What causes a throbbing knee

Knee pain, anterior

Front knee pain: Collective term for various diseases that cause discomfort in the anterior part of the knee joint. Sporty people under the age of 60 are often affected. The common clinical picture includes many inflammatory and stress-related diseases in the capsule, tendons, ligaments and other soft tissues of the knee joint.

Leading complaints

  • Pain behind, beside, or below the kneecap
  • Exertional pain especially when walking down stairs or downhill and when getting up from a crouch, possibly also when walking in general
  • Symptoms often worst at the beginning (initial pain) and / or after the end of an exercise
  • Swelling at or below the kneecap
  • Restrictions in movement due to pain or a feeling of tension.

Various manufacturers offer bandages that stabilize the knee and create supposedly pain-relieving friction through incorporated rings or pressure pads, but at the expense of freedom of movement.
Dr. med. Brigitte Strasser-Vogel, Munich

When to the doctor

In the next few days if there is pain in the knee that lasts longer than 3 days.

The illness

Front knee pain is a very common disease in younger, physically active people. Its cause is usually an incorrect or excessive strain on parts of the knee joint or its tendons and ligaments, particularly often in tendinitis. More rarely, it is an expression of a disease of the kneecap cartilage or the knee joint caused by wear (knee osteoarthritis). It is often difficult to identify which disease causes anterior knee pain, especially since the terms of the disease sometimes overlap. Typical diagnoses are:

Jumper knees (Jumper’s knee, patellar tip syndrome): This most common tendinitis of the knee joint occurs v. a. basketball and volleyball players, occasionally also weightlifters, cyclists, high jumpers and long jumpers. Conventional changes such as high kneecap or congenital ligament weakness favor the disease, as does a previous Osgood-Schlatter's disease. The painful changes are found at the lower pole of the kneecap (patella) and at the front edge of the tibia, where the kneecap ligament (ligamentum patellae) attaches to the bone and has to withstand extreme tensile loads. In 20–30% of cases, the jumper's knee occurs on both sides. It often develops into a chronic clinical picture that lasts for many months or years with phases with few symptoms, but often recurring pain after peaks in exertion.

Runner's knees (Inflammation of the iliotibial band): If symptoms occur on the outer side of the kneecap after long periods of running or cycling, it is often due to inflammation of the iliotibial band. This tendon plate runs from the outer hip over the thigh and knee to the outside of the head of the tibia. When bending and stretching the leg, it slides over the joint roller on the outside of the knee joint. This is where friction occurs when the tendon plate is under increased tension due to a muscular imbalance. The increased friction leads in the long term to irritation and inflammation on the part of the tendon plate near the knee. Bow legs and foot deformities such as splayfeet or arched feet promote the disease.

Attachment tendinosis of the Pes anserinus: In addition to the inner edge of the kneecap, several thigh muscles attach to the head of the tibia in a common tendon plate, the pes anserinus (literally “goose foot”). Painful inflammation occurs particularly in joggers and elderly people with an artificial knee joint. Often, heavy loads do not lead to symptoms until the next day.

Diseases of the Hoffasch fat body: Behind and below the kneecap there is fat tissue, which is called Hoffasch fat body. This can be felt painfully if it tears due to force (e.g. falling on the knee) or if it becomes inflamed when the knee is (sporty) overloaded. In the first case the stabbing front knee pain occurs suddenly, in the second it slowly increases.

Parapatellar pain syndrome (Chondropathia patellae): This frequently made diagnosis describes load-dependent pain behind the kneecap, which occurs particularly when walking downhill or downstairs and when getting up after long breaks from sitting. The pain is not caused by damage to the kneecap cartilage, as was previously assumed, but mainly due to stress-related irritation of tendons and ligaments that attach to the kneecap or run sideways from it. The jumper's knee is also part of the parapatellar pain syndrome, as is the inflammation of the attachment of the quadriceps tendon, which radiates into the upper pole of the kneecap. The doctors suspect the cause is a malfunction of the kneecap in its sliding bearing, which is formed by the two joint rollers of the thigh bone (Fig. Knee). This often affects young people who are active in sport during their adolescent growth spurt or people who work a lot in knee flexion. Since no structures are damaged, the disease heals without consequences.

Chondromalazia patellae is often confused or equated with paratatellar pain syndrome because of the similarity of terms, causes and symptoms. But it is a form of knee osteoarthritis.

In a broader sense, osteochondrosis dissecans and bursitis of the knee, both of which are discussed in a separate section, also lead to anterior knee pain.

The doctor does that

Diagnostic assurance. Through a clinical examination, the doctor records when the symptoms occur, where the pain point is, whether there is swelling, whether the tendons are thickened and whether the kneecap or tendons rub against the plain bearing. Ultrasound can detect thickening and signs of inflammation on tendons and tendon attachments. If the doctor suspects damage to the kneecap cartilage, because For example, if a middle-aged patient shows significant rubbing of the kneecap (crepitation), he orders special X-rays or magnetic resonance imaging to confirm the suspected diagnosis. X-rays sometimes also show calcifications, which are a possible late symptom of chronic tendinitis.

Protection. Since most causes of anterior knee pain are based on momentary overloading of the structures involved, protection is the basic measure of any therapy. Short-term immobilization is rarely required, e.g. B. by a

What every athlete should be aware of: the longer they train in pain, the longer it will take for their damaged knee to fully recover.

Other therapies. Various physiotherapeutic procedures, e.g. B. ultrasound, electrotherapy, manual therapy, application of cold, tendon massage and targeted stretching exercises complement the therapy. If necessary, pain relievers (NSAIDs) and sports ointments (e.g. Diclofenac-ratiopharm® Gel) supplement the therapy. In the case of tendinitis, local injections of anesthetic often bring immediate, if not lasting, pain relief.

If the symptoms persist, the focus is on movement exercises. Physiotherapists and sports teachers develop a suitable training program, especially for athletes, in order to avoid future overloads through special exercises and instructions for correct technique. Some athletes benefit from bandages that are designed to have a stabilizing and pain-relieving effect. However, it is controversial whether the effect goes beyond a psychological effect.

In the case of chronic complaints, extracorporeal shock wave therapy is also increasingly being used; However, the statutory health insurance companies do not cover the costs, as scientific proof of the effectiveness of this application is still pending. The use of cartilage protection agents (e.g. hyaluronic acid) for damage to the kneecap cartilage is also controversial: injected behind the kneecap, they are supposed to relieve pain over the long term.

Operations only play a role in the treatment of anterior knee pain if conservative therapy fails permanently. If the kneecap is severely malfunctioning, an operative transfer is advisable. The intervention usually takes place in the context of a joint mirroring (arthroscopy), which enables the smoothing of roughened cartilage in the same session. A painfully diseased Hoffascher fat body can also be treated arthroscopically.

Complementary medicine

Complementary medical procedures such as acupuncture, magnetic therapy and homeopathy report successful treatment if the therapy is tailored to the individual symptoms. Relaxation therapies such as autogenic training, yoga or progressive muscle relaxation according to Jacobson can help to deal better with pain-intensifying tensions in everyday life and to be able to relax even when the pain is particularly noticeable.

prevention

Prevention for anterior knee pain essentially means avoiding sport-specific overloads. Targeted stretching exercises and a dosed increase in training intensity prepare the affected tendons and ligaments for the strain. Sports-appropriate footwear ensures that peak loads are avoided. Replace running shoes after 600 km at the latest, as the cushioning effect and guidance through the sole then gradually decrease. Also, make sure to change the route and pace frequently to avoid a uniform load.

In everyday life, it is recommended that women with front knee pain wear flat shoes. If necessary, “roots shoes” with a negative heel are also useful, as this relieves the ligamentous apparatus of the knee joint. It is also important to avoid kneeling, squatting and sitting with crossed legs whenever possible - these body positions are poison for the kneecaps.

Further information

  • www.dr-gumpert.de - privately maintained information portal by P. Gumpert, Taunusstein: For the search term knee pain you will find detailed descriptions of various causes of knee pain, under the heading knee you will find helpful background information.
  • www.rheuma-online.de - Rheumatological information platform, Neuss: Offers an extensive, medically-led forum as well as a lot of information on the search term knee pain. Understandable presentation with lots of details.
  • U. Wegner: Sports injuries. Symptoms, causes, therapies. Schlütersche, 2002. Short, understandable description of the most common sports injuries with many pictures.
  • M. Marquardt et al: The Laufbibel. Spomedis, 2007. Standard work on running technique, nutrition, training plans, shoes and injury prevention.

Authors

Dr. med. Martin Schäfer, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 11:41


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.