Knee pain

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Knee pain What injuries can cause knee pain, and what other symptoms may accompany knee pain? How is knee pain diagnosed?
Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones forming the joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints. Ligament injury Trauma can cause injury to the ligaments on the inner portion of the knee (medial collateral ligament), the outer portion of the knee (lateral collateral ligament), or within the knee (cruciate ligaments). Injuries to these areas are noticed as immediate pain but are sometimes difficult to localize. Usually, a collateral ligament injury is felt on the inner or outer portions of the knee. A collateral ligament injury is often associated with local tenderness over the area of the ligament involved. A cruciate ligament injury is felt deep within the knee. It is sometimes noticed with a "popping" sensation with the initial trauma. A ligament injury to the knee is usually painful at rest and may be swollen and warm. The pain is usually worsened by bending the knee, putting weight on the knee, or walking. The severity of the injury can vary from mild (minor stretching or tearing of the ligament fibers, such as a low grade sprain) to severe (complete tear of the ligament fibers). Patients can have more than one area injured in a single traumatic event. Ligament injuries are initially treated with ice packs, immobilization, rest, and elevation. It is generally recommended to avoid bearing weight on the injured joint, and crutches may be required for walking. Some patients are placed in splints or braces to immobilize the joint to decrease pain and promote healing. Arthroscopic or open surgery may be necessary to repair severe injuries. Surgical repair of ligaments can involve suturing alone, grafting, and synthetic graft repair. These procedures can be done by either open knee surgery or arthroscopic surgery (described in the section below). The decision to perform various types of surgery depends on the level of damage to the ligaments and the activity expectations of the patient. Many repairs can now be done arthroscopically. However, certain severe injuries will require an open surgical repair. Reconstruction procedures for cruciate ligaments are increasingly successful with current surgical techniques. Meniscus tears The meniscus can be torn with the shearing forces of rotation that are applied to the knee during sharp, rapid motions. This is especially common in sports requiring reaction body movements. There is a higher incidence with aging and degeneration of the underlying cartilage. More than one tear can be present in an individual meniscus. The patient with a meniscal tear may have a rapid onset of a popping sensation with a certain activity or movement of the knee. Occasionally, it is associated with swelling and warmth in the knee. It is often associated with locking or an

unstable sensation in the knee joint. The doctor can perform certain maneuvers while examining the knee which might provide further clues to the presence of a meniscal tear. Routine X-rays, while they do not reveal a meniscal tear, can be used to exclude other problems of the knee joint. The meniscal tear can be diagnosed in one of three ways: arthroscopy, arthrography, or an MRI. Arthroscopy is a surgical technique by which a small diameter video camera is inserted through tiny incisions on the sides of the knee for the purposes of examining and repairing internal knee joint problems. Tiny instruments can be used during arthroscopy to repair the torn meniscus. Arthrography is a radiology technique whereby a contrast liquid is directly injected into the knee joint and internal structures of the knee joint thereby become visible on X-ray film. An MRI scan is another radiology technique whereby magnetic fields and a computer combine to produce two- or three-dimensional images of the internal structures of the body. It does not use X-rays and can give accurate information about the internal structures of the knee when considering a surgical intervention. Meniscal tears are often visible using an MRI scanner. MRI scans have largely replaced arthrography in diagnosing meniscal tears of the knee. Meniscal tears are generally repaired arthroscopically. Tendinitis Tendinitis of the knee occurs in the front of the knee below the kneecap at the patellar tendon (patellar tendinitis) or in the back of the knee at the popliteal tendon (popliteal tendinitis). Tendinitis is an inflammation of the tendon, which is often produced by a strain event, such as jumping. Patellar tendinitis, therefore, also has the name "jumper's knee." Tendinitis is diagnosed based on the presence of pain and tenderness localized to the tendon. It is treated with a combination of ice packs, immobilization with a knee brace as needed, rest, and antiinflammatory medications. Gradually, exercise programs can rehabilitate the tissues in and around the involved tendon. Cortisone injections, which can be given for tendinitis elsewhere, are generally avoided in patellar tendinitis because there are reports of risk of tendon rupture as a result of corticosteroids in this area. In severe cases, surgery can be required. A rupture of the tendon below or above the kneecap can occur. When it does, there may be bleeding within the knee joint and extreme pain with any knee movement. Surgical repair of the ruptured tendon is often necessary. Fractures With severe knee trauma, such as motor vehicle accidents and impact traumas, bone breakage (fracture) of any of the three bones of the knee can occur. Bone fractures within the knee joint can be serious and can require surgical repair as well as immobilization with casting or other supports.

What are diseases and conditions that can cause knee pain, and what is the treatment for knee pain?

Pain can occur in the knee from diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area. In fact, the knee joint is the most commonly involved joint in rheumatic diseases, immune diseases that affect various tissues of the body including the joints to cause arthritis. Arthritis is inflammation within a joint. The causes of knee joint inflammation range from noninflammatory types of arthritis such as osteoarthritis, which is a degeneration of the cartilage of the knee, to inflammatory types of arthritis (such as rheumatoid arthritis or gout). Treatment of the arthritis is directed according to the nature of the specific type of arthritis. Many people suffer from arthritis; the pain and discomfort can be so limiting that some patients may require a total knee joint replacement. Knee replacement surgery often allows the patient to regain much of their mobility. Swelling of the knee joint from arthritis can lead to a localized collection of fluid accumulating in a cyst behind the knee. This is referred to as a Baker cyst and is a common cause of pain at the back of the knee. Infections of the bone or joint can rarely be a serious cause of knee pain and have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee. These infections are often diagnosed by aspirating joint fluid accumulations with a needle (joint aspiration) and examining the fluid microscopically and with microbial culture techniques. Treatment is done with antibiotics. Tumors involving the joint are extremely rare (for example, synovial sarcomas, and giant cell tumors). They can cause ambulatory problems with local pain. Treatment usually involves surgery; a few individuals may require amputation of the knee and lower leg. Treatments and surgery depend on the tumor type. The collateral ligament on the inside of the knee joint can become calcified and is referred to as Pellegrini-Stieda syndrome. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilization, and rest. Infrequently, it requires a local injection of corticosteroids. Chondromalacia refers to a softening of the cartilage under the kneecap (patella). It is a common cause of deep knee pain and stiffness in younger women and can be associated with pain and stiffness after prolonged sitting and climbing stairs or hills. While treatment with antiinflammatory medications, ice packs, and rest can help, long-term relief is best achieved by strengthening exercises for the quadriceps muscles of the front of the thigh. Bursitis of the knee commonly occurs on the inside of the knee (anserine bursitis) and the front of the kneecap (patellar bursitis, or "housemaid's knee"). Bursitis is generally treated with ice packs, immobilization, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or aspirin and may require local injections of corticosteroids (cortisone medication) as well as exercise therapy to develop the musculature of the front of the thigh.

Knee Pain At A Glance
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The knee joint has three compartments: medial, lateral and patellarfemoral. Causes of knee pain include injury, degeneration, arthritis, infrequently infection, and rarely bone tumors. Ligaments within the knee (cruciate ligaments) and on the inner and outer sides of the knee (collateral ligaments) stabilize the joint. Surgical repair of ligament injury can involve suturing, grafting, and synthetic graft repair. Some patients require total knee replacement. Routine X-rays do not reveal meniscus tears but can be used to exclude other problems of the bones and other tissues. Arthroscopy and MRI studies are used most frequently to diagnose knee ailments; occasionally, a needle aspiration of fluid is done. The knee joint is one of the most commonly involved joints in rheumatic diseases (over 100 disease types). Rheumatic diseases are immune diseases that affect various tissues of the body, including the joints, by causing arthritis (pain, swelling, stiffness, and limited joint movements).



Perkapuran pada lutut merupakan salah satu tanda terjadinya osteoarthritis . Osteoartritis (OA) dikenali sebagai arthritis degenerative, gangguan yang terjadi seiring bertambahnya umur, terutama mengenai sendi yang menopang berat badan, seperti lutut, dan panggul, meski tak jarang juga terjadi pada tangan dan kaki.



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Di Indonesia, OA merupakan penyakit reumatik yang paling banyak dijumpai. Di Kabupaten dan Kotamadya Malang misalnya, angka kejadiannya mencapai 13,5%.

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Sedangkan di poliklinik Subbagian Reumatologi FKUI/RSCM, OA ditemukan pada 43,82% penderita baru reumatik (tahun 1991-1994). Apa penyebabnya Usia dan genetik dikatakan merupakan faktor resiko terjadinya OA.Rawan sendi menipis bersama pertambahan usia. Rawan sendi yang menipis menyebabkan gesekan antar tulang , menimbulkan nyeri dan terbatasnya gerak lutut. Gerakan berulang sendi lutut bertahun- tahun mengiritasi dan menyebabkan peradangan . Tulang rawan yang radang memicu terjadinya pertumbuhan tulang tidak pada tempatnya (spur/ perkapuran.) di sekitar sendi. OA juga sering ditemukan pada beberapa orang dalam suatu keluarga, sehingga faktor keturunan tak bisa dihindarkan. Hal lain yang merupakan faktor resiko, mencakup kegemukan, jenis kelamin (perempuan cenderung lebih banyak terjadi ), trauma, kelemahan otot, sendi yang tidak stabil, meningkatnya pembebanan dinamik. Individu dengan obesitas cenderung mengalami OA lutut 300-400% . Sepatu yang terlalu tinggi, sempit, berat, alas sepatu (sol) yang keras dan kurang lentur , bisa menjadi penyebab. Gejala Nyeri dan kekakuan merupakan hal yang sering dikeluhkan. Nyeri sendi biasanya bersifat tumpul, bedakan dengan nyeri yang tajam menusuk, sampaikan dengan jelas pada dokter. Sifat nyeri yang berbeda , akan memberikan diagnosa berbeda. Nyeri dirasakan setelah aktivitas berulang . Nyeri saat istirahat dapat terjadi , pada OA yang berat. Rawan sendi bisa hilang sama sekali, sehingga terjadi pergeseran antar tulang, yang berakibat keterbatasan gerakan persendian. Kaku sendi, merupakan rasa seperti diikat yang biasanya singkat, tidak lebih dari setengah jam. Nyeri dan kekakuan sendi dapat juga timbul setelah bangun tidur, atau setelah duduk yang lama ( naik kereta api, nonton film). Gejala lain pada OA lutut berupa bengkak , teraba hangat dan bunyi (creaking); bowleg , bila degenerasi tulang rawan sangat progresif; sedangkan bony enlargement sering menyertai terbentuknya perkapuran. Gejala OA dirasakan bervariasi diantara individu yang terkena. Beberapa orang menjadi “cacat” karena gejalanya. Namun ada juga gejala yang dirasakan tidak sedramatis tampilan degenerasi sendi yang citra dari foto rotgen. Bahkan nyeri tidak selalu dirasakan, seringkali hilang timbul. Tak jarang ada masa bebas nyeri yang lama , hingga dalam hitungan tahun. Pemeriksaan penunjang Tidak ada pemeriksaan laboratorium darah spesifik untuk menegakkan diagnose OA, tes darah dilakukan untuk menyingkirkan penyakit lain. Pemeriksaan radiologis sendi yang terkena memberikan penampilan penipisan hingga hilangnya rawan sendi , penyempitan ruang sendi, dan terbentuknya spur / perkapuran. Artrosintesis dan artroskopi merupakan tindakan lanjut yang dilakukan seorang dokter, bilamana perlu. Artrosintesis , dokter akan menusukkan jarum yang steril untuk mengambil cairan dalam sendi, untuk dianalisa. Artroskopi, merupakan tehnik bedah menggunakan tabung kecil, untuk melihat dalam sendi . OA? Apa saja yang bisa dilakukan







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Terapi OA lutut menghilangkan nyeri sendi dan menjaga fungsi sendi. Pada lutut, sesuai dengan fungsi penunjang saat berjalan, diharapkan tidak ada rasa nyeri , serta gangguan akibat kekakuan ataupun keterbatasan. Pada wikimuers yang beruntung tanpa gejala yang dirasakan, pengobatan tidaklah peseharlu , meskipun proteksi agar OA tidak memberat sehingga menimbulkan keluhan , tetap harus dipertimbangkan. Ingat PRITE. P(rotection) ; P(revention): Bertujuan mengurangi beban pada lutut (saat berdiri maupun berjalan). Pengurangan beban selain pastinya mengurangi berat badan , bila memang berlebih, bisa disiasati dengan mnggunakan tongkat. Tongkat bersama ke dua kaki akan memperluas “dasar” tumpuan badan, dengan demikian beban lutut berkurang. Dapat juga diberikan alat bantu, dengan tujuan mengalihkan beban tumpuan lutut. (http://rehabmed.blogspot.com/2007/03/osteoarthrosis-genu-rehabilitation.html) Relative R(est): Istirahat yang cukup untuk lutut, hindari berdiri lama, naik tangga, berlutut, menekuk lutut yang dalam. Mengistirahatkan lutut yang sakit, akan berdampak turunnya tekanan pada sendi, pada gilirannya akan mengurangi nyeri, dan menghilangkan bengkak. “Istirahat” dapat berupa pengurangan intensitas dan frekuensi aktivitas yang secara konsisten membebani lutut. I(ce) Es diberikan bila lutut teraba hangat, alasi es dengan handuk. Wikimuers mungkin akan dipilihkan terapi fisik yang lain misalnya TENS; ES suatu bentuk terapi listrik untuk mengurangi rasa sakit. Pemilihan terapi fisik yang lain seperti diatermi (bersifat pemanasan), atau laser tenaga rendah , pastinya harus melewati pertimbangan dokter . Taping Secara teoritis lutut dibagai menjadi tiga, luar , tengah dan dalam. Lutut sisi dalam yang sering mengalami kerusakan . Taping menggunakan tape yang spesifik, biasanya dipasang pada sisi dalam. Saat ini dokter spesialis rehabilitasi medik, ortopedi dan rematologi- penyakit dalam yang berkompetensi untuk pemakaian taping Exercise/ latihan Bentuk latihan bisa isometrik atau isotonik, Konsultasi dulu dengan dokter, jenis olahraga yang sesuai untuk Wikimuers. Latihan atau olahraga (pada OA) yang terarah akan meningkatkan kelenturan sendi , dengan demikian diharapkan tidak terjadi keterbatasan gerakan sendi dan menurunkan derajat kekakuan lutut. Pada pembahasan kali ini, saya sampaikan satu bentuk latihan penguatan otot paha depan (quadriceps), dengan metoda isometrik. Latihan dilakukan saat tidak terjadi radang pada lutut, (tidak sakit, tidak teraba hangat, tidak bengkak). Sebaiknya sudah dilakukan sebelum memasuk usia resiko terjadinya OA . Tahanan selama 5 detik cukup aman. Obat • Obat yang di berikan pada umumnya golongan NSAID, namun untuk OA biasanya disertai pemberian golongan glucosamine chondroitin . Keduanya ada dalam bentuk minum ataupun olesan . Yang sebaiknya diperhatikan , takaran dan cara pemakaian. • Obat lain berupa injeksi serta tindakan operasi, pastinya harus dengan indikasi yang tepat. Tips:

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Catatan: Arthrocentesis: Suatu prosedur menggunakan jarum dan syringe steril, dipergunakan untuk mengeluarkan cairan dalam sendi. Arthroscopy: Suatu tehnik pembedahan dengan memasukkan tabung ke dalam sendi, untuk melihat, mendiagnosa dan memperbaiki jaringan.

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