Introduction
Pain above the knee often occurs in athletes after overloading the affected area. However, they can also occur if there is a disease in the knee joint itself or in other parts of the body such as the spine. Pain due to a pathological process can not only be localized at the site of the event, but can also radiate.
If pain occurs above the knee joint, the cause should be sought. Beginning diseases are usually easier to treat than advanced diseases. For this reason, it is important not to wait too long before consulting a doctor when symptoms occur.
In addition to a visit to the doctor and the specific treatment of the existing disease, home remedies can also provide relief. Especially in the case of inflammatory reactions due to overstrain or arthrosis, many patients find cold applications and ointments helpful. Even a light painkiller can be taken for moderate pain, but should not be taken for more than a few days without a doctor’s prescription.
The causes of pain above the knee are many and varied. In order to find the cause, it is important to determine the location of the pain more precisely. Accompanying symptoms can also provide clues to the cause of the pain.
Pain above the knee, which is localized on the outside of the knee, often occurs in runners. They are often caused by irritation of the iliotibial tract. This clinical picture is called iliotibial ligament syndrome or runner’s knee because it is so common in long-distance runners.
The tractus iliotibialis is a tendon plate that extends from the pelvic bone to the lower leg. When running, the tractus may rub against the outer side of the thigh, which is the trigger for the irritation. This causes the pain above the knee on the outer side.
This condition is favored by bow legs or knock-knees. Weak hip and pelvic muscles are another predisposition for the runner’s knee. If the pain is localized above the front of the knee, this can be an indication of an inflammation of the quadriceps tendon.
The pain then characteristically increases when bending and when climbing stairs. An inflammation of the bursa in this area can cause similar pain. The quadriceps tendon connects the four-headed knee extensor muscle of the thigh with the patella.
If overstrained, it can become irritated, causing an inflammation that causes pain. If the pain is located above the back of the knee, the cause may be an irritation or injury to the back of the thigh. This is often triggered by overstraining due to sporting activities.
A strain or stress reaction of the popliteal muscle can cause similar pain. A Baker cyst can also cause pain above the back of the knee. A baker’s cyst is a bulging of the knee joint capsule.
It often develops in the course of wear and tear diseases of the knee joint such as knee joint arthrosis. Baker cysts are also frequently found in rheumatic diseases such as rheumatoid arthritis. Increased synovial fluid is formed by stress, which is pressed into this sac.
This results in a bulging elastic swelling in the hollow of the knee, which is painful depending on the severity of the condition. After a longer period of rest, the swelling subsides, as there is less synovial fluid in the joint at rest. However, pain above the knee can also be caused by pain radiation.
For example, nerve root entrapments in the spinal column can cause pain radiating outwards above the knee. This often affects the nerve roots of the spinal column segments L 2 or L 3. Constrictions of the nerve roots can be caused by a herniated disc.
Another cause is spinal canal stenosis. Here, wear and tear or calcification leads to a narrowing of the spinal canal or the exit point of the nerve. This results in an irritation of the nerve, which can be accompanied by pain in the leg above the knee, among other places.
A nerve entrapment and radiating pain above the knee can also occur when tense muscles in the back or buttocks press on a nerve and thus constrict it. Diseases of the ligamentous apparatus can also cause pain above the knee.For example, lesions of the outer meniscus (see: outer meniscus lesion) or the outer ligament can cause pain above the knee on the outside, while localized pain on the inside can originate from the inner meniscus or inner ligament. Pain above the knee can occur in osteoarthritis of the knee joint.
In osteoarthritis, wear and tear causes damage to the joint cartilage. This can lead to pain. Osteoarthritis of the knee joint occurs in many people in the course of their lives.
Favouring factors are overweight and lack of exercise, but also permanent extreme stress on the knee and injuries such as cartilage damage or fractures affecting the joint surfaces. Malpositions of the leg axis also favour arthrosis. If a knock-knee is present, the outer part of the knee is subjected to greater stress, which causes the cartilage in this area to wear out more quickly.
The result is an externally emphasized knee joint arthrosis. With a bowleg it is the other way round, the inner side of the knee is more stressed. The result is an internally accentuated arthrosis of the knee joint.
Other causes of pain above the knee can be a fracture, for example after a car accident. An X-ray should be taken to make sure that nothing is broken. The patella may also have slipped and then cause pain above the knee.
In older patients the cause can also be rheumatoid arthritis. This causes inflammatory processes in the area of the knee, which then lead to pain. These pains can also occur above the knee and are strongest in the morning shortly before getting up.
However, bacteria, viruses and fungi can also cause inflammation in the knee area, which is accompanied by swelling and pain, including above the knee. If pain occurs above the knee on the outside of the leg, this is often due to irritation of the iliotibial tract. The tractus iliotibialis is a tendon plate that extends from the pelvic bone to the lower leg.
Overloading and misalignment can cause irritation, the so-called iliotibial ligament syndrome or runner’s knee. The reason for the irritation is, in addition to general overloading, often chafing on the outer side of the distal thigh, the epicondylus lateralis. This causes pain on the outer side above the knee or at knee level.
This disease often occurs in long-distance runners, which is why it is also called runner’s knee. Favourable malpositions are knock-knees or bow legs. Weak hip and pelvic muscles are another predisposition for the iliotibial ligament syndrome.
Pain in the outer area above the knee can, however, also occur due to pain radiation. Lesions or injuries of the outer meniscus or the outer ligament can be the cause. An externally accentuated knee joint arthrosis, as is often the case with a x-leg deformity, can also make itself felt through pain above the knee.
Nerve root entrapments in the spinal column can also cause radiating pain above the knee. Pain above the knee at the back of the leg can be caused by muscle irritation or injury to the back of the thigh. The cause is often overstraining due to sporting strain.
A local therapy with cold application, ointment bandages as well as protection can often be sufficient to make the complaints disappear. Pain in the back above the knee can also be caused by a problem in the hollow of the knee. Here, the popliteal muscle (M. popliteus) can be overstrained or torn.
Another frequent disease in the popliteal fossa is the Baker cyst. This is a bulging of the knee joint capsule. It often develops in the course of wear and tear diseases of the knee joint such as knee joint arthrosis.
During prolonged strain, it fills with fluid, so that a bulging elastic swelling in the hollow of the knee can be felt and an exciting pain develops. After the joint is spared, the cyst becomes smaller again. A doctor can also puncture the cyst, which leads to pain relief.
If the cyst is severe, surgery may be necessary. Inflammation of the quadriceps tendon can cause pain above the knee when bending. When the knee is bent, the quadriceps tendon, which connects the quadriceps muscle with the kneecap, comes.
The quadriceps muscle is located at the front of the thigh and is responsible for stretching the knee.If the quadriceps tendon is irritated and inflamed due to overuse, the body reacts with pain when overused. In this case, painful movements and strain should be avoided so that the inflammation can heal. If pain occurs above the knee when bending, it is not uncommon that climbing stairs is also painful.
Climbing stairs puts more strain on the knees and surrounding structures than normal walking. For this reason, pain often occurs first when climbing stairs, while normal walking and standing is still possible without pain. Nevertheless, pain above the knee when climbing stairs must be taken seriously.
If the pain occurs for the first time and lasts for more than a few days, a doctor should be consulted to find the cause of the pain. Often the cause is an inflammation of the quadriceps tendon, which connects the quadriceps muscle with the kneecap and can become inflamed when overstrained. To make the correct diagnosis, one: should be made.
Which is the best examination method to make the diagnosis must be weighed by the doctor after his suspected diagnosis. In most cases, he will choose the MRI of the knee, since many suspected diagnoses can be excluded or verified with one examination. Rather less common is a disease of the cartilage of the kneecap, the chondropathia patellae.
This disease is particularly common in girls or young women who are active in sports. When stretching the knee, patients experience increased pain below the kneecap because the cartilage there has degenerated. However, this pain can radiate to above the knee.
Often there is also a knee swelling. Because of the pain, patients try to stretch the lower leg less, resulting in a decrease (atrophy) of the front thigh muscles, since these are responsible for an extension (stretching of the knee).
- Ultrasound examinationor
- An X-ray or
- A CT image or
- MRI of the knee
