How to Get Rid of Your Knee Cap Pain without Dangerous Drugs, Harmful Shots or Risky Surgery!

Your New Knee Pain Guide  Causes, Diagnosis and Best Knee Treatments

New Knee Pain Relief

If you have suddenly developed new (acute) knee pain, then it's important that you get an accurate diagnosis; find the cause(s); and get proper treatment. Please have your knee examined, diagnosed and treated by a qualified medical professional, preferably a Sports Medicine Doctor.

There is a common-sense sequence to solving your pain. The first step is to determine what your knee symptoms are - that will help you get an accurate diagnosis and find the actual cause of your knee pain.

You may need to have your knee diagnosis confirmed by an MRI scan, X-rays, an arthroscopy examination or a bone scan. Once you have an accurate diagnosis and know the cause(s), then not only can you decide the best knee treatment choice for your pain, but you can also take steps towards its future prevention.

Let's start by discussing the four main knee symptoms ... with possible diagnosis and causes.

Common Symptoms

Symptom #1: Swelling

Knee swelling can range from mild to large. There are some serious and possibly life-threatening causes of a swollen knee, especially in combination with other symptoms.

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

Severe Swelling

1. Your knee is swollen, red and hot - with or without a fever
2. You suffer a knee injury and it swells up like a balloon
3. Both your knee and ankle are swollen
4. Large swollen knee with no history of knee injury or trauma

Those types of knee swelling can be caused by:

• infection
• gout or pseudo-gout
• fracture of the thigh bone (femur), leg bones (fibula, tibia) and knee cap (patella)
• dislocation of the knee cap (patella)
• tear in the joint covering (synovial membrane)
• tumor or cancer
• blood clot ( Deep or Femoral Vein Thrombosis)
• tear of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)
• Osteochondritis Dessicans
• patellar tendon tear
• quadriceps tendon tear
• inflammatory arthritis

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

Mild Swelling ... is usually from knee problems such as:

• Osteoarthritis (common knee arthritis)
• Pre-arthritis (also called Patellar Femoral Syndrome - PFS, Chondromalacia and Runners Knee)
• damaged knee cartilage with a tear - often in the medial or lateral meniscus

Symptom #2: Locking

Knee Joint Locking is when your knee gets stuck in one position and won't move. There are two types of knee joint locking - Real and Pseudo (fake).

Real Locking - is when your knee joint gets stuck and will not budge until you deliberately move or manipulate it.

Real Locking is caused by damaged cartilage, usually from either 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). 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 joint cartilage and may cause early Osteoarthritis (common wear-and-tear knee arthritis).

If you can't unlock your knee, get to a qualified medical doctor immediately for evaluation and proper treatment.

Pseudo Locking - is when your knee feels stuck but will move without manipulation, usually unlocking slowly with some pain.

Pseudo Locking is usually caused by damaged, rough or arthritic cartilage on the backside of the knee cap (patella). This symptom is typical of Osteoarthritis (common knee arthritis) and Pre-arthritis, also called Patellar Femoral Syndrome (PFS), Runners Knee and Chondromalacia.

Symptom #3: Pain

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

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

Pain on the inside, outside, around or behind the kneecap and back of your knee could be from any of the following serious swollen knee causes:

• infection
• gout or pseudo-gout
• bone fracture
• dislocation of the knee cap (patella)
• torn joint covering (synovial membrane)
• tumor or cancer
• blood clot ( Deep Vein Thrombosis - DVT)
• a tear in the cruciate ligaments, either anterior (ACL) or posterior (PCL)
• Osteochondritis Dessicans
• patellar tendon tear,
• quadriceps tendon tear
• inflammatory arthritis

Here are the main pain locations with possible causes:

Inside (Medial) Pain

• medial collateral ligament sprain or tear
• medial meniscus injury with tear
• knee Osteoarthritis (common knee arthritis)
• Pre-arthritis (Patellar Femoral Syndrome, Chondromalacia)
• fracture of the leg bone (tibia) or thigh bone (femur)
• dislocation of the knee cap (patella)

Outside (Lateral) Pain

• lateral collateral ligament sprain or tear
• lateral meniscus injury with tear,
• common knee arthritis (Osteoarthritis)
• Pre-arthritis (Patellar Femoral Syndrome, Chondromalacia)
• fracture of the leg bone (tibia), thigh bone (femur) or fibular head
• Iliotibial Band Syndrome

Pain Around or Behind the KneeCap (Patella)

• dislocation of the knee cap or patella
• common knee arthritis (Osteoarthritis)
• Pre-arthritis (Patellar Femoral Syndrome - PFS, Runners Knee, Chondromalacia)
• patella fracture
• patella dislocation
• patellar tendonitis
• Bursitis

Back of Knee Pain

• Baker's Cyst
• Popliteus muscle tear
• lateral meniscus tear, usually posterior horn
• medial meniscus tear, usually posterior horn
• plantaris tear with rupture
• Osteoarthritis (common knee arthritis)
• blood clot (DVT)

Knee Pain on stairs, standing, sitting

• knee Osteoarthritis (common knee arthritis)
• Pre-arthritis (Patellar Femoral Syndrome, Chondromalacia)

Intermittent Knee Pain after walking certain distance, usually with leg and/or calf pain

• Intermittent claudication
• knee Osteoarthritis (common knee arthritis)
• Spinal stenosis

Constant Knee Pain with outside leg, calf or foot pain

• Sciatica
• Spinal stenosis

Knee Pain that Worsens with Activity - especially running

• knee Osteoarthritis (common knee arthritis)
• Pre-arthritis (Patellar Femoral Syndrome - PFS, Chondromalacia, Runners Knee)
• a tear of the meniscus, either medial or lateral
• Iliotibial Band Syndrome
• Bursitis
• a tear of the cruciate ligaments, either anterior (ACL) or posterior (PCL)
• Osteochondritis Dessicans
• Chronic medial collateral ligament sprain or tear
• Chornic lateral collateral ligament sprain or tear

Symptom #4: Buckling

Buckling - This means that you take a step and your knee buckles right out from under you. Buckling, like Locking, can be Real or Pseudo (fake).

Real Buckling - 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 - is when your knee buckles from pain, not instability. Usually, Pseudo Buckling is from Osteoarthritis (common arthritis) or Pre-arthritis (Patellar Femoral Syndrome, Runners knee, Chondromalacia).

Those are the four main knee pain symptoms (Swelling, Locking, Pain and Buckling) ...  with associated diagnosis.

The next step is to confirm your knee pain diagnosis with testing - if needed.

Knee Pain Diagnostic Testing

Most knee pain needs a diagnostic test for confirmation only.

X-Ray - good for common 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 Knee Arthroscopy - This is when the orthopedic surgeon uses the scope to visualize your joint. This is extremely accurate for almost all knee problems, but it does involve the surgical risks of infection, heart attack and brain damage.

Bone Scan - This is an uncommon test for a knee injury but is occasionally needed to confirm diagnosis of 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:

Knee Pain Causes

Infection – red hot swollen knee; you may have fever.

Common causes include:

• bacterial contamination from a knee injection or a penetrating wound
• venereal infection
• blood infection (Sepsis)

Gout – red, hot swollen knee; no fever.

Common causes include:

• Uric acid forms hard crystals in the knee joint, causing inflammation and pain

Pseudo-Gout – red, hot swollen knee; no fever.

Common causes include:

• Calcium pyrophosphate forms hard crystals in the knee joint, causing inflammation and pain

Bone Fracture – usually large swelling of the knee from bone bleeding into the joint; could be a fracture of the thigh bone (femur), inside leg bone (tibia), outside leg bone (fibula) and knee cap (patella). Tibial plateau fractures are often missed - difficult to see on X-ray; may need an MRI or bone scan to be ruled in or out.

Common causes include:

• high-velocity fall or major-force trauma from car accidents or sports such as skiing, football, hockey, rugby and soccer

Torn joint covering (synovial membrane) – usually large swelling of the knee from synovial membrane bleeding into the joint.

Common causes include:

• high-velocity fall or major-force trauma from car accidents or sports such as skiing, football, rugby, hockey and soccer

Tumor or cancer – mild to large swelling; knee pain may go away with aspirin or anti-inflammatory drugs; other symptoms - fatigue, weight loss and general malaise.

Common causes include:

• genetic pre-disposition
• unknown
• exposure to toxins
• metastatic cancer

Blood clot (Deep Vein Thrombosis, aka DVT) - mild to large swelling; often, the ankle is swollen, too. Blood coagulates in a deep vein around the back of the knee (or up higher in the thigh) and is therefore prevented from returning to the heart - instead, it pools in the leg. This is a diagnosis that is often missed. It requires prompt and proper attention! Untreated, DVTs have a mortality (death) rate of 25%.

Common causes include:

• genetic pre-disposition
• sitting for long periods of time, especially with poor fluid intake causing dehydration
• long plane rides, especially with coffee or alcohol which increase dehydration at high altitudes
• being on the birth control pill
• cancer
• trauma to back of the knee

Torn anterior cruciate ligaments (ACL) – usually rapid large swelling immediately following a traumatic knee injury. The thigh bone (femur) drives over top of the leg bone, shearing the ACL ligament.

Common causes include:

• high-velocity fall or major-force trauma from car accidents or sports such as football, rugby, hockey, soccer and basketball
• sudden stop with knee in flexed position

Torn posterior cruciate ligaments (PCL) – usually rapid large swelling immediately following a traumatic knee injury. The thigh bone drives backwards over the leg bone, shearing the PCL ligament.

Common causes include:

• high-velocity fall or major-force trauma from car accidents or sports like football, rugby, hockey, soccer and basketball
• sudden stop with knee in extended position

Osteochondritis Dessicans – mild to large swelling; real locking and buckling. A small piece of  bone and cartilage has been ripped from the knee cap (patella), thigh bone (femur) or the leg bone (tibia).

Common causes include :

• high-velocity fall or major-force trauma  from a car accident or sports such as football, rugby, hockey, soccer and basketball
• Osteoarthritis (common knee arthritis) with cartilage damage
• acute and chronic knee cap (patella) dislocation

Quadriceps tendon tear - swelling depends on how severe the tear; complete tears have large swelling with contraction of quadriceps muscles into the thigh; small tears may have only mild swelling. Injury occurs when the quadriceps muscles are obliged to contract too hard.

Common causes include:

• high-velocity fall or major-force trauma from car accidents and sports such as football, rugby, hockey, soccer and basketball
• sudden stop with knee flexed

Inflammatory arthritis – swelling may be mild to large; knee joint hot and red.

Common causes are usually a combination of:

• genetic pre-disposition
• diet
• leaky gut

Intermittent Claudication - usually no swelling at all; knee pain intermittent, usually with calf pain - like angina of the leg!

Common causes include:

• Atherosclerosis (narrowing) in femoral artery, restricting blood flow

Osteoarthritis (common knee arthritis) – swelling is usually mild; damage to cartilage in knee.

Common causes include:

• major knee trauma from falls and sports injuries
• high-velocity accidents
• minor repetitive trauma - from poor joint mechanics, running and jobs that involve squatting and kneeling
• poor joint nutrition - lack of Omega 3, low-levels of vitamins and minerals in diet, inadequate fruit and vegetable consumption, low Vitamin D3, poor Glucosamine and Chondroitin intake
• genetic predisposition

Spinal stenosis – no swelling; pain while walking.

Common causes include:

• narrowing of spinal canal with aging

Medial collateral ligament sprain or tear –  swelling usually mild but can be large; tears can be from mild sprains to full complete rupture; knee pain is on the inside (medial).

Common causes include:

• trauma from the outside of the knee which stretches the MCL ligament

Medial meniscus injury with tear – swelling usually mild; knee pain is on the inside (medial).

Common causes include:

• any force or trauma that twists the knee under full load.

Pre-arthritis (also called Patellar Femoral Syndrome, Chondromalacia – swelling mild; knee pain is on the inside (medial).

Common causes include:

• poor joint mechanics from misaligned bones (often with functionally flat feet - overpronation) leads to knee cap (patella) mal-tracking which, in turn, irritates and eventually wears away the cartilage at the back of the kneecap.

Knee cap (patella) dislocation – swelling usually large; knee pain is usually on the inside  (medial);  knee cap usually dislocates (slides) too far to the outside.

Common causes include:

• high-velocity fall or major-force trauma  from car accidents and sports such as football, rugby, hockey, soccer and basketball
• pre-disposition for poor joint alignment - excessive knee valgus

Lateral collateral ligament sprain or tear – knee swelling usually mild but can be large; tears can be from mild sprains to full complete rupture; knee pain is on the inside (medial).

Common causes include:

• trauma from the outside of the knee which stretches the LCL ligament too far

Lateral meniscus injury with tear - swelling usually mild; knee pain is on the outside (laterial).

Common causes include:

• any force or trauma that twists the knee under full load

Iliotibial Band Syndrome – swelling usually mild and on the outside (lateral); knee pain lateral.

Common causes include:

• sports involving running, jumping or squatting

Patellar tendonitis –swelling usually mild; knee pain is underneath the knee cap (patella) on the tendon.

Common causes include:

• sports involving running, jumping or squatting

Bursitis – is an inflammation of the bursae (sacs full of fluid to reduce friction where tendons ride over bones); swelling is usually mild; pain location depends on which of the three different bursae is actually inflamed.

Common causes include:

• overuse of the knee causing the tendons to rub on the bursa
• trauma to the bursa

Baker's Cyst – fluid bulge at the back of the knee; swelling is mild to large; knee pain is on the back of the knee.

Common causes include:

• Arthritis
• Meniscal tear
• trauma

Popliteus muscle tear – swelling is mild to large; the Popliteus is a small muscle at the back of the knee.

Common causes include :

• twisting force

Plantaris tear with rupture – immediate large swelling of the calf and knee; the Plantaris muscle attaches to the back of the knee and goes into the calf; usually injured with full rupture; feels like you have been shot!

Common causes include:

• major trauma from falls and sports injuries
• high-velocity accidents

Treatment

The general guidelines are to:

• see a qualified medical professional (a Sports Medicine Doctor, if possible) to find out if your new knee pain is serious and requires urgent treatment
• reduce pain and inflammation right away
• find the causes and correct the possible hidden pain triggers
• take preventative steps to prevent your pain from returning