Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Chondromalacia, technically termed chondromalacia
patellae, is the most common cause of chronic
knee pain. The condition is also called
the patellofemoral syndrome.
Softening of the cartilage beneath the knee cap (the patella) results in
small areas of breakdown and pain around the knee. Instead of gliding smoothly
over the knee, the knee cap rubs against the thigh bone (the femur) when the knee moves. The
changes can range from mild to complete erosion of the
cartilage.
Chondromalacia commonly occurs in females. Girls in their teens are at
elevated risk because the cartilage of the knee is subjected to excessive and
uneven pressure due to the structural changes that accompany rapid growth.
The knee joint has three compartments: medial, lateral, and patellofemoral.
Causes of knee pain include injury, degeneration,
arthritis, infrequently infection, and rarely bone tumors.
Ligaments within the knee (cruciate ligaments) and on
the inner and outer sides of the knee (collateral ligaments) stabilize the
joint.
Surgical repair of ligament injury can involve
suturing, grafting, and synthetic graft repair. Some patients require total knee replacement.
Routine X-rays do not reveal meniscus tears but can
be used to exclude other problems of the bones and other tissues. Arthroscopy and MRI studies are used most frequently to diagnose knee ailments; occasionally, a needle aspiration of fluid is done.
The knee joint is one of the most commonly involved joints in rheumatic diseases (over 100 disease types). Rheumatic diseases are immune diseases that affect various tissues of the body, including the joints, by causing arthritis (pain, swelling, stiffness, and limited joint movements).
How is the knee designed, and what is its function?
The knee is a joint that has three compartments. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third compartment called the patellofemoral joint. The thighbone (femur) meets the large shinbone (tibia), forming the main knee joint.
The knee joint is surrounded by a joint capsule with ligaments strapping
the inside and outside of the joint (collateral ligaments) as well as
crossing within the joint (cruciate ligaments). These ligaments provide
stability and strength to the knee joint.
The meniscus is a thickened
cartilage pad between the two joints formed by the femur and tibia. The
meniscus acts as a smooth surface for motion and absorbs the load of the body above the knee when standing. The knee joint
is surrounded by fluid-filled sacs called bursae, which serve as
gliding surfaces that reduce friction of the tendons. Below the kneecap, there
is a large tendon (patellar tendon) which
attaches to the front of the tibia bone. There are large blood vessels passing
through the area behind the knee (referred to as the popliteal space). The large
muscles of the thigh move the knee. In the front of the thigh, the quadriceps
muscles extend the knee joint. In the back of the thigh, the hamstring muscles flex the knee.
The knee also rotates slightly under guidance of specific muscles of the
thigh.
Picture of the knee joint
The knee functions to allow movement of the leg and is
critical to normal walking. The knee flexes normally to a maximum of 135 degrees
and extends to 0 degrees. The bursae, or fluid-filled sacs, serve as gliding
surfaces for the tendons to reduce the force of friction as these tendons move.
The knee is a weight-bearing joint. Each meniscus serves to evenly load the
surface during weight-bearing and also aids in disbursing joint
fluid for joint lubrication.
The goal of this article is to give the reader an overview of causes of knee pain. Most of the topics covered in this article are further expanded in detail as separate articles. For example,
bursitis, types of arthritis, total knee replacement, and others are covered in articles devoted to knee pain-related topics that include specifics on diagnosis, tests, treatments,
and other details.
Knee Pain - Length Symptoms LastedQuestion: How long did the symptoms of your knee pain last? Was there anything in particular that helped with pain/symptom relief?
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Gout is a condition that results from crystals of uric acid depositing in tissues of the body. Gout is a condition that can lead to abnormally elevated levels of uric acid in the
blood, recurring attacks of joint inflammation (arthritis), deposits of
hard lumps of uric acid in and around the joints, and decreased kidney
function and kidney stones.
A torn meniscus (knee cartilage) may be caused by suddenly stopping, sharply twisting, or deep squatting or kneeling when lifting heavy weight. Symptoms of a meniscal tear include pain with running or walking long distances, popping when climbing stairs, a giving way sensation, locking, or swelling. Treatment depends upon the severity, location, and underlying disease of the knee joint.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
A Baker cyst, also called a popliteal cyst, is swelling caused by knee joint fluid protruding to the back of the knee (popliteal area of the knee). Not uncommon, baker cysts can be caused by virtually any type of joint swelling (arthritis). They are often resolved with removal of excess knee fluid in conjunction with cortisone injections.
Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
Bursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and antiinflammatory and pain medications.
Chondromalacia patella (housemaid's knee or secretary's knee) results from misalignment of the kneecap as it slides over the lower end of the thigh bone. Symptoms include tightness or fullness in the knee area, swelling, and mild discomfort. Treatment includes the use of anti-inflammatory medications, in addition to stretching, strengthening and icing the knee.
An injury to a ligament is called a sprain, and an injury to muscle or tendon is called a strain. Sprains and strains may be caused by repetitive movements or a single stressful incident. Symptoms include pain and swelling. Though treatment depends upon the extent and location of the injury, rest, ice, compression, and elevation are key elements of treatment.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Pseudogout, a form of arthritis, results when deposits of crystals collect in and around the joints. Symptoms of pseudogout include pain, stiffness, warmth, and joint swelling of the knees, ankles, hips, shoulders, and/or wrists. Treatment for pseudogout aims to decrease inflammation through the use of nonsteroidal antiinflammatory drugs, ice, and rest.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Iliotibial band syndrome is an overuse injury of the thigh and knee. Symptoms include knee pain and possible swelling. Treatment may involve anti-inflammatory medications, physical therapy, ultrasound, and the use of orthotics.
Osgood-Schlatter disease, a painful inflammation just below the knee but above the shin, typically affects adolescent boys. Symptoms include localized pain, inflammation, swelling, and calcification. Osgood-Schlatter disease typically goes away over time, however, symptoms can be helped with antiinflammatory and pain-relieving medications, ice, and rest.
Knee injuries, especially meniscus tears, are common in contact sports. Symptoms and signs of a torn meniscus include knee pain, swelling, a popping sound, and difficulty bending the leg. Treatment may involve resting, icing, compressing, and elevating the knee, in addition to wearing a knee brace, taking anti-inflammatory medications, and stretching the knee.
You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it's a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.
It is pain. In its most benign form, it warns us that something isn't quite right, that we should take medicine or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those who appear to have identical injuries or illnesses.
In 1931, the French medical missionary Dr. Albert Schweitzer wrote, "Pain is a more terrible lord of mankind than even death itself." Today, pain has become the universal disorder, a serious and costly public health issue, and a challenge for famil...
Chondromalacia, technically termed chondromalacia
patellae, is the most common cause of chronic
knee pain. The condition is also called
the 
Chronic Pain RSS
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