Pain above the kneecap

introduction

The kneecap (patella) sits at the front of the knee and primarily serves as protection for the knee joint. The kneecap is called a sesame bone. A sesame bone increases the distance between the tendon and the bone and can therefore optimally improve the leverage of muscles, for example. The kneecap is the largest sesamoid bone in the body and transfers muscle power from the thigh to the lower leg because it sits in the tendon of the thigh extensor muscle.

In active people, pain above the kneecap is mainly caused by Injuries or overloads caused in older people stand mainly Signs of wear and tear such as osteoarthritis as a trigger in the foreground. Lots different tapes, Muscles and Tendons connect the big Knee jointwhich is why there are a variety of causes of pain above the kneecap. A distinction is made between acute painthat last a few hours to days and regress over time or through therapy, and chronic pain. Chronic pain can also start suddenly, but can also develop slowly and, by definition, last longer than six weeks to three months.

Knee pain should not be taken lightly and treated promptly by a doctor. Typically the General practitioner or an orthopedic surgeon the first point of contact. Often the principle applies: the earlier the painful knee is treated, the better the chances of recovery.

Symptoms

At Pain, the above the kneecap are localized, a number of other symptoms can occur. The skin can for example with a inflammation be reddened and heated. It can too Restrictions in movement throughout the knee come that Stretching or bending can be restricted to the point of complete blocking. In most cases, the pain is particularly severe burden on or are exacerbated by stress.

For the diagnosis, it is important to distinguish when the pain above the kneecap increases. Pain that occurs after rest and is accompanied by stiffness is typical for, for example arthrosis (Joint wear), while pain that occurs during exercise and at rest, for a inflammatory rheumatic disease could speak. If the pain occurs above the kneecap, especially when climbing stairs, a Inflammation of the bursa be responsible for the complaints.

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My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Typical of certain diseases of the knee is also a snap when moving. This often gives the feeling that the Knee gives way or buckles. It happens again and again when these symptoms occur Swelling of the knee and if the problems occur especially after sporting activities, it can be, for example, a Fold of the synovium act. Typically the pain occurs with this clinical picture above or below the kneecap on, the preferred places where such wrinkles can form.

Also should be on Symptoms outside the knee can be respected, for example more joints from pain to be affected. But also Concomitant symptoms how fatigue, stomach pain, skin rash or fever are possible and may indicate acute or chronic diseases in which several organs are affected. A typical example is that Borreliosis, a bacterial inflammation that is transmitted by ticks and that is both with Knee pain as well as with fever and chills can go hand in hand.

diagnosis

To the Cause of pain in the field of Kneecap to get to the bottom of it, a medical history (anamnese) be collected. The extent, location and characteristics of the pain are of particular importance. During the clinical examination will focus on the knee, however, especially the Feet, Hips and the Spine can also be checked for abnormalities. In some cases abnormalities can already be felt from the outside.

There are a number of them, especially for the kneecap orthopedic teststhat can be done to make the diagnosis. For example, if the patient lies on his back and the examiner pushes the kneecap in the direction of the surface, pain can be triggered, which can provide clues as to the localization of the problem.

Also the Examination using an ultrasound (Sonography) can be useful because it gives a Joint effusion can be represented. With the help of a X-ray For example, tendencies of the kneecaps to deviate to the side can be shown. Come in rare cases other imaging procedures as the Magnetic resonance imaging of the knee (Magnetic resonance / MRI) or Computed Tomography for use.

causes

A common clinical picturewhat concerns particularly active young people as well as people who kneel a lot at work is the Chondropathia patellae or aching kneecap. This leads to severe pain on both sides in the area of ​​the Kneecapthat presumably through Overwork and muscle imbalances caused. Also wearing High heel shoes or sports that require jumping can be possible causes of the symptoms. In the Chondropathia patellae it is a harmless and purely functional complaint that disappears by itself after taking it easy. A Strengthening the Thigh muscles supports the healing process.

Also a Cartilage damage to the kneecap can cause pain above the kneecap to lead. A variety of causes like Leg axis deviations (e.g. Knock knees), Ligament weakness or previous injuries can fray or rub the cartilage on the underside of the kneecap. Pain occurs particularly when bending the knee, climbing stairs or after sitting for a long time with knees bent.

Another common cause ask for knee problems Folds of the synovium that as so-called Plica syndrome summarized clinical picture can occur in several places in the knee. A fold of the synovial membrane can also form above the kneecap, which can swell in the course of inflammation and cause pain. It has not yet been conclusively clarified what the triggers for such wrinkling are. In the course of a plica syndrome there may be changes in the Hoffa fat body. Of the Adipose tissue in the knee can become hard, thickened or calcified and in turn cause severe pain.

Knee pain especially in the area above the kneecap Children and adolescents very often. The causes for this can be very diverse, in many cases it is harmless "Growing pains"But more serious illnesses can also be behind the symptoms.

Also hereditary diseases connective tissue can cause pain above the kneecap. For example with Ehlers-Danlos Syndrome it comes to one decreased crack resistance the skin and hypermobile joints. In the course of growth, the two kneecaps tend to become dislocated. Likewise the hereditary one Nail-patella syndromewhere the kneecap is too small and there may be discomfort in the area.

therapy

In the event of pain in the knee, the knee should initially be protected and only slightly bent. Painkillers can be taken to relieve the discomfort. In most cases it makes sense to do physical therapy exercises and specific leg muscle training in order to support the knee joint with stable muscles.

Depending on the cause of the symptoms, there are also surgical options. For example, cartilage damage can be smoothed out or drilled through as part of a knee examination (arthroscopy) in order to stimulate the formation of replacement cartilage. If the kneecap deviates to the side, the reinforcing ligament (retinaculum) on the outside of the knee can be surgically split. This allows the kneecap to slide over the knee joint in the correct position and the pressure on the kneecap is reduced. Leg axis deviations such as bow legs or knock knees can cause pain above the kneecap. Here, too, there is the possibility of an operative correction of the deformity to alleviate the symptoms.
The conservative, i.e. non-operative therapy of knee pain initially has priority. Surgical therapies can only be considered when all options have been exhausted and the symptoms have not improved.

Please also read our article on this Exercises for the knee joint,

Taping for pain above the kneecap

Taping has to be differentiated into two fundamentally different forms. On the one hand, there is a rigid tape that is stuck to the skin under tension. This partially immobilizes the joint and supports the stretching movements in the knee. In contrast, the kinesio tape is an elastic tape bandage that does not restrict mobility in the knee. It is designed to increase awareness of the movements in the knee and promote blood flow to the soft tissues. The kinesio tape can be used both for the therapy of pain above the kneecap and for prevention.

Please also read our article on this Taping the knee joint.

prophylaxis

To Prevention of knee pain there are some pointers to follow. The regulation of body weight comes first, as the knees are designed for normal weight loads. It's also important to get regular exercise around the Blood circulation throughout the body and especially in the knee. The vital one Cartilage in the knee joint is only a small part of the blood circulation connected and relies on physical activity to get enough nutrients. In principle, it does not depend on which movement is carried out, but mainly on regular exercise. Strength Relieve muscles in the legs the knee joint. Are particularly knee-friendly sports Swimming, cycling and walking.

Carrying heavy loads and high-heeled shoes should be avoided as it puts a lot of strain on the knee.

When does the pain above the kneecap occur?

Pain above the kneecap when stretching

The tendon of the large one runs above the kneecap Quadriceps muscles (please refer Quadruple thigh muscle). If pain occurs, particularly when the knee is stretched above the kneecap, these muscles can be the cause. The "quadriceps" pulls its tendon over the kneecap and attaches to the upper shin. The tendon can become irritated or inflamed through incorrect or excessive loads, as well as through external intervention or inflammation. As you stretch it, it slides towards the thigh and the friction can cause considerable pain. Any inflammation in the area above the kneecap will trigger this pain in motion. Typical signs of inflammation are swelling, reddening, impaired function and tenderness on the knee.
Stretching can also be very painful if the knee is chronic. Osteoarthritis of the knee joint is very common in old age. Stiffness in the morning with extremely restricted freedom of movement is typical. The movements of the worn joint are also very painful and stretching is no longer fully possible.
Please also read our article on this Knee osteoarthritis.

Pain above the kneecap when standing up

Getting up from a crouch is a force-consuming stretching load for the knee in the joint. This is also the case here Quadriceps muscle very demanding. Pain when standing up mainly occurs when the muscle or its attachment tendon above the kneecap is irritated and inflamed. Such pain can also occur in young people. Permanent pain that occurs with just a few movements, such as standing up, is also known as starting pain. This is not uncommon for athletes. The pain subsides slightly after prolonged movement and strain.

Pain above the kneecap when bending

When bending, as when stretching, there is a high level of stress and friction on the cream of the quadriceps muscle. This slides over the kneecap with every movement to increase power transmission. With an inflamed and irritated tendon, every movement becomes torture. Pain when bending is also very typical of rheumatic diseases. These can often be found in the knee. With osteoarthritis of the knee, which is a rheumatic disease, the bones rubbing against each other due to heavy wear and tear on the cartilage. This causes a lot of pain when bending. The overall freedom of movement is also restricted. This can be determined especially in the morning, where severe stiffening of the affected joints is to be expected.
Please also read our article on this Rheumatoid arthritis.

Pain above the kneecap at rest

In many diseases of the knee, pain when moving is typical. However, pain at rest rarely occurs.
One pain that can occur during rest and slight movement is the start-up pain typical of osteoarthritis.
(s. also Symptoms of osteoarthritis)
In adolescent patients, pain in absolute calm, for example at night, can indicate a growth spurt. The pronounced growth in length of the bones can sometimes cause severe pain.
(see also Growing pains)
A disease of the lumbar spine can also cause pain in the knee at rest. Nerve root irritation can sometimes spread pain to the toes. The ISG blockade also often causes pain in the knee area. In very rare cases, malignant tumors of the bones can be behind it.