Your Common Knee Problems Guide- 
Causes, Diagnosis and Best Knee Treatments

Please - always have your knee examined and treated by a qualified medical professional such as a sports medicine doctor.

The first step is to determine what your knee symptoms are - that will help you get an accurate diagnosis and find the cause of your knee problem. Your knee pain diagnosis may need confirmation with an MRI scan, X-rays, an arthroscopy examination or a bone scan.

After you have a confirmed diagnosis (easier said than done), the next step is to find the cause of your knee problems. This helps you with both treatment choice and future prevention. Once you know the actual cause, then you can decide on the best knee treatment choice for you.

Let's start by discussing the four common knee symptoms with possible diagnosis and causes:

Common Signs and Symptoms

Symptom #1: Knee 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 and is usually caused by damage to a blood-vessel-rich structure - 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 problems that result in swelling - especially when 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 and the joint swells up like a balloon
• Both your knee and ankle are swollen
• Large swollen knee with no history of injury or trauma

Those types of swelling are commonly caused by:

• infection
• gout or pseudo-gout
• fracture of the thigh bone (femur), fibula, leg bone (tibia) or 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 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 tear or rupture
• inflammatory arthritis like Rheumatoid arthritis
• quadriceps or hamstring muscles tear

A large swollen knee is usually a serious symptom. 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) caused by chronic knee problems such as:

• Osteoarthritis (common knee arthritis) from degenerative joint disease
• Pre-arthritis also called Patellar Femoral Syndrome (PFS) and Chondromalacia
• damaged cartilage such as 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 flex or extend until you deliberately 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) - that  is why you need to manipulate your joint until the cartilage or loose body gets unstuck. Real Locking is potentially damaging to your knee 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 damaged, rough or arthritic cartilage on the backside of the knee cap (patella). Pseudo Locking is typical of Osteoarthritis (common knee arthritis) and Pre-arthritis - also called Patellar Femoral Syndrome (PFS) 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 really somewhere else. For example: knee pain on the inside (medial) maybe from local structures such as the medial collateral ligament or the medial meniscus - but it is also common-place to feel referred pain which is actually coming from the back of the knee cap (patella).

Pain on the inside, outside, around, below or behind the kneecap (patella) and the back of your knee could be from any of the serious causes listed below:

• 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 ligament (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) Knee Pain

Inside, or medial 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 - aka Patellar Femoral Syndrome (PFS), Chondromalacia, Runners Knee
• leg bone (tibia) or thigh bone (femur) fracture
• knee cap (patella) dislocation

Outside (Lateral) Knee 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 -aka Patellar Femoral Syndrome (PFS), 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 other than the real trouble spot.

Common causes include:

• common knee arthritis
• Pre-arthritis - aka Patellar Femoral Syndrome (PFS), Chondromalacia, Runners knee
• patella fracture
• patella dislocation
• patellar tendonitis
• bursitis

Back of Knee Pain

This is a less-frequent location for pain and knee 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
• blood clot (DVT)

Knee Pain on stairs, standing, sitting

This is quite common and classic for the following conditions:

• Osteoarthritis or common arthritis
• Pre-arthritis - aka Patellar Femoral Syndrome (PFS), Chondromalacia

Intermittent Pain after walking a certain distance, usually in the leg or calf -

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 - aka Patella Femoral Syndrome (PFS), Chondromalacia, Runners Knee
• medial or lateral meniscus tear
• Iliotibial Band Syndrome
• bursitis
• chronic tear of the anterior cruciate ligament (ACL) or the 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

Knee 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 - aka Patellar Femoral Syndrome (PFS), Chondromalcia

Those are the four main symptoms of knee problems - swelling, locking, pain and buckling - each with a possible 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.

Diagnostic tests should be supplementary. Many doctors today over-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 problems 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 the 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 chronic pain) with natural anti-inflammatory supplements and treatments, physical knee therapy, knee exercises, rehabilitation, 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 with knee exercises, weight training, strengthening, flexibility exercises, 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, arthroscopy surgery, knee Replacement Surgery or a High Tibial Plateau Surgery

Warning! Do not get Micro-Fracture Surgery. The clinical results are poor. I had one and would not recommend it under any circumstances.

Hopefully, the above information will help you find the answer to your knee problems.