Chronic Knee Joint Pain Common Causes,
Diagnosis and Best Treatments to Avoid Early Arthritis

You confirm your knee diagnosis with an MRI scan, X-rays, knee arthroscopy examination or a bone scan.

After your confirmed diagnosis, the next step is to find the cause(s) for your old or chronic knee joint pain.

This helps you with both chronic knee pain treatment and future prevention. Once you know your diagnosis and the cause(s) for your chronic knee joint pain, you can decide on the best treatment choice for your body.

Let’s start with common chronic knee pain symptoms with possible diagnosis and causes.

Top 4 Chronic Knee Diagnosis and Causes:

1) Pre-arthritis also called Chondromalacia, Patellofemoral Syndrome (PFS), Runner's Knee

2) Osteoarthritis - common wear-and-tear knee arthritis

3) Cartilage (Meniscus) Tear

4) Chronic Ligament Pain with Instability - old sprain or tear of the collaterial or cruciate ligaments

Here are the common signs and symptoms with chronic knee joint pain:

Common Chronic Knee Joint Pain Symptoms

Symptom #1: Swelling

Swelling ranges from mild to large, with or without pain. Knee swelling in the joint can be from either extra joint fluid or blood. Blood in the joint is a serious problem usually from a blood-vessel-rich structure rupture – this could be a torn joint covering called synovial membrane; a fractured bone; and a torn anterior or posterior cruciate ligament.

There are some serious and possible life-threatening knee pain causes that result in swelling -especially other symptoms.

Serious Joint Swelling

Here are four types of knee swelling that are potential medical emergencies requiring urgent treatment.

• Swollen knee that is red hot - with or without a fever

• You suffer a knee injury or injuries and the joint swell ups quickly like a big balloon

• Both your knee and ankle are swollen

• A large swollen knee with no history of knee injury or trauma

These types of swelling are commonly caused from:

• infection

• gout or pseudo-gout

• fracture of the thigh bone (femur), leg bones (fibula and tibia) or knee cap (patella)

• dislocated kneecap

• tear in the joint covering (synovial membrane)

• tumor or cancer

• blood clot (Deep or Femoral Vein Thrombosis)

• tear in the anterior cruciate ligament (ACL) or the posterior cruciate ligament (PCL)

• Osteochondritis Dessicans

• patellar tendon tear (Osgood-Schlatter Disease in teenagers and kids) with possible tendon rupture

• quadriceps tendon rupture or tear

• inflammatory arthritis like Rheumatoid arthritis

• a quadriceps or hamstring muscle tear

A large swollen knee is usually a serious symptom so get immediate medical help for proper treatment of your knee injury.

Mild Swelling

Mild swelling is usually extra joint fluid from inflammation (not blood) due to chronic knee problems such as:

• Osteoarthritis (common knee arthritis) from degenerative joint disease

• Pre-arthritis, also called Patellofemoral Ssyndrome (P.F.S.) and Chondromalacia

• damaged cartilage – medial and lateral meniscus tears

• chronic medial or lateral collateral ligaments tears

• chronic cruciate ligament injury with tear (ACL or PCL )

• patellar tendon tendonitis (Osgood-Schlatter Disease in teenagers and kids)

• quadriceps tendonitis

Symptom #2: Joint Locking

Knee Joint Locking

This is when your knee gets stuck in one position and won't move. There are two types of joint locking - real and pseudo (fake).

Real Locking

In real locking, your knee joint gets stuck and does not move until you manipulate it. If you can't unlock your knee, get to a qualified medical doctor immediately for evaluation and knee injury treatment.

Real locking is caused by damaged cartilage, usually a medial meniscus tear, a lateral meniscus tear or a loose body getting lodged in between your thigh bone (femur) and your leg bone (tibia). This is why you need to manipulate your joint until the cartilage or loose body gets unstuck. Real locking is damaging to your joint articular cartilage and may cause early Osteoarthritis (common wear-and-tear knee arthritis).

Pseudo Locking

In pseudo locking, your knee feels stuck but will move without manipulation, usually unlocking slowly with some knee pain. This joint locking is usually caused by the damaged rough or arthritic cartilage on the back of the knee cap (patella). Pseudo Locking is typical of Osteoarthritis (common knee arthritis) and Pre-arthritis, also called Patellofemoral Syndrome (P.F.S.), Runner's Knee and Chondromalacia.

Symptom #3: Aching and Joint Pain

Knee Joint Pain Location

Your knee pain location is not quite as helpful for diagnosis as you would think - some tissues in the knee have poor nerve supply. Pain can actually be felt in one place, when the real knee injury or problem is actually somewhere else. For example, knee pain on the inside (medial) may be from local structures like the medial collateral ligament or medial meniscus - but that is also a common place to feel pain that originates from the back of the knee cap (patella).

Any pain on the inside, outside, around, below, behind the knee cap and behind your knee could be from any of the serious causes of swelling listed above.

Where is your knee joint pain? Inside, outside, front or back?

Inside (Medial) Pain -

Inside or medial knee pain is a common location. Causes include:

• old medial collateral ligament sprain or tear

• chronic medial meniscus injury with tear

• knee Osteoarthritis or common knee arthritis

• Pre-arthritis (Patellofemoral Syndrome or Chondromalacia)

• leg bone (tibia) or thigh bone (femur) fracture undiagnosed

• knee cap dislocation (patella) or subluxation

Outside (Lateral) Pain -

This is a less common location. Causes include:

• Chronic lateral collateral ligament sprain or tear

• Chronic lateral meniscus injury with tear,

• Common arthritis or Osteoarthritis

• Pre-arthritis (Patellofemoral Syndrome or Chondromalacia)

• Fracture of the leg bone (tibia), thigh bone (femur) or fibular head undiagnosed

• Iliotibial Band Syndrome

Pain Around, Below or Behind the Kneecap (Patella) -

This location is quite deceptive because the kneecap is poorly innervated and you may feel the pain somewhere else, other than in the real spot.

Common causes include -

• common knee arthritis

• Pre-arthritis (Patellofemoral Syndrome or Chondromalacia)

• patella fracture

• patella dislocation

• patellar tendonitis

• bursitis

Behind Knee Pain -

This is a less-frequent location for pain and swelling. Common causes include:

• Baker's cyst

• popliteus muscle tear

• old lateral meniscus tear, usually the posterior horn

• old medial meniscus tear, usually the posterior horn

• plantaris tear with rupture

• common knee arthritis

• DVT

Knee Joint Pain When Climbing Stairs, Standing or Sitting -

This is quite common and classic for the following conditions, especially Pre-arthritis.

• Osteoarthritis or common arthritis

• Pre-arthritis (Patellofemoral Syndrome or Chondromalacia)

Intermittent Pain after walking certain distance - usually with leg or calf pain -

This is a potentially serious medical condition. Common causes include:

• intermittent claudication

• Osteoarthritis or common knee arthritis

• spinal stenosis

Constant Pain in outside leg, calf or foot

This is not normal with knee pain and is usually something else. Common causes include:

• sciatica

• spinal stenosis

Knee Pain That Worsens with Activity - especially with running

This type of knee pain can be associated with:

• Osteoarthritis or common arthritis with articular cartilage damage

• Pre-arthritis (Patellofemoral Syndrome or Chondromalacia)

• Chronic medial meniscus tear or lateral meniscus tear

• Iliotibial Band Syndrome

• Bursitis

• Chronic (ACL) anterior cruciate ligament tear or ( PCL) posterior cruciate tear ligament with instability

• Osteochondritis Dessicans

• chronic medial collateral ligament sprain or tear

• chronic lateral collateral ligament sprain or tear

Symptom #4: Buckling

Knee Joint Buckling

When you take a step and your knee buckles under you. Buckling, like locking, can be real or pseudo (fake).

Real Buckling

This is usually from a complete anterior cruciate ligament tear with instability. The ACL holds your knee bones together when you move. If your ACL is torn, the thigh bone (femur) can slide over top of the leg bone (tibia) causing you to buckle and fall.

Pseudo Buckling

Your knee buckles from pain, not instability. Usually Pseudo Buckling is from:

• Osteoarthritis or common knee arthritis

• Pre-arthritis (Patellofemoral Syndrome or Chondromalcia)

Those are the four main knee joint pain symptoms of swelling, locking, pain and buckling.

The next step is to find your diagnosis with testing.

Diagnostic Testing

Most knee pain does not need a diagnostic test other than for confirmation (if truly needed).

The following diagnostic tests should be at most supplementary. Most doctors today overly depend on tests for the initial diagnosis - especially MRI Scans. In fact, MRI Scans are often not even 90% accurate and often lead to a misdiagnosis. Your doctor should take a thorough history, perform a complete knee examination and arrive at a possible diagnosis before considering testing. Here are the common knee tests.

X-Ray - good for common knee arthritis and large fractures; only visualizes bones and joint space; may miss small and stress fractures

MRI SCAN - good for cancer and fractures; less accurate for knee ligaments and meniscus cartilage tears.

Diagnostic Arthroscopy - This is when the orthopedic surgeon uses the arthroscope to see into your knee. This is extremely accurate for almost all knee conditions, but does involve extra risk because of the surgery.

Bone Scan - an uncommon test, but needed occasionally to confirm diagnosis of small or stress fractures (especially in the tibia plateau and possibly the fibular head).

Once you know your diagnosis, the next step is to determine the cause(s). Often, in chronic knee joint pain, there are hidden pain and inflammation triggers.

Knee Pain Treatment

The general guidelines are for you to:

• Reduce pain and inflammation right away to break pain cycle (especially in chronic knee pain) with natural anti-inflammatory supplements and treatments; physical therapy; rehabilitation; knee exercises; stretching and a knee brace, if needed

• Find the causes and the hidden pain triggers of your knee pain and correct them with modified sports technique, biomechanics, foot wear, foot orthotics, a knee brace, exercise, strengthening and by avoiding inflammatory foods

• Take preventative steps (to prevent your knee pain from returning) such as knee exercises, weight training, strengthening, flexibility, stretching, cardiovascular fitness, meditation, Tai Chi, an anti-inflammatory diet and natural anti-inflammatory supplements with joint-healthy nutrients

Last Resort and All-Else-Fails Treatments - anti-inflammatory drugs, cortisone injections, Hyaluronic injections, knee arthroscopy surgery, knee Replacement Surgery or a High Tibial Plateau Surgery.

Hopefully, this will help you find the answer to your chronic knee joint pain.

Disclaimer: This information is for educational purposes only. Always check with your qualified medial doctor before making any changes in your diet, supplements, exercise, medications or treatments.