Generality
Gonalgia is the medical term used to indicate a generic knee pain, a widespread symptom that can affect people of all ages.
In addition to supporting the weight of the body, the knee must perform a series of movements that test the structures that constitute its articulation. Furthermore, this area is particularly exposed to traumatic and non-sports injuries, such as sprains and fractures.
Depending on the triggering cause, the treatment of knee pain can include anti-inflammatory drugs, corticosteroids (also with local infiltration) and physiotherapy support.
Basics of anatomy: the knee
- The knee is the intermediate joint of the lower limb, which joins the thigh to the leg and relates bones (femur, tibia and patella), cartilages, muscles, ligaments, tendons, meniscus, vessels and nerves.
- The knee provides stability and resistance to support the weight of the body; at the same time, this structure is flexible, allows you to stand upright and allows the movement of the lower limbs such as walking, running and jumping.
Symptoms
Gonalgia is a localized knee pain.
This symptom can have variable character and intensity, depending on the severity and type of responsible pathology.
In general, it is possible to distinguish acute (often consequent to trauma) and chronic pains .
Gonalgia may or may not be associated with joint effusion, with knee swelling, mobilization pain (active or passive) and functional impotence. At times, a clicking noise can be felt in moving the knee and pain can occur at the level of the joint line.
Gonalgia may also be associated with the presence of neuropathies and the increased risk of fracture (osteoporosis). Sometimes, knee pain is a serious debilitating factor, as it greatly limits the daily activities and lifestyle of patients who suffer from it.
Causes
Gonalgia is a symptom that recognizes multiple causes, as it may depend on the involvement of different knee structures.
The aetiology can also vary depending on the age of the people involved: the pain can manifest itself, for example, in a young sportsman after a traumatic injury or in an elderly person due to arthritis of the knee, while in the adolescent the knee pain can result from Osgood Schlatter syndrome (osteochondrosis of the anterior tibial apophysis).
Excluding inflammatory rheumatic diseases, the gonalgia is generally due to an alteration of the normal biomechanics of the articular elements of the knee: the pain can arise from a nociceptive signal sent by ligaments, joint capsule, synovial membrane and subchondral bone (underlying the articular cartilage).
Meniscuses and cartilages, on the other hand, lack nerve endings, so the knee pain that results from their injury is due to the alterations they cause on other structural components.
gonarthrosis
Osteoarthritis of the knee is the most common cause of knee pain in adult patients (age> 55 years). This chronic disease is due to the progressive wear of the cartilage that covers the surface of the joint heads.
Arthrosis of the knee may be caused by overweight, functional overload or other factors that favor cartilage wear. Over time, the process of degeneration of the knee causes a significant functional limitation.
Gonalgia is the dominant symptom of the disease: it usually increases during movement and is relieved by rest.
Pain is associated with swelling and stiffness (difficulty in starting movements), mainly in the morning or after a period of inactivity.
Knee fracture
Violent and direct traumas, due to falls or accidents of various kinds, can cause various types of injuries.
Fractures can involve one or more parts of the joint and usually occur with pain, swelling, edema and movement difficulties. Other suggestive findings are the inability to flex on the knee of 90 ° and tenderness on palpation of the patella.
Meniscus injury
The meniscuses are cartilaginous rings interposed between the femur and tibia, which facilitate adherence between the ends of the joint and act as shock absorbers.
Lesions of the lateral and medial meniscus are often related to traumatic events or sporting gestures (eg torsions of the leg, repeated bending or kicks), but may also occur spontaneously or after minimal insults on already degenerated structures.
In addition to knee pain, acute injuries cause joint swelling (with or without shedding), knee joint flexion and pain during movement or acupressure.
Ligament rupture
Ligaments are cords of fibrous tissue that connect the tibia to the femur, allowing mobility; in addition, they guarantee stability from the joint (collateral ligaments and cruciate ligaments).
Their break is always related to a traumatic event. At the time of injury, the person experiences a very intense acute pain and a noise similar to a "crack"; subsequently, the knee swells.
Patellofemoral syndrome
This condition is characterized by acute or chronic knee pain due to malalignment of the extensor apparatus of the knee and wear of the articular cartilage.
Patellofemoral syndrome is characterized by the presence of anterior knee pain after prolonged gait, while gonalgia is generally absent at rest. In the most serious cases, the patella can be dislocated.
Patella instability
The patella is a bone located in the front of the knee, which allows the movement of the knee.
If following a trauma, an intense effort or an incorrect gesture, the kneecap moves from its seat it can give rise to problems of instability or dislocations.
In this case, the knee pain is more noticeable when walking downhill or standing up after having been seated for a long time.
In addition to knee pain, there may also be a sort of crackling (due to the rubbing of the patella on the cartilage outside the joint) and a sensation of failure.
Baker cysts
The knee pain depends on the presence of a hygroma (that is, a cystic synovial formation) in the popliteal area. This lesion can reach large dimensions and, in most cases, causes a dull pain, present even at rest and aggravated by knee flexion.
Baker's cyst may be secondary to arthrosis or meniscal injuries.
Osgood Schlatter syndrome
It represents a common cause of gonalgia in adolescents: the repeated tractions exerted by the patellar tendon on the extremity of the tibia still growing (therefore not yet completely ossified) cause the inflammation responsible for the disease.
Osgood Schlatter syndrome manifests itself with pain and swelling of the bony prominence just below the patella.
Gonalgia tends to worsen when the young person practices sports (such as running and jumping) that cause strong pulls on the tendon that fits over the tibia.
Patellar tendonitis
Also called the jumper's knee, it is an inflammation generally due to functional overload.
This disorder is common especially in athletes who perform athletic gestures responsible for continuous and repeated stimulation of the patellar tendon (as runners and basketball and volleyball players).
Tendinitis presents with pain and swelling in the front of the knee, just below the patella. The knee pain is worse when the tendon is stressed with jumps and running.
Patellar bursitis (or laundress's knee)
Repeated trauma can cause inflammation of the bursa, which normally has the function of reducing friction between bones, muscles and tendons.
Patellar bursitis occurs as a result of activities that force you to kneel for a long time, as can happen for example to gardeners or tilers. The knee appears swollen, hot and painful.
Other knee disorders
Gonalgia may occur under other conditions, including:
- Arthritis (inflammatory, septic, etc.);
- Avascular necrosis;
- Hemarthrosis (classic finding in the presence of hemophilia);
- Osteomyelitis;
- Chondromalacia patellar (or runner's knee; pathology affecting the patella cartilage);
- Goose leg tendinitis;
- Osteochondritis dissecans (König's disease);
- Tumors.
Gonalgia due to extra-articular causes may depend on foot problems (excessive pronation or supination during walking or running), hip or lumbar spine.
This symptom can also occur during general diseases of the body, such as gout, rheumatoid arthritis and some infections.
Risk factors
There are numerous risk factors that can favor the appearance of knee pain and include:
- Obesity : excess weight increases stress at the knee, even during ordinary activities (such as walking or climbing stairs), and predisposes to degenerative processes, such as osteoarthritis;
- Use and excessive load : repetitive activities that expose the knee structures to overloading or excessive stress can promote inflammatory reactions, tendinitis and, over time, gonarthrosis;
- Trauma and / or previous fractures : repeated tractions, distortions and bruises are caused by a force that determines movements of the joint greater than those naturally performed;
- Mechanical problems : the "crooked" legs (valgus or varus knee) and other structural anomalies can favor the appearance of problems (first of all arthrosis);
- Adults and the elderly : age is a factor closely related to the appearance of knee disorders, such as osteoarthritis, which tends to occur mainly after the age of 55;
- Reduced muscle strength and flexibility: offers less support for knee function.
Diagnosis
When gonalgia occurs, it is advisable to undergo a thorough examination by your doctor, who will evaluate whether further studies are required.
First, the diagnosis requires an overall assessment of the patient, with particular reference to the medical history and the physical examination .
With the collection of anamnestic data, the doctor will be able to investigate the characteristics, location and activities with which the appearance of knee pain is associated.
The physical examination will then evaluate the possibilities of movement, checking with appropriate maneuvers the integrity of the structures of the knee. In general, "mechanical" symptoms associated with knee pain, such as joint blockage, suggest an articular pathology of the knee, while instability suggests the presence of a ligamentous lesion or a patellar subluxation. The pain that gets worse with the load immediately after a trauma suggests, instead, the presence of a fracture.
Based on the suspicion, the diagnostic path can include a specialized orthopedic assessment, which can make use of radiographs (Rx) of the knee, magnetic resonance (MRI), ultrasound and computerized tomography (CT).
An acute or chronic pain referred to the knee joint generally requires a radiographic study in an anteroposterior, lateral and tangent projection to the patella; to assess the reduction of joint space, the Rx must also be performed under load.
MRI is the technique of choice for diagnosing meniscal lesions, anterior or posterior cruciate ligament rupture, avascular necrosis, osteomyelitis and tumors. Instead, bone scintigraphy can help diagnose infections and tumors.
Acute or chronic knee pain of dubious origin associated with joint effusion must be assessed by aspiration and examination of the liquid withdrawn ; this examination includes Gram staining, cultures, total and differential white blood cell counts and crystal research.
At the end of these tests, the doctor can prescribe the most appropriate treatment for the case.
Treatment
The treatment of gonalgia must be aimed at the specific cause.
Therapeutic approaches can include mobilization and muscle strengthening exercises, local infiltration with substances with chondroprotector effect (such as hyaluronic acid), anti-inflammatories and pain control drugs.
In the case in which the knee pain is associated with a trauma, instead, rest, cessation of the activities of loading and immobilization of the knee are provided (for example, with rigid guardians); in addition, it is possible to apply ice locally and raise the limb.
To allow the repair of ligaments and injured meniscuses, the use of arthroscopic surgery may be indicated. In the presence of severe arthrosis, instead, the indication is given to the intervention of replacement of the joint with a prosthesis.
What to do or avoid
Some tricks can help maintain good knee function:
- Contact your doctor immediately when knee pain prevents you from putting weight on your knee or if you have general symptoms such as chills and fever;
- Practicing sports in a moderate manner without subjecting the knee to excessive strain;
- Perform regular motor activity (such as walking, cycling or swimming) to maintain good muscle tone;
- Protect your knees from trauma, perhaps using knee pads;
- Maintain a balanced body weight and, if necessary, reduce it to avoid exposing the joint to excessive stress.
