Common Injuries Mistaken For Osteoarthritis of the Knee


I feel stiffness, pain and some swelling in my left knee. It has been going on for some time, but I have just been ignoring the pain until recently, when it became more consistent. Before I go to the doctor, what should I be on the lookout for? How can I differentiate the pain experienced among different conditions?

The above is an example we hear often in the question-and-answer section of HealthCentral's Osteoarthritis site. People are confused by the pain they have been experiencing and are concerned that it may be more severe than simple wear-and-tear on the cartilage in the joint. Some patients hold off on going to be evaluated, but the fear of a serious condition reels the person into a doctor's office.

HealthCentral contributor Daniel O'Neill, M.D. helped answer some questions regarding conditions that could be confused for osteoarthritis.

If you are experiencing knee pain, what should you do first?

Use common sense, first and foremost. If your knees hurt, rest them. Your instincts really do kick in. Most people understand when something really bad is going on here. Start with RICE - rest, ice, compress, elevate - and if the pain persists, you will probably know. If you've got something and it's just not getting better - RICE isn't helping - this is the time to get it evaluated.

When a patient comes into the office, we try to get the patient to really pinpoint where the pain is coming from ("point with one finger"). A vague answer could add to complications; any information you can give to the doctor can help with the diagnosis. Pain in the morning is classic for some folks with osteoarthritis (they have to get warmed up) or pain that comes on at 2 pm after standing at a drill press all morning. Arthritis pain should never be "extreme" and can usually be beaten down with some Advil, ice, etc. If you cannot get it under control you might be dealing with something else.

What actions should a person take to treat mild pain? What about more intense pain?

Mild pain is what we are starting to cover in my column: RICE, Advil, knee sleeve, ice, etc. More "intense" pain should be evaluated. I want people to distinguish between pain and discomfort. Pain needs to be checked out; discomfort can be managed with the above until it gets worse.

Assuming that you have osteoarthritis, take care of your joints like you do. Avoid aggressive sports, don't jump off the tailgate of a truck, and don't try to conquer the world while hiking.

We're not talking about a life-or-death patients when people have osteoarthritis; some pain is worse than others, but long-term pain should be evaluated. If you don't get better after above treatments, go get it checked out.

Self-treatment isn't a bad thing - arthritis is a pretty simple thing to treat. People just have to realize that OA is inevitable - whether it's "official" or not - our cartilage is thinning. This is part of natural aging. Your joints are going to age; I just ask that people become aware of this. Do not try to ski at age 60 at the level and endurance that you did when you were 40 years younger.

What would indicate a ligament injury in the knee? How should it be addressed?

Most ligament injuries are obvious. The knee will twist funny, and people will feel a tear or hear a pop. When there is a ligament injury, the knee will swell up and you probably will not be able to walk on it. These symptoms should be evaluated by someone. As a general rule, anything that is not getting better essentially should be evaluated.

Ligament injuries are pretty serious - treatment often requires an operation. Ligaments can have small tears and loosen, leading to a "chronic" ligament injury, but that is rare. When you tear a ligament, you're the first to know it. The knee would swell and it would hurt - you can't move. It doesn't get better in 24 hours; it's not stiffness. Something is wrong here. Your body will let you know.

Bursitis appears to be another condition of the knee. What characterizes this and how is it treated?

Bursitis is an interesting injury because you can feel it - it feels like a sack of water on the knee, for example. It may feel fine, but has swelling. You can feel this "water" sack when you kneel, crawl or put pressure on it, but it is not necessarily painful. It goes away on its own.

What would indicate tendonitis of the knee? How would you treat that differently than osteoarthritis?

Tendonitis is a pretty big topic. Basically, if every time you go for a hike or a bike ride and your knee, hip, etc. hurts in the same spot, it might be tendonitis. You will likely feel this pain before it begins to affect any other aspect of your life. Tendonitis usually responds to some activity modifications and physical therapy.

Although this is a different condition from osteoarthritis, the same treatments should help it get better - anti-inflammatory drugs, RICE, etc. The pain should calm down within a brief rest period. You feel tendonitis pain if you've just done something physical, even just climbing up and down a ladder. We often see tendonitis after the first day of football practice, the first day of skiing, field hockey, and other intensive sports. This pattern likely will not happen with osteoarthritis.

What other injuries could lead to knee pain that could be confused for osteoarthritis?

Any chronic pain in a joint, particularly the knee, can be confused with arthritis. Someone with generally poor flexibility or any kind of malalignment issues (in the feet, ankles, etc.) can lead to pain felt in the knee. Hip arthritis and low back arthritis are the biggest problems we see in a doctor's office masquerading as knee arthritis. The pain can be felt in the knee. Knee x-rays can look fine, and treatment (including physical therapy or injections) will do little good.

Hip pain is the number one thing that people complain about that leads to knee pain. I often hear that people will be on their third doctor and the knee appears fine, when in reality the hip is the problem. If you have poor range of motion in the low back or hip, this could lead to a problem with the knee.

Do you have any advice for individuals who are experiencing knee pain?

Basically we're trying to cover a big field here, but I keep pressing - use common sense and listen to your body. I tell parents all the time - even teenagers have good instincts. Often parents will bring in teenagers swearing that something is wrong when the patient does not appear to be in incredible pain. I always tell them, if something is wrong, the kids will know it. They listen to their bodies. If the injury is serious enough, people will be off their feet.