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My Aching Knee by Ihor Magun, M.D., F.A.C.P. Our knees are pretty special. They allow us to walk and to sit, to kick and to dance. They carry a lot of weight and, if healthy, they are flexible enough to help us lift things and squat down to look for things or sit on the floor and cross our feet in comfort. It is easy to take our knees for granted when they feel good and do what they are supposed to do. When they start acting up, they can cause a lot of paincmd anxiety. The knee, unfortunately, is the most com monly infected joint in the body. There are myriad causes for this, so an accurate diagnosis is para mount to initiate appropriate treatment. To determine the cause of knee pain several questions need to be addressed. The first of these is whether there was any traumatic injury that led to the problem—a fall, a slip, or an awkward move ment that occurred before pain set in? If there was no trauma involved, did the pain start gradually or suddenly? Does some activity or some position (standing, sitting, or lying) bring the pain on? Where specifically is the pain located? Is knee pain some thing that began with aging? Another thing to consider is the presence of other symptoms. Swelling, for example, is common. If it occurs bilaterally, it is probably a form of rheumatoid arthritis. If one knee is tender or swol len, it might be gout (a deposit of uric acid crystals), pseudogout (a deposit of calcium pyrophosphate crystals), or an infection in the joint. An aspiration of fluid with a needle clinches the diagnosis. If swelling occurs immediately after a trau matic injury, it usually means an injury to the ante rior cruciate ligament (commonly referred to as ALC) or to a fracture of the bone. If swelling occurs over hours or days, a tear or a ligament sprain has occurred. A popping or a clicking sound is usually benign, but if pain occurs after this "pop" is heard, it frequently indicates a tear in the ligament. This usu ally leads to instability of the knee. If the knee seems to give out from beneath, this confirms liga ment injury. A grinding sound may indicate bone against bone—an indication of worn cartilage. A common, but frequently misdiagnosed cause of knee pain is actually referred pain. This pain originates in the hip or it may represent some form of back pain. Neurons have specific pathways that travel to the front of the knee, confusing the correct location of the pain problem. Other types knee pain include a type of bursitis called prepatellar (kneecap) bursitis or patellar (kneecap) tendonitis. Prepatellar bursitis affects people who kneel frequently. Patellar tendonitis is usually seen as pain the front of the knee, which gets worse with stair climbing. It often affects people who participate in sports involving frequent jumping. Chondromalacia patellae (a form of arthritis of the kneecap and femur bone) also produces pain in front of the knee, but becomes worse with pro longed sitting and while descending stairs. It fre quently afflicts joggers. Pain in the back of the knee is frequently caused by a cyst formation referred to as a Bakers cyst. Treatment of knee pain depends entirely on • the underlying problem. Radiological methods are frequently employed. In some cases, simple x-rays are the best diagnostic tool. In other cases, MRI/CAT scans may be necessary. Occasionally, the exact cause and the extent of damage can be accurately assessed only during an actual surgical procedure. Work-up and treatment usually utilize an incremental, step-wise approach. Seek medical ad vice early to help prevent long-term problems. Re member that knees can make daily life easier or harder. Be sure to give them the attention they de serve. 18 “НАШЕ ЖИТТЯ”, ЛЮТИЙ 2005 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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