Kneecap Pain: Causes, Symptoms, Treatment, Recovery Period, Braces, Home Remedies, Diagnosis

Pain experienced on the top and around the kneecap which is also known as patella is called as kneecap pain.¹ Kneecap pain can also be experienced when there is a problem underneath the kneecap.

Kneecap is a thick and triangular-circular bone and that is connected to the thigh bone (femur) & provides protection to the anterior area covering the human knee joint.² It is also known as patella bone or kneepan.

In terms of sesamoid bone, kneecap is the biggest bone in the human body. In case of babies, kneecap is in the form of soft cartilage and it gradually starts to develop into bone from the age of 3 years.

Kneecap mainly helps in the movement and extension of knee. The patella facilitates the femur to provide large angle for the tendon to work like a liver and bear the load.

There are multiple conditions which can cause kneecap pain. Some of them are discussed below:

1. Kneecap Pain Caused Due to Patellofemoral Syndrome

   Patellofemoral syndrome is a common cause of kneecap pain. Patellofemoral syndrome is associated by a numerous symptoms that are related to pain in the kneecap resulting due to misalignment between kneecap and underlying groove of femur bone. By analyzing the problems with tracking and alignment of kneecap, it is possible to find out the reasons causing the problem.

2. Kneecap Pain Caused Due to Plica Syndrome

   Plica syndrome or synovial plica syndrome can cause kneecap pain.³ Plica Syndrome is again associated with a numerous symptoms linked with the fold present in the joint that is linked to knee. It is not a very serious syndrome and is normal but it can cause misleading symptoms. In some cases it can misguide you towards wrong treatment.

3. Kneecap Dislocation Causes Kneecap Pain

   Kneecap dislocation or fracture is a serious issue related to the kneecap and causes kneecap pain. Repetitive dislocation of the kneecap can lead to complicated structural problems that can be worse than patellofemoral syndrome and lead to many types of problems. The most common problems associated with kneecap dislocation are high-riding kneecap (patella alta) or patella dysplasia and trochlear dysplasia which results into abnormally shaped kneecap or groove. Kneecap dislocation generally requires a proper surgery in most of the cases to avoid complications.

   

4. Patella Fracture Causes Kneecap Pain

   Kneecap fracture or patella fracture can cause serious kneecap pain. There is another serious issue with kneecap referred as patella fracture and it requires surgery more often or not. It is necessary that surgeon ensures that broken edges are properly linked during surgery. If the links are not re-established properly, the situation may lead to painful arthritis.

   

5. Kneecap Pain Caused Due to Arthrofibrosis

   Arthrofibrosis is another issues related to the kneecap which leads to kneecap pain. It is basically a scar or tethering that can as a result of any injury or surgery linked to kneecap that has gone wrong. It is easy to take control of the situation if there is early detection of the problem. In case of a delay, the issue can lead to stiffness and stretching of kneecap in the downward direction referred as (patella baja). It can cause serious pain and arthritic damage.

6. Kneecap Arthritis Causes Kneecap Pain

   Kneecap arthritis is situation which results from the issues already discussed above and causes severe kneecap pain. It mainly affects the cartilage surface that is located under the kneecap. It can also affect the groove of the femur bone which forms the base for sliding of kneecap during the movement of knee. Kneecap arthritis can be treated and managed with certain cartilage repair techniques. Modern treatments also involve resurfacing of patello-femoral with the help of artificial components.

7. Kneecap Pain Caused Due to Patellectomy

   Patellectomy refers to removal of the kneecap to get rid of the problems. However with availability of better treatment methods patellectomy is rarely preferred and it causes severe kneecap pain. Removal of the patella or kneecap can cause serious complications with the functioning of the knee.

Kneecap pain is generally associated with symptoms like dull and aching pain on the top of the knee. The kneecap pain usually occurs occasionally in the initial phase and can gradually get severe and affect one or both the knees. More common signs and symptoms of the kneecap pain are as follows:

• The feeling of kneecap pain during the physical exercise involving the bending of knee such as running, climbing stairs, squatting, jumping etc… are the symptoms of kneecap pain.
• The feeling of pain in the knees after you have been seated for long time with your knees bent. This occur when you are traveling in a flight or watching a movie in theatre. This is another symptom of kneecap pain.
• Feeling of kneecap pain when you switch from one level of activity to another or in case of change in playing surface, intensity or equipment.
• Generation of popping or crackling sounds from the knee during the act of climbing stairs or when you get up after a long phase of sitting is a symptom of kneecap pain.

There are many risk factors for kneecap pain. Some are listed below:

• Direct trauma to the kneecap is a risk factor for kneecap pain.
• Knee arthritis can be a factor of risk for kneecap pain.
• Contact sports like football/soccer, rugby, baseball can be risk factors for kneecap pain. Proper protection can reduce the risk.
• Prior surgery to the kneecap or knee is a factor of risk for kneecap pain.
• Other risk factors include diseases like plica syndrome or patellofemoral syndrome etc…
• Old age can be a risk factor for kneecap pain.

1. Physical Examination of Kneecap is the First Step in the Diagnosis of Kneecap Pain

   During the physical examination for any issues with the kneecap, the doctor looks for the symptoms of kneecap pain and any other general problems that the person is experiencing. The doctor would be usually interested in knowing the duration and the severity of the kneecap pain as sharp or dull. Most likely doctor would ask about the activities leading to kneecap pain. The doctor usually press or pull the area around the kneecap to find out the exact location of the pain in the kneecap. The doctor may also require you jumping or squatting to determine the strength and condition of the knee.

   Doctor may also perform the following checks to ensure that there is no chance of any other physical problem causing the pain.

   • Testing if the lower leg is aligned properly with the position of the kneecap.
   • Ensuring that knee is stable and there is no problem with rotation of hip and movement of knees.
   • Testing to determine if there are any signs of tenderness in kneecap.
   • Problems with the joint between kneecap and thigh muscles.
   • Checking quadriceps and hamstrings for firmness, strength and flexibility.
   • Ensuring that the feet are flexible and heel cord is tight.

   Eventually doctors tries to analyze the way you walk (gait) to find out if it has to do something with the pain in your knees.

2. X-Rays, Image Scans Can Be used to Diagnose Kneecap Pain

   Physical examination is generally sufficient to find out the case of kneecap pain but doctors recommend X-rays, CT Scan or MRI just to ensure that there is no physical damage in the knee or the tissues linked to knee cap.

The mode of treatment for kneecap pain is determined by the cause of the pain in knee cap. The treatment of knee cap pain results in relieving the pain and helps in restoring the proper motion and strength. It can also be treated without surgery.

1. Nonsurgical Treatment for Kneecap Pain

   Nonsurgical treatments for kneecap pain generally involve RICE method, anti-inflammatory medicines and recommended activity changes. Other procedures are as follows:

   • Shoe inserts helps in proper alignment of foot and ankle which reduces stress on the lower leg.
   • Physical therapy exercises can help in treating kneecap pain. Some specific set of physical exercises can help in improving strength, endurance and motion of knee cap. The exercises are focused on providing strength to quadriceps by gentle stretching. Typical exercise focusing on providing strength to lower back and abdomen are also recommended.
   • Orthotics will also aid in treating kneecap pain. Shoe inserts helps in proper alignment of foot and ankle which reduces stress on the lower leg. Orthotics that suits your foot can be easily obtained and if not then you can get one designed for yourself.
   • Taping of the kneecap will help in treating kneecap pain. This non-surgical treatment process involves using an adhesive tape over patella to improve the alignment and movement of your knee cap. It helps in some cases in reducing kneecap pain. This type of treatment is offered by physiotherapists.

2. Surgical Treatment for Kneecap Pain

   If the problem of kneecap pain cannot be resolved with the nonsurgical treatments, surgical treatment may be required. However it is rarely used. Common surgical treatments are:

   Arthroscopy can help in treating kneecap pain. This type of surgery involves the use of a small camera which is inserted under the kneecap to display the pictures on the television screen. The display output helps the surgeon with the movement of miniature surgical instruments.

   If it is detected that lateral retinaculum is tight and causing the retinaculum is pulling the kneecap sideways, doctors recommends cutting the ligament to ease it out.

   • Debridement for treating kneecap pain. This process involves removal of damaged articular cartilage. This can help in getting rid of the pain.
   • Lateral release treatment for kneecap pain. If it is detected that tightening of the retinaculum tendon is making the patella to get off the trochlear groove, loosening the tissues can help in correcting the patellar mal-alignment.

Home remedies are helpful in relieving kneecap pain.

1. Modification in Activities is a Good Home Remedy for Kneecap Pain

   Avoid such activities that can cause pain in your kneecap is a compulsory home remedy for kneecap pain. You will need to make necessary changes in your routine activities and avoiding high impact activities that can lead to undue stress on knee joint and result in kneecap pain. You can switch to swimming and biking which has low impact. In case of overweight, loosing extra weight helps in reducing extra pressure on the kneecap.

2. The RICE Method is a Good Home Remedy for Kneecap Pain

   RICE has derived its name from rest, ice, compression, and elevation and is a great home remedy for kneecap pain:

   • Rest. Give proper rest to knee by avoiding undue weight.
   • Ice. Apply cold treatment in the form of ice packs for about 20 minutes at a time. Avoid using ice directly.
   • Compression. Tighten the area around the knee cap by wrapping it tightly with elastic bandage. Leave small gap over the knee cap. Make sure that elastic fits nicely and does not cause any kneecap pain.
   • Elevation. Try to keep your knee raised at a height above the heart while resting to avoid kneecap pain.

3. OTC (Over the Counter) Medicines Can be a Temporary Home Remedy for Kneecap Pain

   Non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen are helpful in relieving from kneecap pain and reducing swelling.

   It is recommended to seek help from doctor if the kneecap pain does not go away.

Usually kneecap pain can be relieved from simple treatment procedures like physiotherapy. Complete recovery from a kneecap pain relieving surgery may take 4 to 5 months and you should restrict to low impact activities. In case of about 25 percent of cases, the pain can persist for up to 20 years.

You can offer a proper support and compression to your kneecap pain by using the knee braces. These braces are designed with closed patella. Open patella knee braces are helpful in releasing pressure on the kneecap pain. Certain specially designed braces offer additional support as desired by the patient.

Kneecap pain is not a severe issue and can be easily overcome by physical exercises and therapies. However if you do not make necessary changes in your physical movements and activities, kneecap pain may re occur. You must ensure proper conditioning of knee muscles especially hamstrings and quadriceps.

Some of the additional measures for kneecap pain to avoid the repetition of pain in knee cap are as follows:

• Choosing the comfortable shoes according to activity will help in preventing kneecap pain.
• Getting your body acquaintance to stretching exercises before exercising can help in kneecap pain.
• Including particular set of exercises focused on stretching of hamstring and quadriceps in your routine.
• Avoid abrupt increase in exercise to prevent kneecap pain.
• Try to stay away from the activity that has resulted in knee cap injury in the past.
• By ensuring that your body weight is maintained, you can avoid undue stress on knees thus preventing kneecap pain.

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