Knee Pain: Causes, Treatments, and When to Seek Help

Knee and popliteal fossa?

In February, I experienced pain behind my right knee after sitting down with my right foot propped up on a chair.
I thought I had strained it, so I went to the pharmacy to get some medication, which provided some relief.
However, the pain persisted intermittently until June, when I had to squat down to pick something up.
At that moment, I felt excruciating pain behind my right knee, making it impossible for me to stand or straighten my leg.
My family helped me to sit on the bed, and I went to the pharmacy again to get muscle relaxants.
After taking the medication, I kept my right leg bent because it hurt too much to straighten it.
Eventually, I found relief by lying down with my right leg bent and resting it on my left knee.
I was able to stand up, but I still felt tightness and dull pain behind my right knee.
Later, I visited a rehabilitation specialist who performed an ultrasound and noted some fluid accumulation, suggesting that I might have rheumatism.
However, I found this diagnosis strange, so I sought a second opinion from an orthopedic clinic.
They diagnosed me with ligament inflammation near the knee and administered an injection, which was quite painful.
After taking the prescribed medication, the pain beside my knee subsided, but the issue behind my knee remained unresolved.
I then noticed that my knee started to hurt again, prompting me to visit a larger hospital's orthopedic department.
An X-ray revealed that my fibula was misaligned, which was causing the pain in my knee.
The doctor recommended some quadriceps strengthening exercises, and I have seen some improvement since then.
Concerned that the issue might involve the meniscus, I underwent an MRI, which showed no significant problems.
The doctor suggested that the misalignment of the fibula could be affecting the area behind my knee, leading to the pain.
I was advised to continue taking medication and performing strength exercises, and if the pain persisted, I might need to consider arthroscopy.
Now, I have finished my medication and have been consistently doing the strength exercises, but every time I squat, I experience the same excruciating pain behind my right knee as I did in June, making it impossible to straighten my leg.
I feel as though it is stuck and continues to hurt.
I am unsure which specialist I should consult now.
Can you please help me understand what my issue might be, or should I really consider returning to the hospital for arthroscopy?

Miss He, 20~29 year old female. Ask Date: 2016/08/03

Dr. Shi Guozheng reply Orthopedics

Continue rehabilitation therapy by visiting the rehabilitation department.
If there is no improvement, an arthroscopy may be necessary, as there could be an issue with the patella.
Since there is no obvious injury, the ligaments are unlikely to be torn, but there may be inflammation within the joint, often leading to effusion.
Treatment requires patience.

Reply Date: 2016/08/03

More Info

Knee pain can be a complex issue, often stemming from various underlying causes, and it can significantly impact your daily life. Based on your description, it seems that you have been experiencing persistent pain in the back of your knee, which has not fully resolved despite various treatments and consultations with healthcare professionals. Let's break down the potential causes, treatment options, and when to seek further help.

Understanding the Causes of Knee Pain
1. Ligament Injuries: Given your history of a sudden onset of pain after a specific movement, it is possible that you may have sustained a ligament injury, such as to the posterior cruciate ligament (PCL) or the lateral collateral ligament (LCL). These injuries can cause pain, swelling, and instability in the knee.

2. Tendonitis: Inflammation of the tendons around the knee, such as the hamstring tendons, can also lead to pain, especially when bending or squatting.

3. Bursitis: The presence of fluid accumulation (as indicated by the ultrasound) suggests bursitis, which is inflammation of the bursae (small fluid-filled sacs that cushion the knee joint). This can cause pain and discomfort, particularly when moving the knee.

4. Meniscus Issues: Although your MRI did not show significant meniscal damage, it is still a possibility that minor tears or degeneration could be causing your symptoms, especially if you experience locking or catching sensations in the knee.

5. Patellar Malalignment: The X-ray findings of patellar malalignment could be contributing to your pain. Misalignment can lead to abnormal wear on the cartilage and surrounding structures, causing pain during movement.

Treatment Options
1. Physical Therapy: Continuing with physical therapy is crucial. Strengthening the quadriceps and hamstrings can help stabilize the knee joint and alleviate some of the pain. Focus on exercises that improve flexibility and strength without putting excessive strain on the knee.

2. Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If you have been prescribed muscle relaxants, they may provide temporary relief, but they should not be relied upon long-term.

3. Activity Modification: Avoid activities that exacerbate your pain, such as deep squatting or high-impact exercises. Instead, consider low-impact activities like swimming or cycling, which can help maintain fitness without stressing the knee.

4. Injections: Corticosteroid injections can provide temporary relief from inflammation and pain. If you have not yet tried this, it may be worth discussing with your doctor.

5. Surgical Options: If conservative treatments fail to provide relief and your symptoms persist, arthroscopy (a minimally invasive surgical procedure) may be necessary to diagnose and treat any underlying issues within the knee joint.

When to Seek Further Help
If your pain continues to worsen or if you experience new symptoms such as swelling, instability, or difficulty bearing weight on the affected leg, it is essential to return to your healthcare provider. You may need to consult an orthopedic specialist who can perform a thorough evaluation, including advanced imaging studies if necessary.

In summary, knee pain can arise from various causes, and it often requires a multifaceted approach to treatment. Continue with your physical therapy, adhere to any prescribed medications, and avoid activities that trigger your pain. If your symptoms do not improve, consider discussing further diagnostic options or potential surgical interventions with your healthcare provider. Remember, early intervention can often lead to better outcomes, so don’t hesitate to seek help if needed.

Similar Q&A

Understanding Knee Pain: Causes, Treatments, and When to Seek Help

Timeframe: Started in early February and continues to the present. Physical condition: Occasionally exercises (about two to three times a week, sometimes less), no obvious injury sensations (such as strains or sprains). Symptoms: Initially, there was pain in the right knee, occur...

Dr. Chen Bochen reply Orthopedics
1. I previously had issues with soft tissue injuries, where pain would occur after using that area for a period of time (possibly 10 minutes to half an hour). However, my knee pain mostly occurs when I am not using it. I'm not sure about the condition of my elbow. Is my situ...

Understanding Knee Pain: When to See a Specialist for Relief

I am 45 years old, and recently I have been experiencing sudden knee pain every morning when I wake up. Sometimes the pain radiates down to my calves, but it usually subsides after a while. I have never experienced this before. My family suggests it might be rheumatism, and I wan...

Dr. Chen Xianchang reply Rehabilitation
(1) Pain in the knee upon waking may be due to a previous sprain of the collateral ligaments or the beginning of cartilage degeneration, both of which can cause pain symptoms. (2) Pain in the back of the knee (popliteal region) often radiates to the calf and is most commonly asso...

Understanding Knee Pain: Causes, Treatments, and When to See a Specialist

Hello Doctor, I would like to ask you about an issue I have. Two years ago, I experienced swelling in my knee, and recently, my knee has started to hurt again. I am having difficulty walking, cannot fully extend my leg, and squatting causes pain. The pain is located around the pa...

Dr. Hong Ximing reply Orthopedics
There are many causes of knee joint effusion, not just issues with the meniscus. A thorough examination by an orthopedic specialist is recommended to determine the underlying cause.

Understanding Knee Pain: Causes, Symptoms, and Treatment Options

Hello: Since I was young, I have experienced knee pain that extends to my calves, which worsens in the winter due to the cold and becomes more painful in the summer when exposed to fans or air conditioning. It is especially severe at night when I sleep. In the past, I could relie...

Dr. Lin Junliang reply Orthopedics
Patellar dislocation can initially be treated with rehabilitation therapy; if ineffective, surgical intervention may be considered.