Burning pain in knee inflammation

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Burning pain in the knee area is generally not due to arthritis. There are other situations, though where burning pain is noted.

Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners, with an incidence as high as 12% of all running-related overuse injuries. ITBS is believed to result from recurrent friction of the iliotibial band (ITB) sliding over the lateral femoral epicondyle.

Low mileage, recreational runners usually improve with a simple regimen of anti-inflammatory medication and appropriate stretches; however, higher mileage, competitive runners typically require a more comprehensive treatment approach.

The main symptom of ITBS is sharp pain or burning on the lateral aspect of the knee. Runners often note that they start out running pain free but develop symptoms after a reproducible time or distance. Early on, symptoms subside shortly after a run, but return with the next run. If ITBS progresses, pain can persist even during walking, particularly when the patient ascends or descends stairs.

The knee examination is typically negative except for local tenderness and, occasionally, swelling over the distal ITB where the band moves over the lateral femoral condyle. No tenderness is noted at the lateral joint line, popliteal tendon, lateral collateral ligament, or anterior lateral fat pad. Occasionally, pain or paresthesia extends along the length of the band. Crepitus, snapping, or mild pitting edema can occur over the affected area. Pain may be elicited by having the patient lie on his or her side with the affected knee up and flexed 90°, and applying pressure to the ITB over the lateral femoral condyle while straightening the knee. The test is positive if pain occurs as the knee approaches 30° of flexion, the position in which the tensed ITB rubs directly over the lateral femoral condyle

Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of the knee joint so that tendons and ligaments glide smoothly over the joint. Bursitis can lead to warmth, swelling and redness over the inflamed area, aching or stiffness when a person walks, and considerable pain when they kneel. The pain is described as burning. Sometimes the bursa located in front of the patella (prepatellar bursa) can become infected, leading to fever, pain and swelling. When the pes anserine bursa on the lower inner side of the knee is affected,a patient is likely to have pain when they walk or when they go up or down stairs.

Referred pain from the low back occasionally will present with burning pain located in the knee. This occurs because the nerve supply to the knee originates in the spine.

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