (EMG) can determine if symptoms are related to knee nerve damage. From there, medical teams can come up with treatment plans. Sometimes physical therapy and rehabilitation can bring a person back to normal, but in other cases more invasive therapies like surgery are necessary. It’s not always possible to reverse nerve damage, and a lot of times the best that can be done is to mitigate the problem and stop it from spreading or getting worse.


How the Spine Causes Knee Pain

The nerve roots that transmit the sensation of pain to the legs and feet are located in the lower back. Occasionally with age or injury, the discs between the vertebrae can degenerate or bulge out and press on these nerves.

When this occurs, the nerve becomes irritated and sends out pain signals. The location of the pain depends on which disc is protruding.

The severity of the pain depends on how much of the disc is pressing on the nerve. The nerves that send fibers to the knee are located at the second, third, and fourth lumbar vertebral levels in the lower back area.

If a bulging disc, bone spur, or arthritic joint in the second, third, or fourth lumbar vertebra compresses ("pinches") a nerve, the referred pain will often be felt in the knee.

Referred pain is pain perceived at a location other than where the cause is situated. It is the result of pain signals being sent along the network of interconnecting sensory nerves.

This condition can be diagnosed by your physician with a thorough history and physical exam. If the nerve that travels to your thigh and knee is irritated or pinched, you may feel a host of symptoms, including:  

  • Pain in the front of your thigh
  • Knee pain
  • Numbness or tingling in your thigh
  • Weakness in your hip or quadriceps muscles

If you have any of these symptoms, see a doctor. In some cases, the hip may be the culprit, so a careful examination is necessary to find the true cause of your knee pain.


Important: Causes of lateral knee pain not to be missed:

Although not paticularly common causes of pain on the outside of the knee, it is essentail to consider the following as more serious complications may occur if they are missed and go untreated.

Peroneal nerve injury

Peroneal nerve injury is caused by a direct impact to the outside of the knee which damages the peroneal nerve. Symptoms which might distinguish a Peroneal nerve injury from a straightforward contusion include numbness or tingling in the front or side of the lower leg. As a result the patient will also have weakness lifting the foot up, and in severe cases, a sign known as ‘foot drop‘ will occur. A patient with foot drop will be unable to lift the foot up properly when walking and may tend to drag the toes.

Slipped capital femoral epiphysis

A Slipped capital femoral epiphysis is a hip injury more common in boys aged 11 to 16 years old. A fracture occurs of the growth plate in the thigh bone (femur) develops gradually causing pain in the hip, which may radiate to the outside of the knee.

Perthes’ disease

Perthes’ disease is a hip condition which affects children, most commonly aged between four and eight. Symptoms of tiredness and groin pain are common and the patient may also have a noticeable limp. If Perthes’ disease is suspected then seek medical advice as soon as possible because early intervention is neccessary to prevent future problems.


Inconsistent knee pain= lymphoma

Recently I have being diagnosed with lymphoma (recent scans have shown it is only localised but are unsure which type of lymphoma it is yet). I am 20 years old and quite active, last year I suffered an injury while landing awkwardly. I didnt think too much at the time as it just looked swollen and did the RICE method for a few days and it was all better, but 2 weeks later I did exercise and was all fine until one day the pain came back, it ranged from a stiff feel to a sharp throbbing. This happened February last year, it took me until September to see the GP in Wetherby, Leeds as the pain was so inconsistent and only came on after heavy exercise. Similarly to the GP opinion, we fought it was some form of ligament tear that hasnt fully recovered but had to referred to QMC in Nottingham as thats where I am at uni. There was 2 months from the GP meeting to the apppointment at QMC, the consultant said it looked and what youve said seems like a meniscus tear and going to have keyhole surgery. A month later ,a few days after christmas I was back down to Notts to have the MRI scan to see the extent of the damage of the knee, 2 weeks later I had a call to discuss the results. Then the consultant said theyve found what appears to be a tumour, at the time I wasnt too bothered as I have another tumour in my other (right) knee which found was chondroblastoma (benign) and reffered to the Royal Orthopedic Hospital in Birmingham for a biopsy. The registrar there said there wasnt anything that resembled a sarcoma but had to make sure, I had the biopsy then 2 weeks later I had a call saying theyve found malignancy in the blood. I was in shock but at the same time serious denial, I mean how can on-and-off knee pain resemble blood cancer? If I had all the symptoms that resembled a cancer of the blood I would of been more accepting of it, he said he will refer me to the Bexley Wing in Leeds. For that whole week from the call to the appointment at Leeds, I was on the internet 24/7 looking at information on blood cancers thinking what have I got, myeloma, leukemia, lymphoma or something else? Was the worst period of my life as I was just wondering if I was going to die and theyve just left me with the line "malignancy in the blood". When the appointment came around at the haemotology department in St James' Hospital (Jimmys) I couldnt be bothered getting out of bed, my mum persuaded me and got on with it looking like a rotten vegetable throughout the day. I saw the consultant who was very nice and helpful i must say, she told me they think I have lymphoma. She was asking me all these questions and what I have, abdominal pains? Coughing up blood? enlarged lymph nodes? night sweats? fever? losing weight?. I was chucking a bit as I stressed the only thing I had was inconsistent knee pain. Like I said before, if I had symptoms that resembled lymphoma then I would of been more accepting of it but still cant get my head round it. As I am in my final year of uni, everything is hold, the consultant said I will have to have chemotherapy so will probably defer once treatment is done. I had a bone marrow, PET scan and obviously a blood test. They said the good news was that it was localised, only in the knee and a little bit in the groin which was nothing to worry about, but she said I will have to have more tests as there not 100% sure what it is despite there confidence it is lymphoma. So I am booked into LGI for a CT scan and possible biopsy to confirm this diagnosis, she also said I will have to have radiotherapy. Feel like since September all I am doing is just waiting.

Just goes to show that even something as common as knee pain which resembled a meniscus tear can be something serious as lymphoma ( which I am still in denial about )

Moderator

Inconsistent knee pain= lymphoma

Welcome to the forum and thank you for sharing your story with us. I'm so sorry to hear that you possibly have lymphoma but I'm glad you have been booked in for a CT scan and a possible biopsy as you will then have more clarity.

I'm sure our forum members will be along shortly to offer some support but in the meantime, if you'd like some advice please do feel free to contact our nurses on 0808 800 40 40 (freephone). Phone lines are open Monday to Friday, 9am to 5pm.


Osteoarthritis of the Knee

This occurs when the joint surface cartilage (also called hyaline cartilage or articular cartilage) becomes worn away leaving the raw bone beneath exposed (See Fig 1). The cartilage normally serves as a “pad” or a bearing in the joint and under normal conditions the cartilage bearing is even slicker than a hockey puck on ice. When the bearing wears away the result is a roughed joint surface that causes the pain and stiffness that people associate with osteoarthritis (See Fig 2 and Fig 3). and for most patients who have only mild arthritis the pain can be managed with simple things such as ice rest activity modifications pills or joint injections. However if the arthritis becomes severe (See Fig 4 and Fig 5) the pain may not respond to those kinds of interventions. Patients with severe arthritis sometimes can benefit from joint replacement surgery either partial (unicompartmental) knee replacement or total knee replacement (See Fig 6) which now can be done using a minimally-invasive quadriceps-sparing approach that can significantly shorten the recovery and decrease the pain following surgery.

Click to Enlarge
Figure 1 - Arthritic Knee Click to Enlarge
Figure 2 - Normal Cartilage Click to Enlarge
Figure 3 - Defect in
joint surface cartilage Click to Enlarge
Figure 4 - X-ray showing
arthritis of the knee


Click to Enlarge
Figure 5 - Joint deformity
from knee arthritis Click to Enlarge
Figure 6 - Model of a
knee replacement prosthesis

Immediate medical attention
Osteoarthritis of the knee is not an emergency. It can however result in disturbing “flare ups ” with increased pain and swelling. Many patients who experience a sudden flare-up will go to the doctor for care and for many patients this apparently "acute" set of symptoms will result in the diagnosis of this chronic condition.

Facts and myths

MYTH: Osteoarthritis of the knee is not usually the result of “overuse.”
True. There have been studies of long-distance runners that show that they are not more likely to get arthritis than more sedentary individuals. However people in occupations that require extreme and repeated heavy exertions (such as farmers) experience higher rates of osteoarthritis.

MYTH: Osteoarthritis of the knee is a “normal result of aging.”
True. Studies show aging have more "doctor-diagnosed" arthritis.

MYTH: Osteoarthritis of the knee is just “aches and pains.”
False. It is a condition whose biology x-ray appearance (See Fig 4) and clinical symptoms are defined.

MYTH: Not much can be done for osteoarthritis of the knee.
False. In fact there are exercise programs that can alleviate the pain in mild arthritis a variety of medications and injections can be helpful for moderate arthritis and severe arthritis of the knee is very commonly successfully treated with knee replacement surgery (See Fig 6). New minimally invasive approaches appear to decrease the recovery time from this operation.

MYTH: Women have more “doctor-diagnosed” arthritis than men.
True. Studies show women also report greater activity and work limitations, greater psychological distress and more severe joint pain than their male counterparts.

Symptoms & Diagnosis

Osteoarthritis of the knee is a serious condition. Osteoarthritis is the most common of the more than 100 kinds of arthritis and the knee joint is the most commonly affected large joint in the body. Osteoarthritis of the knee results in pain stiffness and joint deformity (See Fig 5) which can affect one’s ability to walk work and enjoy life. It is is a chronic disease meaning that it takes months to years to appear while it is not “curable ” it most certainly is treatable using activity modifications medications injections and if those interventions don’t work knee replacement surgery. New minimally invasive approaches appear to decrease the recovery time from this operation.

Lethality
Osteoarthritis of the knee is not deadly.

Pain
Osteoarthritis of the knee indeed can and usually does cause pain. Other symptoms include swelling stiffness sometimes warmth and joint deformity.

Debilitation
Osteoarthritis of the knee is progressive and when it becomes severe it indeed can severely affect one’s ability to walk climb stairs enter or exit a vehicle and enjoy one’s day-to-day activities.

Comfort
Osteoarthritis of the knee indeed can and usually does cause pain and discomfort. Other symptoms include swelling stiffness sometimes warmth and joint deformity.

Curability
Osteoarthritis of the knee is not curable. However while it is not “curable ” it most certainly is treatable using activity modifications medications injections and if those interventions don’t work knee replacement surgery. New minimally invasive approaches appear to decrease the recovery time from this operation.

Fertility and pregnancy
Osteoarthritis of the knee will not affect a patient’s ability to get pregnant or have children. However some medications used to treat arthritis need to be used with care (or not at all) during a pregnancy. It is important to inform one’s obstetrician and family physician about all medications and nutritional supplements that one takes.

Independence
Osteoarthritis of the knee indeed can affect one’s ability to walk climb stairs enter or exit a vehicle and enjoy one’s day-to-day activities. These things do affect one’s ability to remain independent particularly as the disease reaches its more severe stages.

Mobility
When osteoarthritis of the knee becomes severe it indeed can severely affect one’s ability to walk climb stairs enter or exit a vehicle.

Daily activities
Osteoarthritis of the knee can affect one’s ability to walk climb stairs enter or exit a vehicle perform housework and enjoy one’s day-to-day activities. Even mild to moderate osteoarthritis of the knee can adversely impact athletic performance and enjoyment of sports particularly impact sports and sports that involve running. Although there is little “hard science” on this point most knee surgeons and rheumatologists (doctors who treat arthritic conditions non-operatively) believe that patients with osteoarthritis of the knee should consider avoiding impact sports such as running in order to avoid increasing the rate at which the disease progresses.

Energy
Many patients indeed find that the chronic pain associated with osteoarthritis of the knee does contribute to fatigue. Osteoarthritis of the knee does not affect metabolism but some patients attribute weight gain to the inactivity that results from the knee pain caused by osteoarthritis of the knee.

It is important that patients with osteoarthritis of the knee avoid decreasing their activity level and it is important that they remain fit. However this often does require some modification of exercise programs – running and walking programs are usually poorly tolerated by (and not recommended for) patients with osteoarthritis of the knee. Stationary bike swimming and water aerobics usually are well-tolerated and they are recommended.

Diet
Diets do not cure or treat osteoarthritis so far as we know. However it is important to try to avoid weight gain when one has osteoarthritis of the knee as increased body weight is associated with worsening of symptoms.

Relationships
Osteoarthritis of the knee can affect relationships and social interactions to the extent that it makes getting around more difficult.

Other impacts
Osteoarthritis of the knee is not contagious and doesn’t predispose one to other diseases or conditions. Osteoarthritis of the knee is associated with joint deformity (such as bowing of the legs “knock-knees” and loss of the ability to fully straighten or fully bend the affected knee See Fig 5). These joint deformities are not readily managed by interventions other than surgery but can be corrected at the time of knee replacement for patients who elect to have that surgery. New minimally invasive approaches appear to decrease the recovery time from this operation.

Incidence
It is not possible to predict who will get osteoarthritis of the knee. However there are some risk factors that may increase the likelihood that knees will become arthritic. These risk factors include:

  1. Genetics. Arthritis often runs in families.
  2. Severe trauma. Fractures (broken bones) and total removal of the supporting cartilages of the knee (meniscus) both increase the likelihood of knee arthritis.
  3. Obesity. This is associated with arthritis of the knees.

Acquisition

Osteoarthritis is not caused by an infection though severe bacterial infections certainly can cause “post-infectious arthritis ” which is in many ways even worse than osteoarthritis of the knee.

There are some risk factors that may increase the likelihood that knees will become arthritic. These risk factors include:

  1. Genetics. Arthritis often runs in families.
  2. Severe trauma. Fractures (broken bones) and total removal of the supporting cartilages of the knee (meniscus) both increase the likelihood of knee arthritis.
  3. Obesity. This is associated with arthritis of the knees.

Genetics
Some arthritis indeed appears to run in families.

Communicability
Osteoarthritis of the knee is not contagious.

Lifestyle risk factors
There are two important “environmental” risk factors associated with arthritis of the knee. These are:

  1. Severe trauma. Fractures (broken bones) and total removal of the supporting cartilages of the knee (meniscus) both increase the likelihood of knee arthritis.
  2. Obesity. This is associated with arthritis of the knees.

Injury & trauma risk factors
Severe trauma including fractures (broken bones) that involve the knee joint can in time result in arthritis of the knee. Whether this really is “osteoarthritis” or should be considered a separate kind of arthritis (post-traumatic arthritis) remains an open question though in the severe stages of this condition the treatments are the same. In the ‘60s and ‘70s it was common for surgeons to remove the supporting cartilages of the knee (meniscus) if the meniscus was torn as part of a trauma. It is now known that this too results in the development of knee arthritis. As a result of learning this fact surgeons now either try to repair or minimize the portion of the meniscus that is removed should it become torn.

Prevention
By maintaining an ideal body weight and avoiding severe trauma to the knee it is possible to minimize the risk of arthritis. However many patients with osteoarthritis are slender and have never severely injured their knees so there is no “guaranteed” way to avoid getting this condition.

Anatomy
Osteoarthritis of the knee occurs when the joint surface cartilage (also called hyaline cartilage or articular cartilage) becomes worn away leaving the raw bone beneath exposed. The cartilage normally serves as a “pad” or a bearing in the joint and under normal conditions the cartilage bearing is even slicker than a hockey puck on ice. When the bearing wears away the result is a roughed joint surface that causes the pain and stiffness that people associate with osteoarthritis.

Initial symptoms
Pain swelling and stiffness are the main symptoms of knee arthritis. When it becomes more advanced joint deformity (knock-knees or bow-legs) can occur.

Symptoms
Pain stiffness swelling and joint deformity are the symptoms of arthritis of the knee.

Progression
Early in the course of arthritis the symptoms can be intermittent perhaps related only to particular activities or sustained activity. At that point usually rest and avoiding the precipitating activity will improve the symptoms.As the arthritis worsens the symptoms can become more persistent or more severe such that simply walking on level ground can result in pain.

When arthritis is severe the pain with activities can linger even after the activity stops such that the knee can remain painful even after one stops walking.

Conditions with similar symptoms
Other forms of arthritis can cause similar symptoms to osteoarthritis of the knee in particular post-traumatic arthritis and post-meniscectomy arthritis are almost indistinguishable in many cases from osteoarthritis of the knee. Rheumatoid arthritis the next most common cause of arthritis can also affect the knee. It tends to cause other joints to be involved and often causes more of an inflammatory set of symptoms (swelling and warmth as well as pain) and can in fact effect other organ systems as well. The diagnosis of osteoarthritis versus rheumatoid arthritis can be made by a physician with experience in treating conditions of this type.

Causes
No one knows what causes osteoarthritis of the knee. However there are some risk factors that may increase the likelihood that knees will become arthritic. These risk factors include:

  1. Genetics. Arthritis often runs in families.
  2. Severe trauma. Fractures (broken bones) and total removal of the supporting cartilages of the knee (meniscus) both increase the likelihood of knee arthritis.
  3. Obesity. This is associated with arthritis of the knees.

Effects
Pain swelling and stiffness are the main symptoms of knee arthritis. When it becomes more advanced joint deformity (knock-knees or bow-legs) can occur. As the condition worsens it often becomes less responsive to medical treatments such as pills or injections.

In many patients with advanced arthritis particularly if those medical approaches are no longer helpful surgery can offer relief of symptoms. Some patients with severe osteoarthritis sometimes can benefit from joint replacement surgery either partial (unicompartmental) knee replacement or total knee replacement which now can be done using a minimally-invasive quadriceps-sparing approach that can significantly shorten the recovery and decrease the pain following surgery.

Diagnosis
To diagnose osteoarthritis of the knee a physician will take a thorough history and perform a thorough physical examination first. Following this simple x-rays taken with the patient standing are an effective way to diagnose this condition.

Diagnostic tests
The simplest test to diagnose osteoarthritis of the knee is the x-ray. Taken with the patient standing up plain x-rays can diagnose the condition with great accuracy.

Very mild arthritis can be seen on a bone scan or an MRI even before it is visible on plain x-rays but in reality these tests are seldom helpful clinically for this purpose.

Effects
The diagnostic tests for osteoarthritis of the knee including x-rays and MRIs are generally not painful and they are well-tolerated by most patients.

Health care team
Osteoarthritis of the knee is common and generally straightforward to diagnose. Family physicians internists orthopedic surgeons rheumatologists and physiatrists often are the ones who make the diagnosis of osteoarthritis of the knee.

Finding a doctor
Both rheumatologists and orthopedic surgeons are “specialists” in arthritis care.

If surgery is being considered to manage osteoarthritis of the knee visiting with a fellowhip-trained high-volume knee replacement surgeon would be a reasonable step to consider.

Treatment

Simple steps that can be taken which don’t have much risk include avoidance of the activities that cause symptoms (activity modification) and weight loss (if appropriate). Some patients find nutritional supplements such as glucosamine and chondroitin to be helpful however the data on these products is somewhat inconsistent. They don’t help everyone.

Some patterns of osteoarthritis of the knee can be treated with an arthritis brace such as a knee sleeve or an “Unloader” type brace.

Should those interventions not be satisfying in consultation with one’s physician the next steps might include over-the-counter pain remedies such as acetaminophen (Tylenol) and over-the-counter anti-inflammatories such as ibuprofen (Advil Motrin) or naproxen (Naprosyn) among others. However these pills are not for everyone and if one hasn’t used them before one should consider consulting one’s family physician first. Sometimes prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed but again this must be done in consultation with a physician and these drugs do have risks and side effects associated with them.

In general narcotic pills (“painkillers” like Tylenol #3 Vicoden Percocet oxycodone) and narcotic pain patches (fentanyl Duragesic) should be avoided for most patients with osteoarthritis of the knee.

Joint injections including intra-articular corticosteroid injections and “viscosupplement” injections like Synvisc Hyalgan Supartz and others can be helpful for some patients.

Patients with severe arthritis who have tried the above remedies sometimes can benefit from joint replacement surgery either partial (unicompartmental) knee replacement or total knee replacement which now can be done using a minimally-invasive quadriceps-sparing approach that can significantly shorten the recovery and decrease the pain following surgery.

Not all surgical cases are the same, this is only an example to be used for patient education.

Self-management
Keeping one’s body weight appropriate and choosing activities that don’t reproduce the arthritic pain are two things patients with osteoarthritis of the knee can do to help decrease the arthritic symptoms.

Health care team
Several kinds of health care providers participate in the management of osteoarthritis of the knee including:

  1. Family physicians and internists
  2. Rheumatologists
  3. Physical Medicine and Rehabilitation Specialists (Physiatrists)
  4. OrthopedicSurgeons

Pain and fatigue
Several approaches can be used to manage the pain associated with osteoarthritis of the knee including:

  1. Activity modification appropriate kinds of exercise and weight loss when necessary may alleviate some knee arthritis symptoms
  2. Nutritional supplementation (glucosamine and chondroitin) are helpful to some patients although the literature on these supplements is not consistently in favor of their use
  3. Non-narcotic pain tablets (acetaminophen/Tylenol) or over-the-counter non-steroidal anti-inflammatory drugs if medically appropriate sometimes are helpful
  4. Prescription strength non-steroidal anti-inflammatory drugs (NSAID) are useful for some patients though in general long-term use of these drugs is discouraged
  5. Arthritis unloader braces or knee sleeves are helpful for some patterns of arthritis
  6. Joint injections (corticosteroid or “cortisone” injections or “viscosupplement” injections such as Hyalgan Synvisc Orthovisc or Supartz) might help
  7. Total knee replacement surgery may be used if non-operative interventions don’t suffice a minimally-invasive quadriceps-sparing approach can decrease the post-operative pain and length of convalescence in some patients undergoing this procedure.

Diet
Keeping one’s weight proportional to one’s height can decrease the likelihood of developing osteoarthritis of the knee and can decrease the symptoms of the condition once it has set in.

Exercise and therapy
There is some evidence that appropriately-designed exercise programs can decrease the pain of knee arthritis in particular earlier stages of the condition. Gentle strengthening of the quadriceps (front of the thigh) muscles such as by using a stationary bicycle is probably the most effective approach for this.

Medications

  1. Nutritional supplementation (glucosamine and chondroitin) are helpful to some patients although the literature on these supplements is not consistently in favor of their use
  2. Non-narcotic pain tablets (acetaminophen/Tylenol) or over-the-counter non-steroidal anti-inflammatory drugs if medically appropriate sometimes are helpful
  3. Prescription strength non-steroidal anti-inflammatory drugs (NSAID) are useful for some patients though in general long-term use of these drugs is discouraged
  4. Joint injections (corticosteroid or “cortisone” injections or “viscosupplement” injections such as Hyalgan Synvisc Orthovisc or Supartz) might help

Narcotic painkillers whether in pill form (oxycodone Tylenol #3 Vicoden Percocet Lortab etc. or patch form (Duragesic fentanyle etc.) in general should be avoided for the treatment of osteoarthritis of the knee.

Surgery
Knee replacement is a surgical procedure that decreases pain and improves the quality of life in many patients with severe arthritis of the knees. Typically patients undergo this surgery after non-operative treatments (such as activity modification anti-inflammatory medications or knee joint injections) have failed to provide relief of arthritic symptoms. Surgeons have performed knee replacements for over three decades generally with excellent results most reports have ten-year success rates in excess of 90 percent.

Broadly speaking there are two types ways to insert a total knee replacement: the traditional approach and the newer minimally-invasive (sometimes called quadriceps-sparing) approach.

Traditional total knee replacement involves a roughly 8” incision over the knee a hospital stay of 3-5 days and sometimes an additional stay in an inpatient rehabilitation setting before going home. The recovery period(during which the patient walks with a walker or cane) typically lasting from one to three months. The large majority of patients report substantial or complete relief of their arthritic symptoms once they have recovered from a total knee replacement.

Minimally-invasive quadriceps-sparing total knee replacement is a new surgical technique that allows surgeons to insert the same time-tested reliable knee replacement implants through a shorter incision using surgical approach that avoids trauma to the quadriceps muscle (see figure 1) which is the most important muscle group around the knee. This new technique which is sometimes called quadriceps-sparing knee replacement uses an incision that is typically only 3-4” in length (see figure 2) and the recovery time is much quicker – often permitting patients to walk with a cane within a couple of weeks of surgery or even earlier. The less-traumatic nature of the surgical approach also may decrease post-operative pain and diminish the need for rehab and therapy compared to more traditional approaches.

The main potential benefits of this new technique include:

More rapid return of knee function. Patients who undergo this procedure seem to get muscle strength and control back more quickly than patients who have had traditional total knee replacement. (See Video) This is because the quadriceps muscle and tendon are not divided in the course of the surgical exposure like in traditional knee replacement and the kneecap is not everted (flipped out of the way) as it is in traditional total knee replacement.

Smaller incision. While this procedure would not be worth performing for cosmetic benefits many patients do prefer the shorter incision. Traditional knee replacement incisions often measure 8” or longer minimally-invasive quadriceps-sparing knee replacement incisions are about 4” in length for most patients.

Decreased post-operative pain. (See Video)This may be a function of the smaller incision and the fact that the incision stays out of the important quadriceps muscle/tendon group.

Same reliable surgical implants as Traditional Knee Replacement. Much has been learned about implant design in the nearly 40-year history of contemporary knee replacement. Minimally-invasive quadriceps-sparing total knee replacement is an evolution of surgical technique which permits the use of time-tested implant designs (see figure 3 and figure 4). This gives some reassurance that while the surgical approach is new the implants themselves have a good proven track record.

The major apparent risks of the procedure compared to traditional total knee replacement:

The procedure is new. Though surgeons have studied the approach the studies are recent and have replicated (repeated and verified) by only a few groups of surgeon-scientists. These studies give some insight into which patients and patterns of arthritis are most suitable for this procedure the relative novelty of the approach it is likely that as time passes we will discover more about the risks and shortcomings of this technique. Also even an experienced knee replacement surgeon will have performed many more surgeries through the traditional approach than through the less-invasive method we know that the more procedures one does the more reliable the results are.

Click to Enlarge
Figure 1 - The incision used for minimally-invasive quadriceps-sparing total knee replacement is much smaller than the one used for traditional knee replacement and in the less-invasive procedure the important quadriceps muscle and tendon are not disrupted as in traditional knee replacement. LifeART image ©2004 Lippincott Williams & Wilkins. All rights reserved. Click to Enlarge
Figure 2 - The skin incision for minimally-invasive quadriceps-sparing total knee replacement is typically about 4? in length compared to about 8? or more for traditional total knee replacements. Click to Enlarge
Figure 3 - X-ray of a traditional total knee replacement. This operation is done for patients who have arthritis throughout the knee. Excellent long-term results are obtained in most patients. Click to Enlarge
Figure 4 - Model of a traditional total knee replacement. The patella (knee cap) is not shown in this model.

The procedure is more challenging. Operating through a smaller surgical window takes some getting used to and this can increase operative time compared to procedures performed using the traditional technique. This may increase the likelihood that an intra-operative injury to tendon or ligament might occur which could compromise the result. This may also increase the likelihood of component malalignments which could affect function and durability. However two preliminary studies on this technique in fact found that these adverse outcomes did not take place.

Joint aspiration
Joint injections can be effective at relieving the symptoms associated with osteoarthritis of the knee. Broadly speaking there are two kinds of injections:

    .These injections have been used to relieve arthritis symptoms--including pain swelling and inflammation--for over 50 years. Despite this there have been surprisingly few well-designed scientific studies to determine which patients might benefit from this treatment or how long the relief might last. Just the same cortisone shots are commonly used--and often are successful--in helping to relieve arthritis symptoms temporarily. Some patients are able to use them to get enough pain relief to hold off joint replacement surgery for months or even years. Cortisone shots are a treatment for pain they do not alter the course of arthritis and they do not cure the condition.
  1. “Viscosupplement” injections. These are any of several compounds that are made up of hyaluronic acid which is a component of normal joint fluid. Some of the common ones include Synvisc Hyalgan Supartz and Orthovisc. They are given as a series of injections usually weekly for 3-5 weeks. There is some disagreement as to how and whether they work. Read more details on JBJS Article - Corticosteroids VS. Hylan GF20 in pdf format (0.13MB).

Splints or braces
Two kinds of braces are sometimes used:

  1. Over-the-counter knee sleeves usually made of neoprene (wet suit material). These can be purchased at drug stores and medical supply houses and some patients find them to be supportive and comfortable.
  2. Arthritis “Unloader” braces. These are custom-fitted to the knee by a bracing specialist (an orthotist) and a prescription is needed. They are not for every pattern of arthritis and work best if the arthritis is limited either to the inside or the outside of the knee. They can be expensive insurance sometimes covers part or all of the cost.

Alternative remedies
Nutritional supplementation (glucosamine and chondroitin are the most common forms of this) is helpful to some patients though the science on this is not entirely supportive of their effectiveness.

There are some studies to suggest that acupuncture can decrease the pain associated with osteoarthritis of the knee.

Work
Looking for a “light duty” alternative to heavy manual labor is one good approach for coping with osteoarthritis of the knee. Many patients who work at desks find that prolonged sitting in one position is associated with stiffness and pain upon first arising so periodically standing stretching or moving the knee through an arc of motion can be helpful at minimizing this “start-up” pain.

Adaptive aids
For some patients particularly those who cannot tolerate surgical interventions for medical or other personal reasons use of a cane crutches or a walker can be of use.

Resources
For more information about arthritis contact the Arthritis Foundation (www.arthritis.org). For more information about orthopedic surgery contact the American Academy of Orthopedic Surgeons (www.aaos.org).

Condition research
Medical researchers continue to look into the causes and best treatments for symptoms of osteoarthritis of the knee which is very common and sometimes disabling.

Pharmaceutical research
There is considerable research being done into the medical management of osteoarthritis. Recently increasing awareness of the complications and problems associated with use of non-steroidal anti-inflammatory drugs (NSAIDs) including effects on the kideys the stomach and the heart.

Surgical research
There is considerable research being done studying the surgical approaches for this condition including newer approaches for total knee replacements one of these the minimally-invasive quadriceps sparing approach appears to help patients recover more quickly and with less pain than traditional approaches to knee replacements.

Other surgical interventions including osteotomy (cutting and re-orienting the bones around the knee) and arthroscopy (using a surgical camera and small motorized shavers to “clean up” the raw bone ends) also are topics of surgical research relevant to patients with knee arthritis.


Chronic Knee Cap Pain after Total Knee Replacement Suprisingly Common

Interesting study out this week that tries to tie lack of blood flow in the knee cap to why some patients have chronic knee cap pain after a total knee replacement.The study authors found that in about 1/4 of the knee replacement patients with chronic knee cap pain, blood flow in the knee cap area markedly decreased with flexing the knee. To be honest, I was surprised to learn that knee cap or patellar pain is a common complication of knee replacement. A 1995 study identified that chronic pain in the knee cap after total knee replacement occurred in about 13% of knees. The doctors who first reported the side effect believed that the type of metal or plastic knee used by the surgeon may make a difference. Since then there have been many studies trying to figure out why these patients still hurt when they should all be be pain free after having their knee replaced. So why do some patients develop pain in the patella after knee replacement? One study looked at wear on the patella after knee replacement and found much more strain on the inside of the patella in a total knee replacement knee when compared to a knee without a prothesis. Another study looked at many different causes of this knee replacement side effect including shortening of the patellar tendon and that the knee replacement prosthesis may be misaligned in some patients. One surgeon postulated that knee cap pain after knee replacement may be due to instability in the patella due to the metal prosthesis not being properly installed. Whatever the cause of this knee replacement complication, the fact that more than 1 in 10 knee replacement patients is walking around with chronic knee cap pain is concerning. It’s maybe a little more concerning that there isn’t consensus about what causes the problem.

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Watch the video: Πόνος στο γόνατο - Αρθρίτιδα - Κακώσεις - Χονδροπάθεια. Φυσίατρος Βελονιστής Δαμουλιάνος Άγγελος (May 2022).