Knee Arthritis In The Elderly
Arthritis is the term for any joint inflammation. One of the more commonly affected joints, especially in the elderly, is the knee. This is partly due to age-related changes in the joint cartilage, wear and tear within the knee joint which has to bear most of the body weight, and certain inflammatory joint diseases that are more common in the senior years. Knee arthritis is a major cause of physical impairment in the elderly and significantly compromises quality of life.
Potential Causes Of Knee Swelling
Whether water on the knee is mildly annoying or painfully debilitating, a person will want to identify the likely cause and treat the symptoms to help reduce the likelihood of future problems. Chronic or long-standing swelling may lead to joint tissue damage, cartilage degradation, and bone softening, therefore treatment is usually recommended.
This article describes 12 conditions that frequently cause knee swelling, also called water on the knee.
1. Injury to the kneeTrauma to the knee’s bones, ligaments, tendons, bursae, meniscus, or articular cartilage can cause pain and swelling. Serious injury can cause blood to flood into the knee joint, leading to significant swelling, warmth, stiffness, and bruising. This condition is called hemarthrosis and warrants urgent medical care.
A patient should also seek medical attention if knee pain is severe, if the affected leg cannot bear weight, or if there is suspicion of a broken bone.
2. Knee osteoarthritisDegeneration of the cartilage of the knee joint can result in an overproduction of joint fluid, causing the knee to swell. A swollen knee due to knee osteoarthritis is typically accompanied by pain.
In fact, evidence suggests people who have severe knee pain from osteoarthritis are more likely to experience knee swelling. One study2Kraus VB, Stabler TV, Kong SY, Varju G, McDaniel G. Measurement of synovial fluid volume using urea. Osteoarthritis Cartilage. 2007 15:1217-1220. doi:10.1016/j.joca.2007.03.017 found that:
What Are The Signs And Symptoms Of Arthritis Of The Knee
There are many signs and symptoms of arthritis of the knee:
- Creaking, clicking, grinding or snapping noises .
- Difficulty walking.
- Joint pain that changes depending on the weather.
- Joint stiffness.
- Knee joint pain that progresses slowly or pain that happens suddenly.
- Your knee locks or sticks when its trying to move.
Pain and swelling are the most common symptoms of arthritis of the knee. Some treatments might reduce the severity of your symptoms or even stall the progression. See your healthcare provider if you have symptoms of knee arthritis.
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What Causes Arthritis Of The Knee
Experts have identified some genes that might cause arthritis, including arthritis of the knee. They predict that there are more genes not yet discovered. You could have a gene linked to arthritis without knowing it and a virus or injury could trigger arthritis of the knee.
Though the cause is unknown, some risk factors increase the possibility of arthritis of the knee. Risk factors of osteoarthritis, specifically, include:
- Age. Osteoarthritis happens to older adults more often than younger adults and children.
- Bone anomalies. Youre at a higher risk for osteoarthritis if your bones or joints are naturally crooked.
- Gout. Gout, also a type of inflammatory arthritis, might lead to osteoarthritis.
- Injuries. Knee injuries can cause arthritis of the knee.
- Stress. A lot of stress on your knees from jogging, playing sports or working an active job can lead to osteoarthritis of the knee.
- Weight. Extra weight puts more pressure on your knees.
How Is The Cause Of Knee Swelling Diagnosed
Your doctor will ask you questions about your pain. These may include:
- What is the exact location of the pain the front of the knee, the back, the inside, the outside, above or below the kneecap?
- Do you feel better or worse at certain times of day?
- Does it hurt more when youre walking up or down stairs?
- How does it hurt? Is it a dull ache or a sharp, stabbing pain?
- Is the knee range of motion decreased?
Along with these questions your doctor will physically examine the knee and afterward suggest the next step in terms of diagnosing the exact problem. You may have a blood test or fluid taken from the knee with a needle for lab examination. Imaging tests may also be used to diagnose your condition.
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When To See A Doctor
Consult a doctor if knee pain does not improve with rest or occurs with other symptoms. Also, see a doctor after a sudden injury, such as from blunt force trauma.
In addition, it is important to receive professional care if there are any indications of an infection, such as a fever or pus coming from a wound.
The Following Measures Can Be Taken To Ease The Pain At Home:
Icing with an ice pack or directly with the ice. This helps in reducing the pain and swelling. After few days of the injury or after any activity that causes knee pain, use ice, a cold gel pack, a bag of frozen vegetables on the affected areas for 15 minutes with a 1-2-hour gap in between every application. Do not directly use them, instead cover the ice or ice pack with a cloth or towel and then put it on the affected knee. To reduce the swelling, perform this remedy while keeping your leg raised above the heart level. Rest for a while and reduce the movements that may enhance the pain in the knee. Forget about squat, too much kneeling and running for some days. Do not use exercise machines like stair-steppers and rowing machines, instead go for a walk or swimming. Pain killers like acetaminophen or ibuprofen may give relief in the painful condition of the knee joint.
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Your Doctor May Not Want To Give You Cortisone If Knee Replacement Is Seen As Ultimately Your Only Answer
We see many patients who tell us that they have gone to their doctors and have asked for one more cortisone injection because of the amount of pain and swelling that they were suffering from that day. You know that the call to the doctors office for an appointment usually comes on the day when your knee hurts worse. The doctor, to his/her credit in many cases, has declined to give his/her patient this one more cortisone shot because their concern is that if you get cortisone injections into your knee prior to surgery, you will have a greater risk of complications after the surgery. There is a lot of debate around this subject.
A December 2020 study published in the medical journal Rheumatology gives this overview assessment of the debate surrounding the use of cortisone for a bone on bone knee. Here are the summary learning points:
- Existing data indicate that intra-articular corticosteroids in knee osteoarthritis provide short-term pain relief and functional improvement which may last from one to several weeks.
- At present, synovitis is the most important predictor of treatment response, and also a target for anti-inflammatory treatment for intra-articular corticosteroids.
- Our explanatory note: If you have a lot of knee swelling, cortisone may be of benefit.
Another Serious Cause Of Ankle Swelling In The Elderly
If both ankles are swollen, this could mean heart failure. Dr. Teitelbaum explains, This is usually associated with shortness of breath, which gets worse after you have been lying down for a while, as well as shortness of breath with exertion.
An elderly person may assume that shortness of breath is a normal part of aging and not see it as a sign of something more serious.
Heart failure is a common cause of unnecessary deaths, continues Dr. Teitelbaum. Why do I say unnecessary? he adds.
Because simple natural therapies are dramatically effective at improving heart failure.
Your physician, sadly, will likely not have seen this research because these treatments are generally low cost and therefore not profitable for the drug companies to advertise.
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Though The Site Of Swollen Ankles In Elderly People Is Quite Common This Commonality Does Not Rule Out A Potential Life
Ankle swelling in an older person can mean a very serious medical condition.
If the swelling is new and only in one ankle, especially if the calf or back of the thigh is tender, see your physician to rule out a blood clot, says Jacob Teitelbaum, MD, medical director of the Fibromyalgia and Fatigue Centers nationally, and author of The Fatigue and Fibromyalgia Solution.
Comprehensive Prolotherapy For Problems Of Knee Instability And Wear And Tear And Bone On Bonerepetitive Inflammation As An Anti
Comprehensive Prolotherapy is an injection technique that uses a simple sugar, dextrose, and in some cases, it is combined with Platelet Rich Plasma Therapy to address damage and micro-tearing of the ligaments or soft tissue in the knee. A series of injections are placed at the tender and weakened areas of the affected structures of the knee. These injections contain a proliferant to stimulate the body to repair and heal by inducing a mild inflammatory reaction.
The localized inflammation causes healing cells to arrive at the injured area and lay down new tissue, creating stronger ligaments and rebuilding soft tissue. As the ligaments tighten and the soft tissues heal, the knee structures function normally rather than subluxing and moving out of place. When the knee functions normally, the pain and swelling go away.
In published research in the Journal of Prolotherapy, we investigated the outcomes of patients receiving Prolotherapy treatment for unresolved, difficult-to-treat knee pain at a charity clinic in Illinois. Here are the bullet points of our research:
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You Are Told To Have A Cortisone Injection
In this video
- The difference between Prolotherapy and Cortisone is extensive.
- Cortisone when injected into the joint can successfully mask pain. Many people have very successful treatments with Cortisone. We typically see patients who have a long history of Cortisone injection and these injections are no longer effective for them.
- Cortisone has been shown, in many studies, to accelerate degenerative osteoarthritis through cartilage breakdown.
- Over the years we have seen many patients who have received corticosteroid injections for joint pain. Unfortunately for many, excessive cortisone treatments lead to a worsening of chronic pain. Again, while some people do benefit from cortisone in the short term the evidence however points to cortisone causing more problems than it helps.
In our article Alternatives to Cortisone, we discuss some of this research including a new study from October 2019 which suggests cortisone leads to the greater need for knee or hip replacement.
Corticosteroid damaged knee cartilage and provided no significant pain relief after two years.
Cortisone disrupts and hurts native stem cells
Treating With Ice Or Heat
Heat or ice can be beneficial in the management of musculoskeletal pain.
Ice is most beneficial if your knee problem is related to an injury. You can try heat to help your pain levels if there’s no swelling and your symptoms are not related to a recent injury.
Never place ice or heat directly on your skin. Use a barrier, like a towel, to protect your skin from a burn.
How long you use ice as a treatment can vary. However, you should generally apply heat or ice for up to 15 minutes. You should also leave a few hours between treatments.
You should stop treating the area with ice or heat and seek advice from a medical professional if you notice an increase in redness, discolouration or blistering of the skin.
If you have any issues with circulation or sensation, you shouldn’t use ice or heat as a treatment for knee pain.
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Symptoms Of Knee Arthritis
The most common symptoms of knee arthritis is pain. Joint pain is medically known as arthralgia. Arthritis pain can vary in nature, intensity and may be constant, only occur with movement or be periodic. Other symptoms that may also be present includes :
- Abnormal sounds from the joint with movement
- Redness of the skin over the joint
- Nodules in the joint
How Does Edema Happen
We notice edema when our shoes are too tight, or we get marks on our ankles from our socks. But whats really going on inside the body?
Edema happens when fluid moves outside of blood vessels and into whats called the interstitial spaces of the body. These spaces are also sometimes called the extra-vascular space , and is basically the moist space between cells, organs, and body parts.
Although you make think of blood vessels as being waterproof, physically they are more like a semi-permeable membrane, made of blood vessel cells that usually stay close together, and its normal for small quantities of fluid to pass back and forth.
If more fluid than usual passes out of the blood vessels, and this happens in the legs or near the surface of the body, it looks like a swollen or puffy area under the skin.
Fluid can move into the interstitial spaces and cause edema for a few different reasons. The most common causes are
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A Villain In All This The Synovial Macrophages Eating Away At Your Knee
First, lets identify what Synovial macrophages are. A paper in the journal Frontiers in Immunology describes them this way: Synovial macrophages are one of the resident cell types in synovial tissue and while they remain relatively quiescent in the healthy joint, they become activated in the inflamed joint and, along with infiltrating monocytes/macrophages, regulate the secretion of pro-inflammatory cytokines and enzymes involved in driving the inflammatory response and joint destruction. Probably what you got the most out of this paragraph is driving the inflammatory response and joint destruction.
How are the synovial macrophages doing it? By bloating chondrocytes and making them puke up corrosive substances in your knee
Here is a May 2021 study in the journal iScience that explains what is happening in your knee: Synovial macrophages that are activated by cartilage fragments initiate synovitis, a condition that promotes hypertrophic changes in chondrocytes leading to cartilage degeneration in osteoarthritis. . . Stimulated macrophages promoted hypertrophic changes in chondrocytes resulting in the production of matrix-degrading enzymes of cartilage. So the chondrocytes become bloated with matrix-degrading enzymes of cartilage and puke them out in the knee.
These Problems Are Getting Worse Despite Years Of Medications
When we see a patient in our clinic with knee swelling, we ask, what have you been taking for this?
Typically the first line of treatment will include the use of anti-inflammatory drugs. The list includes many familiar names, medications you may already be on as well.
- Most common : aspirin, ibuprofen , naproxen
- Prescriptions: celecoxib, diclofenac indomethacin, oxaprozin , piroxicam
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Research: Patients Do Not Know How Bad Their Inflammation Is Or How Destructive It Is To Their Knees
This is really something that is hard to imagine. The patient does not know how bad swelling is for their knee. Knee osteoarthritis and the eventual development of bone on bone knees do not usually happen overnight. We say usually because there is the phenomenon of rapidly accelerated knee osteoarthritis where a patient can go from stage 1 to stage 4 osteoarthritis in a matter of months or a few years. So even in this rapid stage, bone on bone does not occur overnight. As this is a gradual progression it is easy to stay with the same management routine day after day, month after month, year after year of painkillers, anti-inflammatories, and knee braces. You know all the while your knees are getting worse but you need to work or be a caregiver or do the things you need to do so you manage your knees on a daily as needed basis. On a daily basis, unless there is an acute event, it is difficult to see how your knees are moving forward to a degenerative disease requiring knee replacement.
Inflammation Comes Before Cartilage Breakdown Inflammation Therefore Causes Bone On Bone Not The Other Way Around In Other Words Knee Swelling Causes Bone On Bone Knees
Here is what this paper said:
- . . . our results suggest that inflammation of the synovium, which occurs prior to cartilage degradation, is an early event during osteoarthritis initiation and progression.
- Note: Inflammation comes before cartilage breakdown. Inflammation, therefore, causes bone on bone, not the other way around.
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Everything In The Knee Affects The Ligaments And The Ligaments Affect Everything In The Knee Undetected Micro Ligament Damage Causes Swelling
Ligaments function primarily to maintain smooth joint motion, restrain excessive joint displacement, and provide stability across the knee joint. When the forces to which ligaments are subjected are too great , failure occurs, resulting in drastic changes in the structure and physiology of the joint. In your knee, it is causing a lot of swelling and functional instability.
Above we discussed research that suggested that the patient did not realize how bad their knee was and that is why they had chronic swelling. Knee instability and swelling can be caused by microdamage which causes instability that is not easily seen on MRI and is difficult to determine in a knee examination? Why because when the whole knee is in failure, it is hard to see the little things. Like micro-tearing of the knee ligaments. One thing is easy to see however, that is the result of micro ligament damage also referred to as ligament laxity.