Shin pain with knee arthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known 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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The knee is a vulnerable joint that is stressed by weight-bearing activities such as walking, running, pivoting, and so on.
The knee is formed by the following components:
• tibia - shin bone or larger bone of the lower leg.
• femur - thighbone or upper leg bone.
• patella - kneecap.
Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. The knee is held together by muscles, ligaments, and tendons.
There are two groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.
Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments on the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).
Many knee problems are a result of the aging process and continual wear and stress on the knee joint (i.e., arthritis). Other knee problems are a result of an injury or a sudden movement that strains the knee. Common knee problems include the following:
• A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking.
• Trauma to the kneed can tear the menisci (pads of fibrocartilage that act as shock absorbers and also enhance stability). Cartilage tears can often occur with sprains. Treatment may involve wearing a brace to protect the knee form further injury. Surgery may be needed to repair the tear.
• Inflammation of the tendons may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper's knee. This often occurs with sports such as basketball, where the force of hitting the ground after a jump strains the tendon.
• Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, and often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight.
Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.
The most common being prepatellar bursitis – in front of the knee- or anserine bursitis felt along the inner part of the shin just below the knee.
In addition to a complete medical history and physical examination, diagnostic procedures for knee and shin problems may include the following:
• magnetic resonance imaging (MRI)
• computed tomography scan
Specific treatment for knee problems will be determined by your physician based on:
• your age, overall health, and medical history
• extent of the disease, injury, or condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease, injury, or condition
• your opinion or preference
If initial treatment methods do not provide relief, and x-rays show destruction of the joint, the physician may recommend total joint replacement for the knee.
Another cause of shin pain with arthritis is shin splints. The list of possible underlying conditions mentioned in various sources as possible causes of shin splints includes:
• Stress factures of the tibia
• Periostitis - bone surface inflammations
• Poor circulation
• Shin muscle irritation
• Compartment syndrome
Symptoms of shin splints include:
• Shin pain
• Pain along the back and inside of lower tibia (shin bone)
• Pain around the shin bone
• Shin pain when running
For shin splints, avoid strenuous exercise - seek treatment as soon as the problem is noticed rather than continuing to exercise through the pain.
Treatments of microfractures include rest, avoidance of weight-bearing.
Periostitis management includes rest, avoidance of weight bearing, an-inflammatory medicines.
Compartment syndrome may require surgical fasciotomy.
Try alternative non-weight bearing activities - a rest period need not be an inactive period; try non-weight bearing exercises such as swimming, cycling or rowing.
Patients who have had extensive knee reconstructive surgery may get shin pain. Shin pain after knee surgery could be related to hardware that was used to fix the ligaments.
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