SUDDEN KNEE PAIN
He has a very high keen in treating [Sudden Knee Pain].
Under his enthutiast research and investigation,
he manages to list down 20 signs and symptoms (will be shared within this article).
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As a private physiotherapy practitioner, we have been seeing many cases with complaint of “sudden onset knee pain”.
As a practitioner, what will come to your mind first thing? MCL? ACL? LCL? Meniscus injury? Fracture?
However, upon subjective history, often, patients do not have any “clear reason/clue”, “direct trauma”, “fall” prior to this “sudden onset knee pain”.
Indeed, most patients have similar expression that, “they were still fine and able to walk/ shopping YESTERDAY”, or “they just came back from travel yesterday”.
Often, “sudden onset knee pain” to come out of nowhere4, no trauma blow, or hard fall for the parts of the knee to become injured1,2. However, the phenomena is not well explained scientifically, but routinely are explained as due to stretched out, worn, aggravated, partial torn, or fully ruptured1. The common anatomical causes that are used to explain “sudden onset knee pain” are such as ACL2,3,5,6,7,8,10, PCL2,3,5,6,7,8,10, collateral ligament injury5,6,7, meniscus tear2,3,5,6,7,8,10, fractures2,3,5,6,8,10, PFS2,3,5,6,10, tendinitis2,3,6,7,8, bursitis2,3,6,7,8,10, Osgood schlatter2,3,6, arthitis2,3,4,5,6, runner’s knee4, ITB syndrome5,7,8,10, cartilage torn5,10. dislocation of knee cap5,8,10. If you notice sudden knee pain, it can be hard to know what caused it or what you should do next3.
Some categorised the cause of sudden onset knee pain as being overweight5,9, or history of arthritis5.
Common knee pain area is frontal of knee joint. Researchers found that among all people seeking medical treatment in the country between 2007 and 2011, 1.5–7.3% sought care for pain in the front of the knee alone6. There are some differential diagnosis of knee pain by anatomic site7.
According to our observation and clinical assessment for last 14years, common area of “Sudden onset knee pain” is in between 2 tibial landmarks along the tibial-femoral joint line, which are Pes Anserinius and Medial retinaculum.
Commonly, “Sudden onset knee pain” characterised by Sharp pain, excruciating pain, unable to weight bearing, unable to stand up onto that leg, feel “weakened” to stand onto the leg, unknown triggering activity, the “sudden onset” can be described as “yesterday still able to walk / run, but today totally cannot weight bear”.
HERE, I would like to propose that, this “sudden onset knee pain” is due to popliteus muscles spasm (either short locked or long locked), with specific signs and symptoms as listed below.
- Sudden onset, no blow/direct trauma onto knee
- Non gradual onset
- Unable to weight bearing during attack
- Patient feels “giving way” after some walk
- Knee flex: limited lag -60° to -130° (acute phase)
- Knee flex: end range pain (recovery phase)
- Functional: Unable to squat DOWN (recovery phase)
- Knee ext limited lag 5°-10° (acute phase)
- Knee ext limited lack 5° (recovery phase)
- Gait: excessive HIP flexion, or reduction knee flexion, with excessive ankle DFlx
- Xray: rotated tibial (featured with medial epicondyle narrowing and lateral epicondyle gapping)
- Tibial observation in prone lying (knee extended): rotated tibial bone
- TIbial observation in prone lying (knee flexed): rotated tibial bone, feet pointing outwards
- MRI: may featured with meniscus tear
- Acute phase may Positive to Meniscus Apley’s maneuver test
- Observation: varicose veins surrounding the poplitues area
- Observation: bulky muscle of popliteus fossa
- Observation: cold feet patients
- Patients may have LBP characterised with Gluts pain (psoas tightness/stiffness)
Popliteus muscles are located behind the knees.
Symptoms: excruciating pain, unable to weight bearing, unable to bend the knee & straighthen the knee.
9: knee pain, 2007, https://jamanetwork.com/journals/jama/fullarticle/206652
11: AFP, Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis, https://www.aafp.org/afp/2003/0901/p917.html
12: https://pubs.rsna.org/doi/10.1148/rg.342125082, Comprehensive Review of the Anatomy, Function, and Imaging of the Popliteus and Associated Pathologic Conditions, Siddharth P. Jadhav , Snehal R. More, Roy F. Riascos, Diego F. Lemos, Leonard E. Swischuk, 2014
29 Mar 2022