Symptoms

Patellar pain: symptoms, causes and therapy

Patellar pain: symptoms, causes and therapy



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Pain on the kneecap

Patellar pain is particularly common in people who are active in sports and who kneel a lot due to work. The complaints are particularly noticeable when going downhill, for example when hiking, climbing stairs and descending, kneeling, long standing or sitting (theater knee, cinemapain). Pain on the kneecap (lat. Patella) is often a result of overwork and goes back on its own after a period of protection.

However, if there is an injury or disease to the kneecap, such as Therapy is required for cartilage damage (chondromalacia patellae), knee pain caused by osteoarthritis or a so-called patella dislocation in which the kneecap jumps out of its guide. Depending on the diagnosis, drug, physical and pain therapies can be used. Physiotherapy exercises are also often prescribed. Surgical interventions are usually only carried out if the conservative measures do not lead to success.

Disease symptoms of kneecap pain

Retropatellar cartilage damage, patellar luxation (jumping out / dislocation of the kneecap), patellar lateralization (lateral patellar displacement), patella crepitus (noticeable rubbing behind the kneecap), patella arthrosis, chondropathia patellae and others.

Symptoms

Those affected are particularly affected when walking downhill and climbing stairs due to pain in the kneecap. Many people also experience pain when kneeling or standing for a long time. The so-called “cinemapain” or “theater knee” refers to pain that occurs on the kneecap after sitting for a long time.

The pain can occur on, to the side of, and behind the kneecap. Pain below the kneecap is also possible. The complaints often occur at the transitions to bones, ligaments and cartilages, which those affected perceive as punctual and piercing.

Causes of pain on the kneecap

The kneecap is a flat, disc-shaped, triangular, viewed from the front, free-running bone that lies in front of the knee joint. It protects the knee joint, reduces the friction of the four-membered thigh muscle and increases its leverage. The kneecap is connected to the knee joint capsule by tendons, ligaments and muscles and slides up and down in a groove on the femur (femur) when the knee joint is moved.

Due to the high forces in the kneecap joint and the lack of stable bony joint guidance, muscular disorders and malformations of the plain bearing can lead to severely restrictive symptoms, which sufferers perceive as extremely painful. Another cause can be impact accidents and twisting of the knee joint.

The diagnosis of kneecap pain is not always easy in principle and often requires examinations that go beyond the knee joint. Because the function of the kneecap depends, among other things, on the functions of the thigh extensor, the overall statics of the pelvis and legs, the supply of vessels and nerves from the lower back and the metabolism in general.

A holistic view of the patient's complaints is therefore particularly important. For example, possible chronic circulatory disorders, back pain, low back pain or buttocks pain should be taken into account when diagnosing and treating the problem of the patella. This is the case, for example, in osteopathy.

Patellar lateralization

In a so-called patellar lateralization, the kneecap tends to shift laterally due to slight instability and thus "get out of the lane". A muscle imbalance (dysbalance) is often the cause of the tendency to shift, in which the outer muscle parts predominate and the kneecap is therefore increasingly pushed to the sides.

Patellar lateralization can lead to permanent instability and wear and tear of the articular cartilage (patella arthrosis, chondropathia patellae) and cause severe pain and audible rubbing noises (crepitus).

In order to prevent permanent damage and signs of wear and tear on the cartilage, targeted muscle training and stretching of the shortened muscle groups against the lateral tendency of the kneecap to move are primarily used. If conservative therapy is not enough, arthroscopic surgery can be performed to stabilize the movements of the kneecap.

Patellar luxation

A patellar dislocation is a dislocation of the kneecap. Colloquially, it is also said that "the kneecap jumped out". Usually the petall luxation occurs the first time as a result of a fall or an impact and is felt to be very painful. A bruise in the joint and an injury to the internal extensor (medial retinaculum) can go hand in hand with the dislocation of the kneecap. The cause can also be a system-related flat malformation of the plain bearing or a ligament and muscle weakness.

Children and adolescents are often already affected by a patella luxation. In order to avoid consequential damage, treatment should be given as early as possible. Because, like a shoulder dislocation, the risk of it occurring again and again increases with every further dislocation of the kneecap. As with patellar lateralization, there is no causative conservative therapy, but appropriate muscle training and wearing certain orthoses can reduce the risk of renewed patellar luxation.

If these measures do not lead to success, a surgical intervention is often necessary, in which the capsule is gathered or the patella is restrained, so that the path of the kneecap is specified during movements.

Patellar tip syndrome

The so-called patella tip syndrome describes a chronic and degenerative overload disorder of the patellar extensor at the bone-tendon transition of the patellar tip. The "jumper’s knee" can be very painful, similar to a "tennis elbow".

Overloading the patellar tendon causes hardening and limescale deposits in the tendon attachment on the patella. This is caused by repeated strong tensile loads, for example in ball sports and athletics. Sufferers complain of needlestick-like, severe pain, which usually occurs like a relapse for 15 to 20 minutes.

To cure the overload, first and foremost, care and a sports leave is required. Pain and anti-inflammatory drugs are often prescribed and special bandaging is used. Treatment with shock waves can also be promising. If the degeneration has already progressed and the pain is chronic, a surgical intervention is often necessary, in which a patellar tendon solution or a stimulation of the regeneration process takes place.

Paticular pain due to Plica syndrome

Patella pain can indicate the so-called Plica syndrome. These are enlargements and thickenings or folds (plica) of the joint skin, which swell due to inflammation and lead to painful pinching in the joint.

The folds appear above and below the patella, laterally and towards the center of the joint. The consequences are a swollen knee and pain behind the kneecap up to overloading and cartilage damage. Sufferers report the feeling that the knee is not stable and is yielding or blocked. The cause of the wrinkles can be previous injuries, but also overuse by sports such as kafting or cycling. An instability of the knee can also trigger the Plica syndrome.

The therapy mainly consists of protection, physiotherapy and pain relieving medication. If the knee is swollen, treatment with ice usually helps: Simply put a few ice cubes in a plastic bag and rub the painful area with them for half a minute. Then warm up the area and then repeat the cold application. The fold can also be removed arthroscopically, provided that the conservative measures do not provide relief.

Chondromalacia patellae

“Chondromalacia patellae” is a softening and degeneration of the cartilage on the underside of the kneecap. Young people and athletes are particularly affected ("Runner’s knee"). The pain often occurs on the front of the knee or kneecap. After sitting for a long time or climbing and climbing stairs, the pain worsens and appears to move from the front of the knee to the back.

The causes here include overuse, trauma, particularly high force on the knee cartilage, functional disorders of the thigh muscles, chronic wear and inflammation of the knee joint, X-legs, high kneecap and ligament weakness.

Treatment of chondromalacia patellae consists of physical therapy and physiotherapy exercises. On the other hand, painkillers are administered. Affected people should take care of their knees and bend only a little. Surgical interventions aim to smooth the frayed cartilage during arthroscopy or to stimulate the formation of replacement cartilage. Depending on the cause of the cartilage damage, other interventions may also be necessary, for example in the event of a leg axis defect.

When is medical help needed?

Since kneecap pain can have different causes, those affected should always consult a doctor to prevent possible subsequent damage. The causes of patella pain listed here are only a selection and do not claim to be complete.

Naturopathy therapies

In naturopathy, acupuncture has long been used as part of traditional Chinese medicine (TCM) in the treatment of knee and patella problems. Especially in pain treatment, the setting of fine needles along so-called meridians - channels in which the life energy (Qi) flows - leads to the relief of the symptoms. The needles inhibit the processing of pain in the spinal cord, so that the actual pain decreases. Often, several acupuncture sessions are necessary to completely relieve the pain.

Leech therapy is promising for knee arthrosis. During treatment, the leeches secrete their saliva (salvia), which contains many health-promoting substances. For example, the enzymes inhibit blood clotting, widen the blood vessels and counter inflammation and knee pain.

So-called cupping can also relieve knee pain. This is also one of the old natural healing methods. The cupping glasses are drawn on the oiled skin along the muscle pathways, which accelerates the lymph flow. Cupping also affects the pain pathways, so that the pain is relieved after a few sessions.

Another natural treatment for knee pain is Ayurveda therapy. Ingredients such as lemon, caraway, boxhorn clover and onions are used. Herbal bags and various warm herbal oils are used in Ayurveda massages to stimulate blood circulation and metabolism. They also loosen hardening and soften the muscles and tendons.

In addition to the massage treatment, a certain diet is also part of Ayurveda therapy. Another component of what is probably the oldest surviving health system are yoga exercises that patients learn to strengthen their knee muscles and stimulate their metabolism. Basically, building muscle in most of the symptoms mentioned is extremely important to improve joint guidance. (ag, no)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr Astrid Goldmayer, Barbara Schindewolf-Lensch

Swell:

  • Clinic of the University of Munich: Knee cap dislocation - patellar luxation, (accessed 09.09.2019), LMU
  • Danielle Campagne: Patellar Luxations, MSD Manual, (accessed 09.09.2019), MSD
  • Dieter Kohn: Plica synovialis syndrome, knee expertise DOI: 10.1055 / b-0035-126879, II Special part: 17 athlete's knee, (accessed 09.09.2019), thieme
  • Klinik am Ring: patellar tip syndrome / Jumpers knee, H. & P. ​​KLINIK am RING for operative medicine GmbH & Co.KG, (accessed 09.09.2019), KaR
  • Carl Joachim Wirth, Wolf Mutschler, Dieter Kohn, Tim Pohlemann: Practice of Orthopedics and Trauma Surgery, Thieme Verlag, 3rd edition, 2013


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