After you have a confirmed diagnosis (easier said than done), the next step is to find the cause(s) especially in old or chronic knee pain. This helps you with both treatment choice and prevention. Once you know the actual cause(s), then you can decide on the best treatment choice for you.

Let’s start by discussing the four common knee pain symptoms with possible diagnosis and causes.

Common Knee Pain Signs and Symptoms -

Symptom #1: Swelling

Swelling ranges from mild to large without 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 getting damaged – a torn joint covering ( the synovial membrane), a fractured bone or a torn anterior or posterior cruciate ligament.

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

Serious Swelling

Here are four types of knee swelling that are potential medical emergencies, requiring urgent diagnosis and proper treatment.

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

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

• Both your knee and ankle are swollen

• 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), fibula, leg bone (tibia) and knee cap (patella)

• dislocated kneecap (patella)

• joint covering (synovial membrane) tear

• tumor or cancer

• blood clot (Deep or Femoral Vein Thrombosis)

• cruciate ligament tears; either anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tear

• Osteochondritis Dessicans

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

• quadriceps tendon tear or rupture

• inflammatory arthritis like Rheumatoid arthritis

• quadriceps or hamstring muscles tear

A large swollen knee is usually a serious symptom and you should seek immediate medical help for proper treatment of your knee injury.

Mild Swelling

Mild swelling is usually the result of extra joint fluid from inflammation (not blood) with chronic knee problems like

• Osteoarthritis (common knee arthritis) from degenerative joint disease

• pre-arthritis also called Patellar Femoral Syndrome (P.F.S.) and Chondromalacia

• damaged cartilage like medial or lateral meniscus tears

• old or chronic, medial or lateral collateral ligament tears

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

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

• quadriceps tendonitis

Symptom #2: 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 will not move until you move or manipulate it. If you can't unlock your knee, get to a qualified medical doctor immediately for evaluation and proper knee injury treatment.

Real Locking is caused by damaged cartilage, usually from either a medial or 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 potentially 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 manipulating, usually unlocking slowly with some knee pain. This knee pain symptom is usually caused by the damaged rough or arthritic cartilage on the backside of the knee cap (patella). Pseudo Locking is typical of Osteoarthritis (common knee arthritis); pre-arthritis, also called Patellar Femoral Syndrome (P.F.S.) and Chondromalacia.

Symptom #3: Aching and Pain

Pain Location

The knee pain location is not quite as helpful for diagnosis as you would think because some tissues in the knee have poor nerve supply. Pain can be felt in one place while your actual knee injury or knee problems are actually somewhere else. For example, knee pain on the inside (medial) maybe from local structures like the medial collateral ligament or the medial meniscus -but it is also a common place to feel pain actually coming from the back of the knee cap (patella).

Pain on the inside, outside, around, below or behind the knee cap and the back of your knee could be from any of the serious causes like

• infection

• gout or pseudo-gout

• bone fracture

• knee cap (patella) dislocation

• torn joint covering (synovial membrane)

• tumor or cancer

• blood clot ( Deep Vein Thrombosis - DVT)

• torn anterior cruciate ligaments (ACL) or posterior cruciate ligament (PCL),

• Osteochondritis Dessicans

• patellar tendon tear,

• quadriceps tendon tear

• inflammatory arthritis

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

Inside (Medial) Pain -

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

• medial collateral ligament sprain or tear

• medial meniscus injury with tear

• knee Osteoarthritis or common knee arthritis

• pre-arthritis, Patella Femoral Syndrome, Chondromalacia, Runners Knee

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

• knee cap dislocation (patella)

Outside Knee Pain (Lateral Pain)-

This is a less common location. Causes include -

• lateral collateral ligament sprain or tear

• lateral meniscus injury with tear,

• common arthritis or Osteoarthritis

• pre-arthritis, Patella Femoral Syndrome, Chondromalacia, Runners Knee

• leg bone (tibia) or thigh bone (femur) or fibular head fracture

• Iliotibial Band Syndrome

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

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

Common causes include -

• common knee arthritis

• pre-arthritis, Patella Femoral Syndrome, Chondromalacia, Runners knee

• patella fracture

• patella dislocation

• patellar tendonitis

• bursitis

Back of Knee Pain -

A less frequent location for pain and swelling. Common causes include

• Baker's cyst

• popliteus muscle tear

• lateral meniscus tear usually posterior horn

• medial meniscus tear usually posterior horn

• plantaris tear with rupture

• common knee arthritis

• DVT

Knee Pain on stairs, standing, sitting-

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

• Osteoarthritis or common arthritis

• pre-arthritis, Patella Femoral Syndrome, Chondromalcia

Intermittent Pain after walking a 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 with outside leg, calf or foot pain

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

• sciatica

• spinal stenosis

Knee Pain That Worsens with Activity - especially with running

• Osteoarthritis or common arthritis with articular cartilage damage

• pre-arthritis, Patella Femoral Syndrome, Chondromalcia, Runners Knee

• medial meniscus tear or lateral meniscus tear

• Iliotibial Band Syndrome

• bursitis

• chronic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) with instability,

• Osteochondritis Dessicans

• chronic medial collateral ligament sprain or tear

• chronic lateral collateral ligament sprain or tear

Symptom #4: Buckling

Buckling

This means 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

This is when your knee buckles from pain, not instability. Usually pseudo buckling is from:

• Osteo-arthritis or common knee arthritis

• pre-arthritis, Patellofemoral Syndrome, Chondromalcia

Those are the four main knee pain symptoms of swelling, locking, pain and buckling with associated diagnosis.

The next step is to confirm your diagnosis with testing, if needed.

Diagnostic Testing

Most knee pain does not need a diagnostic test other than for confirmation.

These diagnostic tests are supplementary. Many doctors today depend on tests (especially MRI Scans) for diagnosis. MRI Scans are often not even 90% accurate and can lead to a misdiagnosis. Your doctor should take a thorough history, perform a complete knee examination and arrive at a possible diagnosis before 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, fractures. Less accurate for knee ligaments and meniscus cartilage tears.

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

Bone Scan - an uncommon test but needed occasionally to confirm small or stress fractures especially in the tibia plateau and possibly fibular head. Once you know your diagnosis, the next step is to determine the causes. Often, in chronic knee pain, there are hidden pain and inflammation triggers.

Knee Pain Treatment

The general guidelines are to:

Reduce pain and inflammation right away to break the pain-cycle (especially in chronic knee pain) with natural anti-inflammatory supplements and treatments, physical therapy, rehabilitation, knee exercise, 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, avoiding anti-inflammatory foods, exercise and strengthening

Take preventative steps to prevent your knee pain from returning by knee exercise, weight training, strengthening, flexibility, stretching, cardiovascular fitness, meditation, Tai Chi, an anti-inflammatory diet, 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 helps you find the answer to your knee pain.

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