Knee Pain: Causes and Treatments for Patellar Discomfort

Sharp pain in the front of the right knee?

Hello doctor, last year at the beginning of the year, I injured my calf while skiing when it twisted inward and strained.
At that moment, I couldn't stand up, but after resting for a while, I was able to walk, so I didn't think much of it and didn't have any issues afterward.
However, when winter came last year and the weather started to get cold, I began to feel something unusual in my right knee, especially when going up and down stairs, which was uncomfortable.
I consulted a doctor who rotated my calf and listened for sounds during the examination.
He said there was nothing wrong, and after an X-ray, he confirmed that my bones were not injured.
However, he suggested that if I continued to feel discomfort in my knee, I should get an MRI.

Since last winter until now, my knee has felt off, and walking has been strange.
By early this year, I noticed a painful spot just below the patella, and especially in the last month, I've been experiencing radiating sharp pain beneath the patella.
A few days ago, the pain became so intense that I could hardly walk.
Additionally, I've noticed that sometimes a tendon above the patella also starts to hurt.

I would like to ask if this could be arthritis or if there is inflammation somewhere? Why did it start off with no issues and then develop pain after some time? Is there a trend of worsening? Should I wear a patellar compression brace or a knee support? Thank you.

Xiao Lan, 20~29 year old female. Ask Date: 2016/04/22

Dr. Shi Guozheng reply Orthopedics

It may be effective to use a knee brace for tendonitis near the patella.
If the pain persists, you should consult a physician to see if a corticosteroid injection is appropriate.

Reply Date: 2016/04/22

More Info

Knee pain, particularly around the patella (kneecap), can arise from various causes, especially after an injury like the one you described during skiing. The symptoms you're experiencing, including discomfort when walking, pain beneath the patella, and radiating sharp pains, suggest that there may be underlying issues that need to be addressed.

Potential Causes of Your Knee Pain
1. Patellar Tendonitis: This condition, often referred to as "jumper's knee," occurs when the tendon connecting the kneecap to the shinbone becomes inflamed. It can result from overuse or injury, particularly in activities that involve jumping or running.

2. Patellofemoral Pain Syndrome (PFPS): This syndrome is characterized by pain around the kneecap, often exacerbated by activities such as climbing stairs or sitting for prolonged periods. It can develop due to muscle imbalances, overuse, or misalignment of the kneecap.

3. Chondromalacia Patella: This condition involves the softening and breakdown of the cartilage on the underside of the kneecap. It can lead to pain and discomfort, particularly when bending the knee or engaging in activities that put pressure on the joint.

4. Meniscus Injury: Although your X-ray showed no bone damage, a meniscus tear can sometimes be missed on X-rays. This type of injury can lead to pain, swelling, and difficulty moving the knee.

5. Osteoarthritis: While less likely given your age and the nature of your injury, osteoarthritis can develop over time, leading to joint pain and stiffness.

Why Symptoms May Develop Later
It's not uncommon for symptoms to appear after some time following an injury. Initially, the body may compensate for the injury, and pain may not be apparent until the compensatory mechanisms fail or the underlying issue worsens. Factors such as changes in activity level, weather (cold can exacerbate joint pain), and the natural healing process can all contribute to the delayed onset of symptoms.

Recommendations for Management
1. Consult a Specialist: Since your symptoms have persisted and worsened, it would be wise to follow through with the MRI your doctor suggested. This imaging can provide a clearer picture of any soft tissue injuries, cartilage damage, or other underlying issues.

2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the knee, improve flexibility, and correct any biomechanical issues that may be contributing to your pain.

3. Pain Management: Over-the-counter pain relievers like acetaminophen or topical analgesics can help manage pain. If you have a history of gastrointestinal issues, consult your doctor for alternatives to NSAIDs.

4. Knee Support: Wearing a patellar brace or knee sleeve can provide support and alleviate some discomfort. However, if you experience increased pressure or pain while wearing a brace, it may be too tight or not the right type for your condition. It's essential to find a supportive device that fits comfortably.

5. Activity Modification: Avoid activities that exacerbate your pain, such as running or jumping, until you have a clearer diagnosis and treatment plan. Low-impact exercises like swimming or cycling may be beneficial.

6. Ice and Rest: Applying ice to the affected area can help reduce swelling and pain. Ensure you rest your knee adequately to allow for recovery.

Conclusion
Your symptoms warrant further investigation, especially given the progression of your pain. While conditions like arthritis or tendonitis are possibilities, a definitive diagnosis will require imaging and possibly further evaluation by an orthopedic specialist. In the meantime, consider supportive measures and modifications to your activities to manage your discomfort. Always consult with your healthcare provider before starting any new treatment or therapy.

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