Diagnosis
The diagnosis of the disease that leads to the development of pain in the kneecap area is usually done in several steps. Simple clinical examinations are in many cases supplemented by radiological procedures. The most important clinical examinations include palpation of the patella surface and assessment of the patella’s displaceability.
In addition, the triggerability of pain in different positions of the knee joint must be recorded. During an initial examination, the treating physician first examines the leg axes from two planes (frontal and sagittal plane). In this way, malpositions such as O or X legs can be ruled out.
In addition, any deformations of the knee can be assessed. Inspection of the musculature is also essential for diagnosing knee-cap pain. In order to get a first clue to the underlying disease, the condition of the skin must also be inspected by comparing the sides.
The doctor pays particular attention to possible redness, swelling and scars. In addition, attention must be paid to swellings, dents and thickenings in the area of the patella and the hollow of the knee of the affected patient. In a further step, the knee and kneecap are thoroughly palpated.
The treating physician pays particular attention to the presence of typical signs of inflammation. Overheating of the kneecap compared to the muscles of the lower and upper leg indicate an inflammation within the knee joint. In the case of effusions, a so-called “dancing patella” can be observed when the joint space is stretched out with the knee joint.
Pain in the kneecap can have many different causes. If no cause can be determined by the above-mentioned examination methods, an MRI examination of the knee is recommended. It can detect many different possible changes in the knee joint area and thus be diagnostically groundbreaking.
For example, pain in the kneecap can be caused by damage to the cartilage. The kneecap has a cartilaginous coating on the underside and slides in its cartilaginous sliding bearing consisting of the thigh and lower leg bones. If there is an injury or arthritic change there, this can be determined by MRI and the size and depth of the cartilage damage can also be assessed.
The quadriceps tendon is also a possible trigger for the complaints. This is the tendon of the large thigh muscle or the front of the thigh, which starts at the patella and extends as the patellar tendon from the patella to the front of the tibia. Injuries to this tendon apparatus can also be recorded with high accuracy in MRI (tears, partial tears, inflammation).
This already covers the main causes of pain in the patella region. Irritant conditions of tendons, ligaments and joint capsule can also be depicted. The irritated structures are usually thickened and lack signal amplification.
In the area of the knee joint, the so-called Hoffa fat body is also located. It is an accumulation of fatty tissue between the kneecap and the tibia.In Hoffa-Kastert syndrome, the Hoffa fat body is enlarged and leads to pain and restricted movement in the knee joint. The syndrome is best diagnosed by an MRI of the knee.
In addition to the examination methods just described, extensive functional examinations are often used for knee-cap pain. During these examinations, the behavior of the patella is evaluated in different positions and under different movements. In addition, radiological procedures (X-ray, MRI) can be used for diagnosis.
