There are many causes of knee pain

Common causes include osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Most patients with osteoarthritis or knee arthritis complain of pain in the knee itself. People also complain of instability, stiffness, and shooting pains. Knee pain can also be referred from the hip and lower leg. The pain is constant and typically characterized as aching and may occur with sleep. Knee pain causes a gradual reduction in ability to walk and exercise. Activity worsens the pain while rest and heat relieve the pain.

Arthritis of the knee

illustration of knee painis a common and painful condition. Osteoarthritis is defined as the loss of cartilage in the menisci. Menisci are the layers of cartilage that are located between the tibia and the femur that allow the joint to move smoothly. Nearly 50% of people develop osteoarthritis of the knee by age 85.  [Data Source: 1999-2003 Johnston County Osteoarthritis Project data] This condition is so prevalent because of the weight and other forces that the knees are subjected to throughout the course of life.


Risk factors for development of osteoarthritis of the knee include age, overuse, traumatic injuries, obesity, neurologic diseases, genetics or heredity diseases.

Other conditions that may mimic knee osteoarthritis pain include low back pain, lumbar radiculopathy, hip pain, bursitis, and meralgia paresthetica.

Knee injuries

Injury is the most common cause of knee pain. Specific causes include sprains or strains of the muscles or ligaments that surround the knee joint. Knee pain may also be caused by chronic conditions. The knee joint is a complex joint that is formed by four bones: the femur, the tibia, the fibula and the patella. . The femur is the long bone of the thigh and it’s one of the largest bones in the body. The lower leg is comprised of the tibia and fibula. The fibula is the small bone on the outside of the lower leg. The fourth bone is the patella or the kneecap bone. Tendons and ligaments connect the bones and allow them to move. The ligaments can become torn or stretched, causing pain and discomfort.


in the knee allow the joint to move smoothly. Menisci resemble a crescent or a disc and act as the shock absorbers for the joint. If there’s too much strain, or sprain or repetitive damage, these can become warn and degenerated. If there’s tearing or excessive wear, this can interfere with normal joint function and cause pain.

Any one of these anatomic structures can be damaged but the most common areas that are damaged are the menisci that typically become worn out, frayed and degenerate. There can also be loss of fluid and loss of hyaluronic acid inside the knee joint. There could be tears in the ligaments including the anterior and posterior collateral ligaments, the lateral and medial collateral ligaments, as well as the patellar tendon. Chondromalacia of the patella or degeneration of the underside of the kneecap can cause pain. The smooth cartilage that normally allows the joint to move smoothly and effortlessly may lose its cushioning effect and can become pitted and irregular. Parts of the cartilage may even wear away completely, leaving the bone ends exposed. Bony spurs can then form at the edges of the joints causing pain. There is typically narrowing of the joint space as well.


Bursitis is an inflammation of the small fluid sacs in the knee. Bursae are sacs of fluid in or around joints that help tendons and ligaments to move smoothly and freely along the joints.

Chronic inflammation of the knees can also accelerate degeneration. Common signs of knee dysfunction include stiffness, inability to bend or straighten the knees, warmth along the knee swelling surrounding the knee, crepitus or an audible clicking, popping or grinding sound when moving the knee joint. Serious signs and symptoms of knee dysfunction include inability to stand, limping, falling, numbness in the limb, abnormal appearance, malformation, swelling, redness, and fever.

Knee pain diagnosis

Diagnostic studies include x-rays, which are radiographs of the knees. X-rays are the best at finding bone injuries such as dislocations and fractures. MRI of the knee is useful for tendons, ligaments, menisci and cartilage that surround the knee joint. Occasionally, computerized tomography, also known as a CT scan, is used for diagnosing knee problems, as well as ultrasound, which uses high-frequency sound waves. Diagnostic testing includes, laboratory evaluations including complete blood count, sedimentation rate, antinuclear antibody, and C reactive protein.

Knee Pain Treatment

Woman with knee painTreatment of knee pain includes physical therapy, bracing, anti-inflammatory medications, knee injections such as steroids. Also, hyaluronic acid can be injected into the knee joint for degeneration. This treatment is commonly known as Supartz, Synvisc or Hyalgan. Surgery may also be used to treat knee problems, including arthroscopy, or even total knee replacement. Prevention of knee problems includes healthy diet, regular activity, maintaining normal weight, and stretching. Warm-ups and cool-downs before and after exercise can also help to reduce knee pain.

Conservative therapy treatment includes non-steroidal anti-inflammatory medications, physical therapy, bracing of the knee, and knee injections (including corticosteroids and hyaluronic acid). The bursitis and tendonitis may contribute to knee pain. Recently PRP and stem cell therapy has added to the therapy for knee pain.

Knee bracing for osteoarthritis helps reduce pain by minimizing the weight on the damaged portion of the knee and shifting it to the less damaged portion of the knee. It can improve stability and your ability to function and walk. There are a variety of designs of knee braces, however most are made with a combination of both rigid and flexible materials that encompass the knee and are fitted with Velcro. The purpose of knee bracing is to reduce malalignment of the knee joint and take pressure off the part of your joint that is most affected by osteoarthritis. Knee braces can help people move with more confidence and stability, and reduce the risk of falls and further injury. The risks of knee bracing include discomfort, skin irritation, swelling or lack of benefit. Some patients cannot use off-the-shelf knee bracing and must see their provider for a medical grade knee brace. Occasionally disproportionate legs will require custom fitted knee braces.

There are different types of injections for knee joints including steroid and hyaluronic acid replacement therapy. They are an important part of the treatment regimen for treating knee osteoarthritis. Typically some local anesthetic is used to numb the knee. After, a small needle is placed into the knee joint. Usually these are more accurately done with ultrasound or X-ray guidance such as under a fluoroscope. The knee injection is done under the kneecap, directly into the joint between the femur and the tibia.

Steroids reduce the inflammation in the knee joint itself. The steroids are potent anti-inflammatory medications and typically provide very rapid pain relief, usually within 24 to 48 hours. The benefit however can be short-term and last only from 6 to 12 weeks. However, that’s often long enough to get you through a flare-up of pain or osteoarthritis.

Knee corticosteroid injections shouldn’t be given too frequently. Typically, if the steroid injections don’t work, then patients need to move on to other types of therapy including hyaluronic acid such as Hyalgan.

Hyalgan can provide long lasting relief of knee osteoarthritis pain. Hyalgan is not a drug, rather, it is a naturally appearing substance called hyaluronic acid that already is present in knee joints. It acts by lubricating and increasing the presence of hyaluronic acid in the joint and stopping degeneration in the knee.

Hyalgan Treatment

When is Hyalgan the right choice for knee pain?
Hyalgan is the treatment of choice for osteoarthritis of the knee when the pain has become prolonged and conservative measures, including nonsteroidal inflammatory medications such as Ibuprofen or Acetaminophen, as well as physical therapy, have not relieved the pain.

Who should not receive Hyalgan?
If you are allergic to Hyalgan or have had difficulty with Hyalgan injections in the past, you should not receive them.

How quickly does Hyalgan produce pain relief?
Most patients noticed a difference within one week following the third injection. However, there were some patients in the studies that did not receive relief until the fifth injection.

How long does Hyalgan treatment last?
Injection of Hyalgan into the knee joint can give long lasting pain relief for as long as six months. Pain relief duration varies with each patient.

What are the side effects of Hyalgan therapy?
Side effects include bleeding, infection, rash, itching, and possible allergic reaction.

Can treatments with Hyalgan be repeated?
Yes, a second cycle of Hyalgan injections can be initiated six months after the first set.

Can Hyalgan help make my knee function better?
Hyalgan can relieve osteoarthritis knee pain that helps retain and improve function.