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.
What are diseases and conditions that can cause knee pain, and
what is the treatment for this knee pain?
Pain can occur in the knee from
diseases or conditions that involve the knee joint, the soft tissues and bones
surrounding the knee, or the nerves that supply sensation to the knee area. In
fact, the knee joint is the most commonly involved joint in rheumatic diseases,
immune diseases that affect various tissues of the body including the joints to cause arthritis.
Arthritis is inflammation within a joint. The causes of
knee joint inflammation range from noninflammatory types of arthritis such as
osteoarthritis, which is a degeneration of the cartilage of the knee, to
inflammatory types of arthritis (such as rheumatoid arthritis or gout).
Treatment of the arthritis is directed according to the nature of the
specific type of arthritis. Many people suffer from arthritis; the pain and
discomfort can be so limiting that some patients may require a total knee
joint replacement. Knee replacement surgery often allows the patient to
regain much of their mobility.
Swelling of the knee joint from arthritis can lead to a localized collection of fluid accumulating in a cyst behind the knee. This is referred to as a
Baker cyst and is a common cause of pain at the back of the knee.
Infections of the bone or joint can rarely be a serious
cause of knee pain and have associated signs of infection including fever, extreme heat,
warmth of the joint, chills of the body, and may be associated with
puncture wounds in the area around the knee. These infections are often diagnosed by aspirating joint fluid accumulations with a needle (joint aspiration) and examining the fluid microscopically and with microbial culture techniques. Treatment involves antibiotics
and sometimes joint surgery.
Tumors involving the joint are extremely rare (for example, synovial sarcomas, and giant cell tumors). They can cause ambulatory
problems with local pain. Treatment usually involves surgery; a few individuals may require amputation of the knee and lower leg. Treatments and surgery depend on the tumor type.
The collateral ligament on the inside of the knee joint
can become calcified and is referred to as Pellegrini-Stieda syndrome. With this
condition, the knee can become inflamed and can be treated conservatively
with ice packs, immobilization, and rest. Infrequently, it requires a
local injection of corticosteroids.
Osgood-Schlatter disease is caused by chronic inflammation at the area of the tendon below the kneecap where it attaches to the tibia bone. This can cause local pain and tenderness of the attachment point. It requires treatments to reduce inflammation, restricted activity, and gradual rehabilitation. Osgood-Schlatter disease is a common cause of pain in the front of the knee in children.
Chondromalacia refers to a softening of the cartilage under the kneecap
(patella). It is a common cause of deep knee pain and stiffness in younger
women and can be associated with pain and stiffness after prolonged
sitting and climbing stairs or hills. While treatment with
anti-inflammatory medications, ice packs, and rest can help, long-term
relief is best achieved by strengthening exercises for the quadriceps muscles of the
front of the thigh.
Bursitis of the knee commonly occurs on the inside of the knee (anserine
bursitis) and the front of the kneecap (patellar bursitis, or "housemaid's
knee"). Bursitis is generally treated with ice packs, immobilization,
and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or aspirin and may require
local injections of corticosteroids (cortisone medication) as well as exercise
therapy to develop the musculature of the front of the thigh.
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.
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