Why does my knee hurt?
Choosing which doctor to see if your knee is swollen is difficult because there are many causes for this condition. Mainly knee pain occurs due to:
- fresh injuries;
- consequences of long-term damage;
- joint diseases;
- common diseases that lead to joint pain or deformation.
In each of these cases, the help of different specialists is needed. At the initial stage, a regular therapist can provide assistance and prescribe basic diagnostic procedures. But in most cases, patients with complaints of pain in the knee joints need to visit several specialists and undergo a thorough examination.
What to do if your knees hurt?
Knee pain can have many causes. Alexey Yurievich Krasovsky, a traumatologist-orthopedist at the Expert Clinic Irkutsk, told us about why it occurs, whether it is possible to cope with it on your own, what preventive measures exist, and much more.
— Alexey Yuryevich, why do your knees hurt? What are the most common causes of pain?
— The causes of pain can be degenerative-dystrophic changes in the knee joint, injuries, arthrosis, arthritis. Pain can be associated both with systemic rheumatic diseases and with instability of the lumbosacral spine, so-called referred pain. This is a violation of the static-dynamic function of the muscle attached to the upper third of the inner surface of the tibia. People think that they have pain in the knee joint, but in fact it is simply tension in the adductor muscle group of the thigh and the muscles of the attachment point to the inner surface of the upper third of the leg. So-called crow's feet tendonitis.
— In what cases should you see a doctor if you have pain in the knee, and in what cases can you endure it?
— If the pain appeared and went away within several hours without any treatment, then this may be associated with any neurological symptoms or physical activity. That is, these are muscle pains or in the area of attachment of muscles, tendons and ligaments. They usually go away on their own within two to three days.
If, for example, your knees hurt and are swollen, that is, there is swelling in the area of the knee joint, then you need to look for some kind of pathology. And the swelling does not have to be large, it can be minor. In this case, you need to contact a specialist to prescribe an examination.
— Which doctor should you see if your knee hurts?
— If there is no specialist such as an orthopedic traumatologist, you should contact a surgeon. If there is no surgeon, then see a therapist or general practitioner.
— What diagnostics are carried out for knee pain?
— If your knee hurts, then the main thing is the clinical picture (examination and history taking). The doctor finds out when the pain began and what the patient associates with its occurrence.
An experienced orthopedic traumatologist makes a diagnosis based on the clinical picture with, let’s say, 70–80% confidence. And additional research methods are confirmatory according to the principles of evidence-based medicine. For example, for cases of inspection of insurance companies or examination of the quality of care.
If the knee hurts, the patient may also be prescribed diagnostic methods such as MRI or CT. Magnetic resonance imaging is performed if the soft tissue component is examined (cartilage, ligaments, joint capsule, menisci). And if we want to look at the bone structure and clarify the spatial location of some pathological formation or process, then a computed tomography or x-ray is done.
— What treatment is prescribed for knee pain?
— First, you need to make a diagnosis in order to understand what pathology is a manifestation of knee pain. If the knees hurt for reasons related to injury, then first of all, this is immobilization (immobilization) with the help of a splint, orthosis or plaster cast, and analgesics.
As for arthritis, it can be infectious and non-infectious, purulent and non-purulent. Because These are different pathologies, and therefore the treatment is different. If it is arthritis that is not associated with any infectious agent, then anti-inflammatory therapy is carried out. And this treatment is usually carried out by both a general practitioner and a rheumatologist.
Knee arthroscopy
In cases where the disease is associated with a purulent inflammatory process, you should contact a purulent surgeon. If purulent arthritis is treated in time using arthroscopic technology, then we get very good results by completely washing all corners of the joint with saline solution. After such treatment, a person is less susceptible to disability. And, as a rule, it recovers quite well.
For arthrosis, intra-articular injections of glucocorticoids and, in some cases, plasma lifting and PRP therapy (platelet-rich plasma therapy) are used. The doctor can also try to eliminate conflicts in the joint and maintain range of motion by removing intra-articular chondromic bodies and damage. That is, it carries out the so-called debridement of the joint, and thereby creates smooth movement in the joint, prolonging its life. During arthroscopic treatment, intra-articular injection of chondroprotectors is mandatory in the postoperative period. If patients live where it is not possible to receive intra-articular injections, then they receive chondroprotectors intramuscularly or taken orally.
Despite the above-mentioned measures taken for arthrosis, their effectiveness may be insufficient. In such cases, the question is raised about performing total joint replacement, that is, when the joint is replaced with an endoprosthesis.
Well, the main thing is the motor regimen, the use of exercise therapy and rehabilitation. This makes it possible to support the joints.
However, in any case, a full examination is necessary. For this, the clinical picture and additional research methods that I listed above are used.
— Alexey Yuryevich, what will happen if you don’t treat your knees or treat them yourself, using some folk remedies?
“This will lead to a sharp decrease in a person’s quality of life and disruption of the static-dynamic function of the limb. And then to diseases of adjacent joints (hip, ankle), to damage to the lumbosacral spine. In the future, the number of health problems may increase. If you do not consult a doctor in time, then ignoring the situation can lead to the replacement of the joint with an artificial one.
— Is it possible to avoid knee pain? Tell us about prevention methods.
— Firstly, this is an active lifestyle. If a person has not moved for a long time and then puts a strain on it, this is very bad for the joints. A constant maintaining, let's say, range of movements, and certain physical activities are required.
Secondly, use the right shoes. Very often, pain in the knee joints is associated with wearing the wrong shoes. These are sneakers, moccasins, ballet shoes, etc. That is, shoes that do not have the criteria for healthy shoes. What does this mean? This necessarily includes a classic heel (2–3 cm), a solid last that is rigid in the middle part, and the use of an instep support. Previously, back in the Soviet Union, these criteria were observed, and all shoes produced in factories were clearly standardized. If you take apart a sample of shoes that were made in those days, you can find a metal plate in the last. It was an instep support that supported the arch of the foot and contributed to shock absorption (reduction of impact force) when walking and running.
You can make an appointment with a traumatologist-orthopedist at the Expert Clinic Irkutsk here. You can read more about the services of a traumatologist at the Expert Clinic Irkutsk here and here
The editors recommend: “I fell, I woke up...”. What is a meniscus tear?
For reference:
Krasovsky Alexey Yurievich
In 1995 he graduated from the Faculty of Medicine of Irkutsk State Medical University (IGMU).
1995 - 1996 - Internship at the Department of Traumatology and Orthopedics of IGMU.
1996–98 — Clinical residency in the specialty “Traumatology and Orthopedics”.
He has been involved in joint arthroscopy for more than 15 years.
For 12 years he was the chief traumatologist in Irkutsk.
For 2 years he was the chief freelance traumatologist-orthopedist of the Ministry of Health of the Irkutsk Region.
Currently, he is a traumatologist-orthopedist of the highest category at the Expert Clinic, Irkutsk.
Reception is conducted at the address: st. Kozhova, 9a.
Choosing who to contact
Which doctor you need to see if your knee is swollen depends on the circumstances under which the problem arose and how it manifests itself.
Knee joints can also hurt because a nerve is pinched somewhere. Such cases are treated by a neurologist, but for neurological reasons the joint does not swell.
Pain that occurs gradually over several weeks and then manifests as swelling usually indicates chronic illness. This may be arthritis (inflammation of the joint) or arthrosis (non-inflammatory deformity), inflammation of the ligaments, tendons, joint capsule and other components of the knee joint. These diseases are dealt with by a doctor whose specialty is the treatment of the spine and joints. He is called an "orthopedist". Regardless of why the knee hurts and is swollen, this is the doctor who will definitely be recommended to contact, if not to treat the disease, then to eliminate its consequences.
Which doctor treats joints
Depending on the clinical picture, the therapist may refer you to an orthopedic traumatologist, rheumatologist, surgeon, neurologist, endocrinologist, osteopath or chiropractor.
- Rheumatologist.
Most often, if knee arthrosis or arthritis is suspected, they are referred to a rheumatologist. Before the consultation, you will need to undergo additional tests - for example, rheumatic tests, examination of C-reactive protein, synovial fluid, cryoglobulin analysis, etc.
- Traumatologist surgeon.
They are referred to him in difficult cases, if treatment for arthrosis of the hip joint or therapy for other pathologies prescribed by a rheumatologist has not yielded results. This doctor comes to the rescue when the joints are severely deformed, the disease is protracted and the pain remains even at rest.
An orthopedic surgeon uses arthroscopy, joint replacement, and performs corrective surgeries and other surgical interventions on large joints.
An orthopedic surgeon sees patients with advanced cases
- Orthopedist-traumatologist.
This specialist deals with a variety of diseases of the musculoskeletal system, including congenital and acquired pathologies of joints and tendons, ligaments and muscles. He diagnoses and treats lesions of soft tissue structures, consequences and complications of injuries, post-traumatic arthrosis, and neoplasms.
- Neurologist.
Sometimes the cause of joint pain is neurological in nature - inflammation of a nerve, pinching in the spine, injuries that change the position of the vertebrae, etc. A neurologist also examines functional pain in the joints caused by intensive growth of the body in adolescence, during pregnancy or due to severe physical exertion. As a rule, they go away on their own without treatment, but still need monitoring.
- Endocrinologist.
In some cases, joints hurt due to disruption of hormone synthesis, due to metabolic failures. Excess weight and regular stress lead to their defeat. An endocrinologist deals with such pathologies: a rheumatologist or orthopedist will not help the patient in such cases.
- Chiropractor.
Sometimes therapists recommend that patients turn to alternative medicine. The chiropractor uses the contact method to correct disorders of the musculoskeletal system.
Do your joints hurt? Perhaps your need is not an orthopedist, but a neurologist or endocrinologist
What is needed for diagnosis
An examination in a situation where the knee is swollen will help clarify which doctor to contact. Mandatory stages of diagnosis:
- determining the circumstances under which pain and swelling occurred;
- examination: the doctor must feel the knees, compare one with the other, evaluate their mobility;
- X-ray examination: traumatologists usually take an image of only the diseased joint, orthopedists and other specialists - of both.
If X-ray findings are insufficient to assess the condition of the joint, doctors may recommend an ultrasound (US), magnetic resonance imaging (MRI), or computed tomography (CT) scan.
Causes of knee pain
Unpleasant sensations in the knee joint can be caused by various conditions. Causes of pain:
- inflammation;
- injury;
- degenerative changes in the joint;
- accumulation of fluid or blood in the joint capsule;
- damage to nervous tissue.
In the latter case, the pain does not arise in the knee itself, but only radiates (“gives”) into it. In this situation, treatment will not specifically target that area.
How to treat sore knees
There are two main directions of treatment - surgical and therapeutic. They usually start with therapy. The exception is complex fractures, when the joint needs to be actually reassembled, or bone fragments need to be fixed so that they do not damage the soft tissue. In other cases, surgical intervention is resorted to only if it was not possible to help the patient through therapeutic means. Nowadays, a gentle technique for restoring the condition of the joint cavity is actively used - arthroscopy.
Therapeutic treatments include medications, physical therapy, limited mobility, orthoses—joint-relieving devices—and exercise therapy. At the same time, it must be remembered that all these methods, which work well in specific phases of the disease, can seriously harm if they are applied at the wrong time.
Getting used to blockades is a myth
Oh, for example, with arthritis it lasts about three months. At this time, the inflammatory process is in the exudative, primary phase, and the reversibility of the disease with basic therapy is very high. In some cases, after the first blockade, the pain syndrome is relieved and the pain in this joint never returns.
In addition to the lack of a rheumatologist in most district clinics, there is another reason why a patient is not referred to a rheumatologist. This is a mistrust of drug blockades, which are widely used in rheumatology. Unfortunately, even many doctors have a very biased attitude towards this method. Many are convinced that after using the blockade, the patient allegedly becomes addicted to the drugs and after using them, nothing will help anymore. It is a myth.
Moreover, blockades, as an invasive method, are included in Russian standards of medical care, which in turn are based on international and European standards. They are successfully used in Europe and Israel. According to our experience and the experience of our colleagues, direct administration of medications into the joint cavity or tissues adjacent to the joint in case of arthrosis allows us to stop the pathological process and restore the patient’s ability to work. The method is considered one of the most effective and is often used to provide quick assistance, and patients for whom the blockade is done correctly speak positively about the results.
Prevention
The key to healthy knees is reducing the load on them. To do this, you need to avoid gaining weight, and use protective knee pads when doing physical exercise. When running, it is advisable to choose springy surfaces - soil, special treadmills, and not asphalt. If you receive even minor injuries, you should definitely consult a doctor, without hoping that the pain will go away on its own.
And most importantly. If your knee is swollen, you need to quickly decide which doctor to go to. The longer the inflammatory process in a joint lasts, the less chance there is of completely restoring it. If not cured in time, the process will become chronic, and it will be much more difficult to get rid of its consequences, sometimes even serious ones that require constant treatment of diseases.
Types of joint pain
Reflected
. Characteristic of diseases of the pelvic organs, heart and some other diseases of internal organs. The pain in this case does not occur in the joint itself, but is only a “reflection” of pain in one of the organs.
Starting
. If the joint has been at rest for a long time, such pain occurs when the movement begins. This type of pain can occur at any age.
Mechanical
. People with joint problems experience such pain at the end of the day after physical activity. They go away after rest, but appear again with repeated exercise. In advanced cases, even after walking.
Congestive night
. During sleep, the muscles that support the normal position of the joint relax and its blood supply slows down, which provokes increased pain.
It is also worth paying attention to additional symptoms, such as redness of the skin in the joint area, swelling, and increased body temperature. This indicates the inflammatory nature of joint pain.
Joint doctor
Joint doctor
A doctor who deals with joints, namely inflammatory and degenerative-dystrophic pathologies, is an orthopedist. He conducts consultations in specialized outpatient or inpatient medical institutions of various forms of ownership. To reliably determine the cause of the disease, the nature of the pathological changes, as well as the degree of their severity, he prescribes an objective examination, which usually includes various imaging techniques (ultrasound, tomography, arthroscopy).
Routine laboratory tests are required. After the diagnosis, the orthopedist prescribes appropriate treatment, which may include the use of medications or surgery. If necessary, during diagnosis and therapy, the orthopedist can prescribe a consultation with doctors of other specialties, in particular an infectious disease specialist, a dermatovenerologist, and a phthisiatrician. This is due to the fact that a significant number of arthritis can be the result of the development of specific infections (tertiary syphilis, tuberculosis, brucellosis). Very often, a doctor treating the joints of the knees, other structures of the legs and spine is faced with degenerative-dystrophic pathology.
Joint doctor (skeleton)
Joint doctor (skeleton)
A joint doctor in Moscow conducts consultations in a specialized medical institution of state or private ownership. An orthopedist and traumatologist can diagnose and treat the corresponding pathology in a clinic and in the orthopedic and trauma department of a medical hospital.
The clinic usually sees outpatients with diseases or injuries that do not require hospitalization. The department treats severe pathologies that require constant medical supervision.
A medical specialist rheumatologist usually conducts consultations in large clinics. He also provides consulting assistance to doctors of other specializations. Patients with severe autoimmune rheumatic pathology are often treated in a cardiology or orthopedic hospital, but the attending physician is a knee and elbow doctor from the clinic.
Treatment
The treatment regimen depends on the diagnosis. For short-term pain relief, ointments based on non-steroidal anti-inflammatory drugs (Diclofenac, Finalgon) are used. If the pathology is widespread, it is advisable to prescribe NSAIDs systemically in the form of tablets. In case of chronic lesions, the drug is administered directly into the joint capsule.
In cases where pain is caused by damage to the nervous system or an infectious process, treatment is carried out by a specialist - a neurologist or an infectious disease specialist.
When your knees hurt, you don’t need to think about what to do or how to treat it. It is better to immediately consult a doctor for a full examination. This will help to stop the development of the disease in a timely manner and avoid complications.
Dear patients! Remember that only a qualified doctor can make an accurate diagnosis, determine the causes and nature of the disease, and prescribe effective treatment. You can make an appointment with our specialists or call a doctor at home by calling 8-(4822)-33-00-33
Be healthy and happy!