Why and how pain appears when walking on the inside of the knee, how to cope with it. Bobyr Clinic

Author of the article: Victoria Stoyanova, category 2 doctor, head of the laboratory at the diagnostic and treatment center (2015–2016).

Article publication date: 04/07/2016

Article updated date: 01/28/2020

If you are worried about pain on the inside of the knee (or on the inside side), you need to consult a doctor with a detailed diagnosis, since it is impossible to accurately determine the cause of the pain “in absentia”.

What could be the reasons for this problem:

When a ligament or tendon is sprained or torn, sharp pain usually occurs on the side of the knee joint.
Pain syndrome of varying intensity in the popliteal fossa occurs with subchondral, synovial, parameniscal meniscus cyst, damage to the tibial nerve, and aneurysm of the popliteal artery.
In other cases, the causes of pain in the back or side of the knee are the same. There are many systemic and joint diseases that are symptomatic of pain in any area of the knee (including the back and/or side). For example, this is gonarthritis.

(if the table is not completely visible, scroll to the right)

Causes of pain in the back and/or side of the knee	Diseases, pathologies
Injuries of periarticular and intraarticular elements (usually the pain in this case is on the side of the knee)	Tendon sprain or rupture, internal meniscus tear, knee joint fracture, bruise, pinched nerve
Diseases of the structures of the popliteal fossa (pain directly behind the knee)	Baker's cyst, bursitis, tendinitis, tendovaginitis, meniscal cyst, arthritis
Vascular diseases (discomfort may be on the back or side of the knee)	Varicose veins with thrombosis of the popliteal vein, aneurysm or embolism of the popliteal artery
Damage to the nerves of the neurovascular bundle (pain both behind and on the side)	Pinching, inflammation, swelling of the tibial nerve

Types of popliteal artery aneurysm

If pain appears on the inside or side of the knee, you need to contact a therapist, who, having made a preliminary diagnosis, will refer you to a specialist: a rheumatologist, arthrologist, orthopedist or traumatologist.

Some of the diseases listed above have dangerous consequences. For example, gonarthrosis in advanced 3rd degree leads to deformation of the joint with a pronounced limitation of mobility up to immobilization. Other diseases, for example, tendinitis, do not lead to such severe consequences.

You can get rid of pain (stop it) if you get good treatment. The sooner you visit a doctor and start treatment, the more effective it will be.

Next, we will take a closer look at common diseases and types of injuries that manifest as pain on the lateral and inner side of the knee, as well as general ways to combat discomfort.

Meniscus injuries rank first among other injuries of the knee joint. They are diagnosed mainly in people from 18 to 40 years old. Moreover, 75% of cases occur due to damage to the internal (medial) meniscus.

What kind of knee pain is there?

Acute knee pain occurs suddenly and is most often caused by external influences (injuries) or an acute inflammatory process. It can be cutting, stabbing or bursting, depending on the cause and mechanism of the lesion.

Chronic knee pain occurs gradually and persists for more than 3 months. The cause is most often degenerative diseases or chronic inflammatory processes. It can be aching or bursting. During physical activity, the pain intensifies. In some diseases, it occurs during the first steps, then gradually subsides.

Pain may be accompanied by:

swelling of the joint;
redness;
crunch;
limited mobility;
joint deformation.

Why do my knees hurt?

The most common cause of acute knee pain on one side is injury. Damage can occur during sports, unsuccessful falls, or sudden movements. Common types of knee injuries:

bruise – accompanied by pain, increase in size, bruising;
ligament rupture due to sudden twisting of the leg or thigh;
meniscus tear – occurs under heavy loads, impacts, falls;
fractures – accompanied by unbearable pain and pathological mobility of the joint;
dislocations of the knee joint and patella;
cartilage damage – a torn fragment of tissue in the joint cavity causes severe pain.

An experienced orthopedist can diagnose some types of injuries based on the appearance of the joints.

Another common cause of knee pain is diseases of the joints and periarticular tissues:

arthritis – inflammation of the joint, can be infectious, post-traumatic, autoimmune, metabolic;
bursitis - inflammation of the joint capsule, sometimes with accumulation of fluid in it;
periarthritis - damage to muscles, tendons and ligaments in the joint area;
osteomyelitis – inflammation of the bones;
chondropathy – degenerative diseases of articular cartilage;
tumors and cysts - compress adjacent tissues, causing pain and impairing function;
Osteoporosis is a metabolic disorder in which calcium is washed out of bone tissue.

Knee pain may be a sign of a neurological disorder:

neuritis is an inflammatory disease of the peripheral nerves.
pinched nerves – can occur due to trauma, compression by a tumor.

One of the causes of joint pain may be depression and other psychological problems (so-called psychosomatic disorders).

The structure of the joint in MRI images of the knee?

Despite its apparent simplicity, the structure of this site has a complex structure. In addition to the anatomical connection of the two bones of the lower limb (tibia and femur), the articular area is represented by cartilage fibers, connective, ligamentous and muscular apparatus, nerve and blood channels. The front side of the fold is usually called lateral, and the popliteal (inner) side is called medial.

The natural joint is kept in a dynamic state by the cruciate ligaments, which also provide the force for movement. An MRI of the knee shows that between the dense surfaces of the two bones there is a cartilage seal - the meniscus disc. Its purpose is to evenly distribute the load on the limb. The tissue does not wear out in the interosseous space, as it is surrounded by liquid-filled capsules - bursae.

Maximum mobility of the area is ensured by the work of the quadriceps anterior muscle, which is also evident on MRI of the knee. According to an anatomical algorithm, it straightens the limb, and the tendons located in the inner part of the bend pull the tibia to the tibia. In the absence of damage or systemic diseases, wear and tear of bones and cartilage does not occur for many years, unless the joint areas of the body are overstrained. But in some cases, premature aging of the “hinge” part of the legs appears. The following factors influence the anomalous process:

Osteoarthritis and arthritic damage that can lead to complete immobility of the bone joint.
Age-related changes in the body leading to tissue aging.
Excessively high weight, putting a lot of stress on the legs.
Hormonal changes affecting blood circulation.
Congenital developmental pathologies and genetic predisposition to bone diseases.
Previous surgery and other types of trauma.
Forced physical overload caused by occupational hazards.

In addition to the above list, the treating specialist can detect premature joint aging due to poor posture, adverse environmental influences and addiction to smoking and alcohol.

Additional symptoms?

Associated symptoms will help determine the approximate mechanism of the lesion and establish a preliminary diagnosis. Their combination may be characteristic of a specific disease or group of diseases:

inflammatory processes are accompanied by swelling, redness of the joint and an increase in local temperature;
increased pain when moving, crunching in the joints, limited mobility speak in favor of chronic degenerative diseases;
impaired mobility with preserved tissue sensitivity is characteristic of tumors, cysts, arthropathy;
In case of injury, joint deformation, pathological mobility, and accumulation of blood in the joint cavity or soft tissues are observed.

Systemic diseases (osteoporosis, rheumatoid arthritis, gout) cause pain not only in the knee, but also in other joints. Arthritis that occurs against the background of a general illness is accompanied by malaise, fatigue, weakness and fever.

Only a doctor can make an accurate diagnosis, taking into account the symptoms and examination results.

Injury to the medial collateral ligament

The internal collateral ligament is not actually located inside the joint, but on its inner side, that is, closer to the other leg. With injuries and unsuccessful movements, you can observe stretching of this ligament, tears and micro-tears. Complete avulsions of the internal ligament occur rarely, usually with severe concomitant leg injuries.

Diagnosis of sprains in this area is based on clinical examination and symptoms. A nagging, sharp pain is localized on the side of the knee joint and intensifies when the lower leg is moved to the side, sometimes when flexed. In order for the ligament to heal completely, it needs rest and wearing an elastic restraint (knee brace).

Diagnostics

Orthopedic doctors diagnose and treat knee pain. According to indications, a consultation with a neurologist, vascular surgeon, rheumatologist and other specialists may be prescribed. When identifying a psychosomatic disorder, work with a psychologist is required. The first stage of diagnosis is questioning the patient, carefully collecting complaints and anamnesis. Next, the doctor examines the affected area, makes a presumptive diagnosis and performs laboratory and instrumental studies. It includes:

radiography of the joint in several projections - allows you to detect injuries, degenerative-dystrophic processes of the joint;
x-ray of the lumbar spine or hip joints (if the pain is caused by damage to this area);
Ultrasound of the knee joint is an effective method for inflammatory and degenerative processes, lesions of soft tissues;
MRI – allows you to identify changes that are not visible on an x-ray;
densitometry - an x-ray method for diagnosing osteoporosis;
general and biochemical blood tests - relevant for inflammatory, metabolic and autoimmune diseases

The sooner the patient seeks help from specialists, the easier it will be to establish a diagnosis and the more effective the treatment will be.

Causes of pain seen on MRI of the knee

There are temporary pathological conditions, manifested in episodic joint pain, and permanent ones, indicating the development of a disease. Temporary discomfort may occur due to improper distribution of physical activity, mild to moderate injuries, a reaction to weather changes, or minor sprains of ligaments or tendons.

Chronic pain requires an urgent MRI. A knee that constantly bothers you indicates a pathology that can manifest itself as persistent discomfort or a painful syndrome that appears after walking, running, bending and straightening the legs, or squats. So, if unpleasant sensations arose after the first run, then most often this is evidence of muscle overstrain. But if the pain repeats after each race, this is a signal of meniscus damage, dislocation of the cup, rupture of ligamentous fibers or the appearance of an intervertebral hernia, which is also visualized on MRI. The knee suffers from this anomaly due to pinching of the nerve passing through the damaged vertebra.

When walking, the joint may hurt due to poor circulation or wearing uncomfortable shoes. Pain in the popliteal space occurs after an “unsuccessful” lifting of heavy objects or an injury that is not noticeable at first glance. If you experience an aching sensation when trying to sit down, go up or down stairs, this indicates the initial stage of development of arthritis or arthrosis, Schlatter's disease, or microscopic fiber sprains resulting from improper exercise.

Knee pain on the side on the inside: when to see a doctor

It is recommended to consult a doctor (traumatologist) as soon as possible if the following symptoms appear:

1. Severe swelling of the knee.

2. Fever, which is accompanied by severe pain under the knee.

3. Deformation of the knee joint.

4. Inability to step on or bend the leg.

5. Redness in the joint.

After the examination, the doctor will prescribe the following mandatory diagnostic procedures:

1. General blood test.

2. General urine analysis.

3. X-ray of the knee joint.

Treatment[edit | edit code]

Conservative treatment[edit | edit code]

Treatment of iliotibial band syndrome is mainly conservative and aimed at eliminating internal and external predisposing factors. At the first stage, inflammation is relieved with rest, ice compresses, NSAIDs and ultrasound or phonophoresis. After the disappearance of acute symptoms, a course of physical therapy begins, including exercises for all parts of the lower limb. In addition to stretching the iliotibial band, tensor fascia lata, and external hip rotation muscles, you should also strengthen and stretch the hip adductors. To eliminate external factors, they change the training program: exclude running on hilly terrain, reduce the duration and intensity of training, change the side of the track or the direction of movement. Cyclists may benefit from changing their seat height or using pedals without foot locks. For excessive pronation of the foot, rigid wedge-shaped instep supports or a standard orthosis are recommended.

Surgical treatment[edit | edit code]

Surgical interventions for iliotibial band syndrome have been described in the literature, but they are rarely used in practice. Surgical treatment consists of removing a small portion of the tract located just above the lateral epicondyle with the knee at 30 degrees of flexion. This approach is justified if conservative treatment fails and severe symptoms persist.

The causes of gonarthrosis can be:

Excess weight
Gastrointestinal problems
Diabetes
Poor nutrition
Hereditary factors
Weakened immunity
Congenital pathologies

Another well-known disease is inflammation of the knee joint - knee arthritis or knee arthritis. The most famous type of monoarthritis. It can also be one of the manifestations of polyarthritis. Patients suffering from gonarthritis complain of severe pain and difficulty moving the knee. Often the cause of gonitis is an infection that penetrates the joint through damaged tissue during injury. Infections can also enter the body from other foci during a general purulent infection. It also happens that after infection, an immunological breakdown begins and then damage to the articular cartilage.

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The main causes of knee pain on the side and inside

Tendon rupture, meniscal injury with the development of meniscitis or meniscopathy, fractures are accompanied by sharp pain not only on the back of the knee, but also in any area. It is impossible to lean on your leg when walking, or simply bend, straighten, or make any other movement. The intensity of pain decreases after immobilization, application of ice, and novocaine blockade.

Six diseases

Popliteal artery aneurysm

With this disease, dissection of the aortic wall occurs with the formation of a sac-like protrusion. The causes of this pathology: endarteritis, atherosclerosis, congenital anomalies of the aorta.

A sharp, unbearable pain occurs, the intensity of which decreases over time, but sensitivity is impaired. Weakness appears in the leg, it freezes and goes numb. The skin turns pale to blue.

Differences from Baker's cyst are the pulsation of the swelling and its persistence after pressing.

Serious complications in the form of vascular thrombosis, gangrene, and acute arterial insufficiency in the ankle vessels cannot be excluded.

Inflammation of the lymph nodes of the popliteal fossa

Lymphadenitis is accompanied by swelling, local fever, severe pain when palpating the lymph nodes and straightening the knee.

Baker's cyst

This is a protrusion of the synovial bursa in the form of a hernia into the popliteal fossa. Appears in people after 40 years of age, often under both knees as a complication of synovitis or arthritis.

At first, unobtrusive unpleasant sensations arise. As the cyst enlarges, the vessels and nerves on the inside of the knee are compressed, the pain intensifies, and numbness, tingling or other paresthesia of the sole area occurs.

A characteristic symptom is a reduction in the hernia when pressing on it due to the reverse flow of joint fluid.

Avascular osteonecrosis

This is a severe non-inflammatory pathology of the joints, leading to tissue death due to impaired blood supply. Necrosis of the knee joint is characterized by pain on its inner surface.

Arthritis of the knee (gonarthritis)

Gonarthritis is inflammation of the knee joint of various origins. It can be infectious, rheumatoid, gouty, post-traumatic, reactive, aseptic - and that’s not all its types.

It may affect one knee (monoarthritis) or both (polyarthritis).

At first, the pain occurs periodically, intensifying with physical activity and in the evening. The knee swells, the temperature rises locally, and the skin over it turns red. As inflammation progresses, stiffness in movement, bone deformities, impaired muscle nutrition, contractures, and even complete loss of joint mobility develop.

Of all joint inflammations, knee arthritis is diagnosed in 35–52% of cases. It is detected among people of any age group, but more often in people 40–60 years old.

Knee tendonitis

With this pathology, the tendons of the knee become inflamed and affected. A nagging or sharp pain occurs in the affected area.

In stage 1 tendonitis, the pain is moderate, occurs only in response to normal load on the knee, and goes away with rest. At stages 2–3, it intensifies, not disappearing even after many hours of rest. A moderate restriction appears in the joint, microtears or complete rupture of the tendon are possible.

Other possible diseases

Other causes of pain on the back of the knee joint include Hoffa's disease, malignant or benign neoplasms, such as hygroma.

Knee pain on the inside side: causes

Most often, pain on the inside of the knee occurs for the following reasons:

1. Knee injuries . They can be mild (sprain, bruise) or severe (bone fracture, rupture of ligaments, muscles or tendons). In any case, when the knee is damaged, inflammation forms in it. The leg hurts and feels hot and swollen to the touch. It is difficult for a person to walk.

For minor injuries to the knee, it is recommended to apply cold to it. If a fracture occurs, a diagnosis should be made and a tight cast should be applied.

It is important to know that even minor knee injuries need to be fully treated, otherwise they can progress in the future and lead to more serious illnesses.

2. Arthrosis of the knee joint is a disease in which the knee cartilage is severely affected, which leads to their gradual destruction. Typically, this disease develops after an untreated injury. Unfortunately, in most cases it is chronic and rapidly progressive. In particularly advanced cases, the patient needs a complete replacement of the knee joint with an endoprosthesis.

3. Gonarthrosis is one of the subtypes of arthrosis, which affects men and women aged about forty years, as well as athletes after injuries.

At first, this disease is characterized by aching pain. Over time, the pain intensifies and becomes constant. There may also be a crunching and numbness in the leg.

If gonarthrosis is not treated in time, the person may become disabled.

4. Arthritis is a disease that affects the structural components of the knee joint. It may be caused by previous injuries, joint hemorrhage, viral infection or hypothermia.

In acute arthritis, a person suffers from fever, pain in the inside of the knee, hyperemia and limited mobility of the joint. Treatment of this disease must be comprehensive.

5. Rheumatoid arthritis is a more severe form of arthritis that affects the ligaments, muscles and connective tissues of the knee joint much more quickly. Usually in this condition a person suffers from severe pain under the knee. If left untreated, rheumatoid arthritis will lead to knee stiffness and ankylosis.

6. Damage to the meniscus can occur under a variety of circumstances (trauma, fall, bruise, etc.). Its rupture is characterized by severe swelling of the knee and increasing pain. There are also cases of a damaged ligament getting stuck between bones, which leads to complete immobility of the joint. The only reasonable way out of this situation is to undergo surgery.

7. Inflammation of the tendons can be associated with a person being overweight. Most often, people over forty years of age are susceptible to this condition. In this case, they will experience pain on the inside of the knee. Lifting heavy objects, as well as moving over long distances, provoke increased pain.

8. Rheumatism is a disease that usually occurs after previous viral infections. At the same time, certain processes are formed in the human body, which give impetus to the development of rheumatism.

This disease is characterized by severe joint inflammation and pain. If left untreated, it will gradually develop complications in the form of arthritis or osteoarthritis.

9. Rickets . It develops at a fairly early age (one to two years). Its main manifestation is considered to be deformation of bones due to their softening. As a result, already in adulthood a person may experience pain in different parts of the body, including the knees.