PAIN AND ORTHOPAEDICS · Health guide
What Causes Knee Pain? Symptoms and the Treatment Approach
What causes knee pain? Assessment of swelling, locking, pain on stairs and loading problems, and an individually tailored treatment approach.
Updated: · General information
Who is affected?
The knee is one of the body’s largest joints and carries considerable load during daily activity, which leaves it open to injury and degenerative change. It is commonly affected in those who play sports such as skiing, basketball and football, in people who are overweight and in those with age-related degeneration. Diffuse knee pain that cannot be localised usually arises from intra-articular disease, whereas pain felt in a confined area may originate in the surrounding tissues.
Causes and diagnosis
There are three main groups of causes: traumatic injuries (anterior cruciate ligament tear, meniscal damage, collateral ligament injuries), degenerative conditions (osteoarthritis, meniscal degeneration) and inflammatory diseases (rheumatoid arthritis, spondyloarthritis). Patellofemoral pain and inflammation of the surrounding tissues, such as tendinitis or bursitis, are also common causes. Blood tests may be used to investigate inflammatory arthritis, MRI where there is no response to conservative treatment or where there is instability, and musculoskeletal ultrasound to assess joint fluid or tendinitis and bursitis.
Treatment approach
Most patients improve with conservative measures such as medication, physical therapy, exercise and targeted injections. In inflammatory cases, anti-inflammatory drugs can reduce pain; cold application may be preferred in acute trauma and heat in osteoarthritis. Minimally invasive options such as PRP, prolotherapy and steroid injection may also be considered. Suitable footwear, gradual increases in exercise, weight control, avoiding prolonged squatting, warming up and regular leg-strengthening exercises can help reduce the risk of injury.
Which information matters in the knee examination?
We ask whether the symptoms began with an injury or developed over time, and whether there is swelling, locking or a sense of the knee giving way. Pain around the kneecap, along the joint line and behind the knee may relate to different causes. Hip strength and foot loading may also be examined during movement.
How is return to activity planned?
Goals such as stairs, squatting, long walks or sport are addressed one by one. The programme is advanced by monitoring strength, range of movement and the response to loading. A hot, red and swollen knee accompanied by fever, or an inability to bear weight after an injury, must be assessed without delay.
Your questions
Patient information
Is a noise from the knee a sign of disease?
A painless noise alone does not indicate disease. If the noise is accompanied by pain, swelling, locking or loss of function, examination is needed.
Is MRI needed for every knee pain?
No. Imaging is selected if it is considered appropriate after examination. In some situations a radiograph is sufficient; for some complaints no imaging is needed at all.
