I. Anterior knee pain is the most common phenomenon of joint pain, mainly from the patellofemoral joint, other structures in front of the knee, systemic or total joint pathology can also cause pain, the following are a few of the most common knee pain conditions.
1, chondromalacia patellae
Patellar cartilage chondromalacia, also known as chondromalacia patella, is a degenerative degeneration of the articular cartilage of the patellar cartilage surface and its corresponding femoral condylar surface, the cause is still inconclusive, it is generally believed that there are endocrine theory, cartilage nutritional disorders theory, chondrolysis theory and trauma theory can be divided into two categories: one is the abnormal joint mechanics, called biomechanical causes, the second is the disease, age and medical infection called biological The patellar cartilage is similar to other articular cartilage, except that the patellar cartilage can be up to 6-7mm thick to withstand the pressure, trauma and strain, thus the incidence of chondromalacia patellae is much higher than other joints.
Chondromalacia patellae can be divided into four stages: stage I, softening is the main, the cartilage loses its normal luster, superficial unevenness, limited softening (diameter does not exceed 1-2 cm) swelling or fibrosis. Stage II, fissures predominant, fissures either less or more, deep or shallow, deep up to subchondral bone, with obvious fibrous changes. In stage III, ulceration is predominant, with cartilage erosion, fragmentation, and exfoliation so that the bone is exposed. In the fourth stage, the cartilage becomes thin and untidy, the bone is exposed more, the subchondral bone plate is hardened, and the joint space is narrowed by the formation of bone redundancy, which is mostly seen in middle-aged and elderly people, namely osteoarthritis or degenerative joint disease.
Clinical manifestations.
This disease occurs mostly before adolescence, generally have a typical squatting knee once injured, or repeated strain history, susceptibility factors are: ligament laxity, obese people working in a fixed position, sedentary knee immobilization and athletes, etc., more women than men, the onset of the knee only feel sore and weak, diffuse discomfort gradually aggravated, posterior patellofemoral pain, up and down stairs obvious, disappear after rest, too much activity too hard The pain increases, especially in the semi-squatting position, and the knee joint feels weak and unstable, with the feeling of wanting to kneel down. Inflexible joint movement, stiffness and stagnation, pseudo-interlocking of the knee joint, the patient feels “stuck”, accompanied by a ringing sound, which is caused by the unevenness of the cartilage surface.
X-ray examination.
1, early ordinary X-ray film shows normal, late can show joint space narrowing cartilage sclerosis cystic changes, osteophytes, arthroscopy, can be a clear diagnosis, laboratory tests normal diagnosis 1, patellar posterior pain, activity aggravated, more downstairs.
2, grinding patellar test, single foot half squat test negative.
3, X ray has corresponding performance, knee arthroscopy can see the change of patellar cartilage. Differentiate from meniscal tear, infrapatellar fat pad inflammation, synovial crease syndrome.
If the symptoms of treatment are not obvious, you should take proper rest and avoid strenuous exercise and long-term work in semi-squatting position with bent knees. Simple can do some home physiotherapy, heat therapy, infrared magnetic therapy, spectrum therapy massage, serious people must be formal treatment, oral some anti-inflammatory painkillers, Chinese medicine soup, Western medicine is generally the main intra-articular injection, closed treatment, easy to damage the joint cavity. Severe cases with fire acupuncture, warm silver needle treatment, to achieve complete healing.
2, patellar ligament injury
Patellar ligament injury is clinically common, and most of those who come to the clinic are chronic, mainly due to the sudden force with the leg, sharp contraction of the quadriceps muscle is more likely to damage the patellar ligament, or by external force forced flexion of the knee joint is also prone to injury; strain after the patellar ligament in the tibial ramus attachment point are part of the fiber avulsion or tear, resulting in chronic small amount of bleeding, local metabolism is blocked, and the surrounding tissue adhesion, causing intractable chronic pain The clinical manifestation of the patellar ligament attachment point, pain and pressure pain at the tibial ramus, knee joint is not easy to straighten, difficulty in going downstairs, diagnosis generally has a history of trauma, patellar ligament attachment point, tibial ramus has pain and pressure pain, treatment can be physical therapy, massage, hot compresses, local injection, amber cream external paste.
3.Subpatellar fat pad injury
Infrapatellar fat pad injury, also known as infrapatellar fat pad inflammation, Hoffa pain, is a kind of aseptic inflammatory reaction of the infrapatellar fat pad, which can involve the related synovial tendons, the infrapatellar fat pad has the role of lining and lubricating the joint to prevent friction of the joint surface, when the fat pad is stimulated by some factors causing acute and chronic injury, it can produce aseptic inflammation, bleeding, exudative hyperplasia, hypertrophy, sclerosis, fibrous degeneration or Adhesions, stimulating the dermal nerve and causing pain, the main causes of fat pad injury are.
(1) trauma, mainly by falls, falls, etc.
(2) strain, repeated stretching and compression of local ligaments by flexion and extension activities, such as athletes, tricycle workers, porters, etc.
(3) Joint inflammation, such as synovitis, premenstrual water retention in women, meniscal injury.
(4) Knee antalgia deformity, which leads to fibrosis in the long term.
Clinical presentation.
The disease is mostly seen in women, young and middle-aged people, frequent squatting and walkers mountaineers predominantly, soreness and weakness below the anterior knee, pain is aggravated by knee extension or force on. The pain is located behind and on both sides of the infrapatellar, sometimes radiating to the lunar fossa, or even along the posterior aspect of the calf to the heel, joint activity is generally not significantly impaired, kicking, jumping, running, symptoms are aggravated after exertion, symptoms are alleviated after rest, pain is aggravated when fully extending the knee, alleviated by slightly flexing the knee, alleviated by wearing semi-high heels, fat pad hypertrophy compared to the healthy side, fullness of both knee eyes.
Diagnosis.
1. common in young and middle-aged people who often go out, walk, squat or have a history of knee trauma, strain and cold.
2. soreness and weakness of the knee, aggravated by exertion, swelling and bulging of the heels of both knees, increased pain with hyperextension, which may radiate to the periarticular and lower legs.
3. Significant subpatellar pressure pain, a few may present with impingement, jamming, and clouding of the subpatellar fat pad on x-ray.
Treatment.
1, enhance quadriceps strength exercises, wear semi-high heels, prevent knee reversion to prevent this disease.
2. physical therapy, Chinese herbal fumigation, hot compresses, acupuncture, massage and other methods of treatment may be used to reduce the condition.
3, local pain points injection or oral anti-inflammatory and analgesic drugs.
4, amber cream can be used externally to directly eliminate local inflammation, severe cases with warm silver needle, 2 courses of treatment to cure.
4, medial collateral knee ligament injury
Medial collateral knee ligament injury is mostly seen in soccer, wrestling, basketball, jumping action sports, etc., knee extension or flexion position of the valgus injury, especially the knee flexion 30 ° -50 °, the calf suddenly abducted external rotation, or the foot and calf fixed on the ground, while the thigh suddenly inward internal rotation, can cause medial collateral knee ligament injury, injury, such as not timely and correct treatment (tendon is not completely ruptured is common), and the formation of chronic If the injury is not treated correctly (tendons are not completely ruptured), and chronic pain is formed, adhesions are formed over time, and scarring occurs.
Clinical manifestations.
(1) acute injury, generally manifested as acute pain in the knee joint, significant medial swelling, subcutaneous hemorrhage and restricted movement.
(2) chronic injury, medial knee pain, activity aggravated, limited when the affected leg is completely straight, walking limp, in severe cases can not walk, squatting is also difficult, in the medial femoral condyle or medial tibial condyle there can be palpable small subcutaneous nodules.
Diagnosis: acute injury with a history of trauma, local pain, swelling, functional limitation, subcutaneous petechial hemorrhage, inability to walk in severe cases, joint instability, positive slipped patella test in those with intra-articular bruising; in complete rupture, the joint is excessively valgus, a local depressed defect can be felt, and X-ray shows widening of the medial joint space.
In chronic pain, there is a history of trauma of different severity, often with calf valgus sprain, and obvious pressure pain can be found in the medial femoral condyle and tibial condyle, and the medial collateral ligament separation test is positive.
5.Osteoarthritis
Osteoarthritis is a non-inflammatory degenerative change of joint cartilage caused by old age or other reasons, and there is bone superfluous formation at the edge of the joint, which can produce clinical symptoms such as joint pain, restricted movement and joint deformity. There are many common synonyms, such as osteoarthrosis, degenerative joint disease, age-related arthritis, hypertrophic arthritis deforming arthritis.
Etiology: Osteoarthritis is mainly a pathological change in the degeneration of cartilage with the degree of wear and tear with age, the positive cause is unclear, but it is certain that aging is one of the causative factors, and traditionally, the disease is divided into two categories: primary osteoarthritis refers to the aging with age and not associated with other diseases of the joint lesions; secondary osteoarthritis is caused by injury, inflammation, genetic and Secondary osteoarthritis is caused by injury, inflammation, genetic and metabolic endocrine diseases, and its pathological changes are as follows.
(1) gradual loss of lubricity of the cartilage, shiny as glass-like in nature, becoming dry, rough, unsmooth, lacking in elasticity, and yellow in color.
(2) Osseous changes: the appearance of osteoid neoplasia at the edge of the cartilage, osteophytes within the subchondral bone marrow, and the formation of intra-articular subchondral bone cysts is a feature of this disease.
(3) Synovial changes: synovial hyperplasia forms multiple, overlapping, etc.
Clinical manifestations.
(1) Age of onset, mostly over 50 years old.
(2) Preferred site The affected joints tend to be in joints with a lot of weight-bearing activities, such as the patellar and ankle joints, but the knee joint is the most common.
(3) Joint pain.
(1) pain at the beginning of movement, pain when changing position from stationary, also known as gliosis.
(2) weight-bearing pain.
(iii) pain without movement.
(4) pain at night, pain at rest, pain that can be aggravated by excessive activity, weather changes, and emotional effects.
(4) joint swelling, can be joint effusion, can also be soft tissue degeneration hyperplasia, osteophytes into the three coexist, swelling into three degrees, slightly than the healthy muscle side swelling for mild, swollen tissue and patellar flat for moderate, more than the patella for severe.
(5) deformity: inversion of the knee is common, there can also be internal rotation of the lower leg, patellar enlargement, and muscle atrophy.
(6) Joint movement disorders, various different rattling sounds when moving, such as creaking and rubbing sounds, joint stiffness and joint instability.
Auxiliary examination
(1) Three major routine, blood sedimentation, mucin, rheumatoid factor are not abnormal findings.
(2) X-ray examination: X-ray film shows only degenerative changes of cartilage in the early stage of the disease, on standard X-ray film, the knee joint gap is 4mm in adults, less than 3mm for narrowing, in normal people over 60 years old, the joint gap is 3mm, less than 2mm for narrowing, individuals may have disappearance of the joint gap, the joint edge (i.e. cartilage edge) and soft tissue stop may have bone redundancy formation, or see intra-articular free body bone In some cases, the joint space may disappear, and there may be bone redundancy at the edge of the joint (i.e., cartilage edge) and at the soft tissue stop. Sclerosis of the subchondral bone plate and formation of bone redundancy are the basic features of osteoarthritis.
Diagnosis.
(1) Mostly seen in middle-aged and elderly people.
(2) Mostly involving weight-bearing joints, such as hip, knee, spine, etc.
(3) Involving joints with vague pain, initially active, aggravated by exertion, relieved by rest, then continuous pain with joint stiffness, improved by activity, later swollen and enlarged joints, limited motion, deformity but no ankylosis.
(4) The late X-ray shows joint space narrowing, cystic changes and osteosclerosis under the cartilage, bone spur and bone superfluous formation at the edge of the joint, and bone superfluous dislodged into the joint cavity to form free body.
Treatment
(1) Rest: Combine work and rest, rest appropriately, allow the patient to move within the scope of his condition, do not overload, get cold and damp, avoid being sedentary, especially not to bend the knee less than 90° for a long time, ask the patient to lose weight to reduce the weight.
(2) Functional exercise, mainly active non-weight-bearing activities, first to enhance muscle strength exercises, and then gradually practice to increase joint movement.
(3) Physiotherapy: it can relieve pain and muscle spasm, help improve blood circulation and reduce swelling, and can be applied with heat, preferably wet heat, hot air baths and hot spring baths can also be effective.
It should be noted that the acute phase of joint redness, swelling, heat pain, not hot compresses, heat therapy. Hypertension, heart disease should be used with caution, more attention in summer when the temperature is high.
(4) The application of anti-inflammatory and analgesic drugs, commonly used within the anti-inflammatory pain, compound aspirin, Pau Taisong. In recent years, ibuprofen, feprazone, tamponade, fenpropathrin, furosemide, etc. are commonly used.
6.Special knee pain in women
(1) Painful fatty knee in short and fat women, also known as lipofuscinosis, fibro-fatty syndrome, fatty pressure pain syndrome or non-arthritic rheumatism. Common in postmenopausal women, can also occur at any age, the minimum age of onset is 13 years old, the etiology of the disease is still unclear, may be related to endocrine, such as menopause, hypothyroidism, after the application of hormones, etc..
The patient is mostly obese and the affected limb is fatty and bloated, with the anterior medial side of the inner tibial condyle on both sides as the prevalent site. Tender fat pads can be seen, and tenderness can also occur in other parts of the fat and soft tissues.
(2) Premenstrual water retention syndrome, mainly located in the subpatellar fat pad in the anterior knee area, also often shows pain vague, widespread, and inaccurate localization, which is characterized by painful swelling of the subpatellar fat pad bilaterally 7-14 d before menstruation in women, repeated once a day, the swelling causes swelling and pain due to compression of the nerve plexus in the fat pad, with secondary changes such as fat pad hypertrophy, fibrosis and exudation.
The disease is long, recurrent and periodic, sometimes heavy and sometimes light, with bilateral knee pain, often deep or anterior knee pain, which is relieved after rest, aggravated when the knee is fully extended and disappears with slight knee flexion, and relieved by wearing high heels.
Preventive treatment, strengthening quadriceps exercise, intermittent wearing of high heels.
Second, the prevention of chondromalacia patellae
1, actively participate in qigong, taijiquan and other traditional physical exercise to improve the overall quality. This is especially important for the elderly.
2, strengthen muscle strength training. In addition to strengthening the quadriceps strength exercises, should also enhance the lower limb rear muscle group strength and waist and hip muscle strength exercises, in order to enhance the stability of the knee joint and improve the mobility of the knee joint.
3, for athletes, for different age, project, technical ability, training level and physical fitness, etc., reasonable arrangements for training programs, so that training as scientific as possible, to prevent a single knee flexion and extension of excessive activities, for manual workers and the party, not to pay the force of heavy physical labor, especially in the case of existing knee pain, more should be legal labor intensity.
4, strengthen self-protection and medical supervision, and actively treat injuries and illnesses, before exercise or labor, do preparatory activities for each joint to improve the flexibility of the joint, after exercise or labor, you should actively carry out relaxation activities, can enter the self-massage or receive health care physician massage. Use knee pads to protect the knee joint.
5. Clear the mind and abstain from sexual intercourse to prevent liver and kidney deficiency, which can lead to a decrease in the strength of the knee joint and make it easy to damage it.
The principles of prevention are also suitable for other knee pain conditions, such as lateral collateral ligament injury of the knee, infrapatellar fat pad injury, and osteoarthritis of the knee.
Third, the prevention of chondromalacia patellae, how to exercise therapy for osteoarthritis of the knee?
Exercise therapy for this disease, some scholars believe that the original vertical sports therapy is not in line with the biomechanical point of view, and proposed a horizontal paragravity sports therapy; patients lying on their backs, both lower limbs flexed hip and knee, the right and left knee up for extension and flexion activities, alternately exchanged, just like pedaling a bicycle, also a bit like acrobats stirrups stirrups, flexion when the heel as close as possible to the hip, straighten when the knee as hard as possible to straighten. The point is that the flexed foot should not be placed on the bed, the right foot should be suspended against the hip when the left knee is extended. Straighten the foot up, thigh force, not forward stirrups (the movement should be slower, it is best to hook the ankle joint upward a little, in the straightening of the lower limbs feel the back side of the pull tighter, there is a sense of soreness and swelling, which is the so-called “sense of getting gas” in Chinese medicine). Each treatment is not based on time but on the number of knee extensions and flexions. The general principle is to go from less to more to ensure quality. At the same time, the number of knee extensions and flexions must be increased day by day during each treatment, and the results will be seen within 1-3 months.
This method has the following advantages.
1, supine bed, no weight-bearing knee joint, pressure is relatively reduced, the muscles and ligaments related to the knee joint in the state of non-weight-bearing for a larger range of powerful and safe movement.
2.When the knee is flexed, the lower leg falls in accordance with gravity, the angle of movement is large, and the joint cartilage is relatively evenly stressed.
3, when the knee is straightened, the knee is lifted against gravity, which enhances the muscle strength of the quadriceps, and the strengthening of this muscle has an extremely important role in the knee joint, elderly patients may wish to try.
Fourth, why is active prevention of osteoarthritis of the knee proposed?
First, most of this disease can be prevented. Recurrent knee pain is an early sign of osteoarthritis of the knee, which should be taken seriously and treated aggressively. The most common diseases that cause knee pain are chondromalacia of the patella, infrapatellar fat pad injury, and medial and lateral collateral ligament injury of the knee. These diseases usually reflect problems with the soft tissues surrounding the knee joint, and active treatment of these diseases is important for the prevention of osteoarthritis of the knee joint. The so-called “kidney deficiency”, such as “soreness and weakness of the lower back and knees”, is an early sign of osteophytes in the lower back and knees, and it is important to treat them with “kidney tonics”, abstinence from “sexual intercourse”, and active physical activity. The “kidney” treatment, abstinence from “sexual intercourse” and active sports can delay the occurrence of osteophytes in the back and knees.
The preventive measures for osteoarthritis of the knee can be referred to the preventive measures for chondromalacia patellae.
V. Why is early treatment of osteoarthritis of the knee advocated?
This disease has a long history of recurrent knee pain, and when patients are asked “why not treat it early”, the answer is often “I can tolerate it” and “I hope it will drag on”. In fact, any disease should be treated early, and the more difficult it is financially, the more reputable the place of treatment should be. In the treatment of many patients, money is spent, but the disease is missed the best time for treatment, prolonging the recovery time, someone has made a survey, the incidence of osteoarthritis of the knee in people over 55 years old is 44%-70%. The incidence of osteoarthritis of the knee is 44%-70% in people over 55 years of age, and 10% of the patients are functionally restricted, and those who are functionally restricted become disabled 20-25 years after the onset of the disease and finally have to rely on surgery to solve the problem. Therefore, the prevention and early treatment of this disease is of great social significance.
Sixth, what should be noted in the exercise of patients with osteophytes of the knee joint?
Severe osteophytes of the knee joint can cause dysfunction of the joint, and when the activity is too much, it can also induce acute traumatic synovitis, so after suffering from osteophytes of the knee joint, the following points should be noted when doing knee exercises.
1, to prevent doing heavy exercise, such as running, high jumping, long jumping, can do half an hour of walking around the room.
2, adhere to do quadriceps (front thigh muscle) active contraction, 4-5 times a day, 10-20 times each time.
3, supine knee and hip flexion to do pedal bicycle-like action, 2-3 times a day, each time 50.
4.Do squat and stand up without weight, 30-50 times a day, 2-3 times a day.
5. Do not do the knee joint half flexion rotation movement to prevent half plate injury.
Seven, knee osteophytes health care knee osteophytes how to treat?
Knee joint hyperplasia often takes a long time to treat, the effect is slow, the usual care is more important than drug treatment, first of all, usually should pay attention to the patient’s rest, should not be excessive weight bearing, sedentary, standing, should be under the guidance of doctors, gradual exercise, knee joint to maintain a certain activity, can prevent muscle atrophy, control the development of the disease. Joint pain and swelling can be treated with amber ointment, which has a strong penetrating function, and the drug can quickly reach the painful area and eliminate the swelling, pain and stiffness of the joint caused by hyperplasia, and its good softening and dispersing function can effectively soften the bone spur and control the hyperplasia.
Eight, what medical gymnastics should be done for osteophytes of the knee?
1, standing position, intention to keep Dantian for a moment. With both feet together, bend over and hold both knees with both hands, with the Laogong point facing the Blood Sea point, and the Laogong point in both hands. Both knees simultaneously force the knee joints straighten backwards from the flexion position to the extension position, while exhaling, then recover, inhale, repeat 8 times.
2, the same posture as (1), both hands hold the knee so that the knee joint clockwise for a week (exhale), and then counterclockwise rotation for a week (exhale). Then open both knees and rotate from inside to outside for one week (inhale), then rotate from outside to inside for one week (exhale). Repeat 8 times.
3, sitting position, intention to guard the Dantian for a moment, lead the Dantian gas to the spring, the use of muscle contraction force to straighten the calf, while inhaling. Then use the gravity of the lower limbs, so that the knee joint flexion, while exhaling, repeat 8 times. Finally, draw Qi back to the Dantian point.
4, supine position, intention to keep the Dantian for a moment, then two hands on the side of the body, the whole body relaxation. Use muscle contraction to raise the straight leg of the lower limb, while inhaling. Exhale when recovering. Repeat 8 times, then supine position, lower limbs according to cycling action repeatedly 16 times, natural breathing.
Nine, how to protect the knee joint?
According to the factors of knee osteophytes, the following preventive work should be done in a targeted manner.
1. Avoid excessive activities and strain on the knee joint, especially for those who play strenuous sports on both lower limbs (such as dancers, athletes, porters, etc.), and pay more attention to the combination of work and rest to prevent tissue damage caused by excessive force, otherwise, osteophytes will easily appear as we grow older.
2. When a fracture occurs in the knee joint, it is important to go to the hospital in a timely manner so that the fracture end meets the requirements of anatomical repositioning as much as possible. If the reset is not satisfactory, surgery should be taken in time.
3. For those who are too obese, it is necessary to control the diet properly, pay attention to adjust the diet structure, reduce the calorie intake, and keep the weight within the appropriate range to reduce the pressure and wear on the joint.
4, the elderly can appropriately supplement calcium, vitamin D and other drugs closely related to bone metabolism joints, while engaging in moderate physical exercise to slow down the aging and degenerative change process of bone tissue.