Knee and Shin Injuries

The knee is one of the most stressed and largest joints in the body.  It is vital for movement and is a joint that can be rather vulnerable to injury.  It is the most commonly injured joint in adolescent athletes. Movements at the knee joint are essential for everyday activities, which include running, walking, standing, and sitting. 

The primary function and anatomy of the knee

The knee joint is responsible for the flexion and extension of the lower leg relative to the thigh while also supporting the person’s body weight.  The knee is a hinge joint and is made up of bones, cartilage, ligaments, and tendons. 

• Bones:  There are three bones that form the knee joint: the femur, tibia, and patella.  The femur is the thighbone, the tibia is the shinbone, and the patella is the kneecap.  
• Cartilage:
  • Articular: The ends of the bones are covered with cartilage called articular cartilage.  This is a smooth substance that allows the bones to glide against each other while bending or straightening the leg.
  • Meniscus: There is a different type of cartilage that is called the meniscus.  This plays the role of “shock absorber” of the knee. These are rubbery wedge-shaped pieces of cartilage located in the joint that act as a cushion between the femur and the tibia.

• Ligaments: Bones are attached to other bones by ligaments.  There are four main ligaments in the knee that hold the bones together and provide stability.  Two are found on the sides of the knee and two are found crossing in the middle.
• Tendons: Muscles connect to bones through tendons.  

Common Types of Knee and Shin Injuries Seen in Our Practice

• Sprains and strains:  A strain is a muscle injury where the muscle is overstretched or torn.  A sprain is a tearing or stretching of a ligament, which is a fibrous tissue connecting two bones.
• Runner’s Knee (Patellofemoral Pain Syndrome):  This is pain around the kneecap found commonly in activities requiring running and jumping.  Issues with kneecap alignment and overuse activity are often significant factors. 
• Osgood-Schlatter disease:  This is a common cause of knee pain in growing adolescents.   It occurs below the kneecap where the patellar tendon attaches to the shinbone.  It is seen during growth spurts or with overuse activity.  
• Iliotibial band syndrome:  The iliotibial tract is a thick band of fascia that runs on the lateral side of the thigh from the pelvis into the lateral aspect of the knee.  With overuse and repetitive motion, there can be excessive friction between the lateral femoral epicondyle and the iliotibial tract resulting in pain in the lateral knee. 
• Knee Ligament injury:  The bones in the knee are connected together by four ligaments: the ACL, PCL, LCL, and MCL.  When the ligaments are damaged, the knee joint may become unstable. The ACL is one of the most common ligaments to be injured.
• Osteoarthritis: Referred to as the common “wear and tear” arthritis.  This degenerative condition occurs when the cartilage covering at the end of the bones wears down over time.  
• Meniscus injury:  Tears in the meniscus usually occur during forceful twisting motions in the knee.  Older people may also have degenerative meniscus tears associated with osteoarthritis.  Meniscus tears are among the most common knee injuries.
• Knee Bursitis:  Bursas are small sacs of fluid resting between tissues such as muscle, bone, and tendons, which are located in different areas of the body.   Knee bursitis is inflammation of these sacs situated near the knee joint. 
• Shin Splints (Medial Tibial Stress Syndrome):  Shin splints are an inflammation of the muscles, tendons and bone tissue around the tibia.  The pain is usually located around the medial aspect of the tibia where the muscle attaches to the bone.  This is usually associated with overuse physical activity, often long-distance running. 

How is the cause of knee and shin pain diagnosed?

First and most important is a good thorough medical history intake and a physical exam. 

Imaging tests can also help with the diagnosis.

• X-Ray:  X-rays use radiation in the form of electromagnetic waves of high energy to pass to create pictures of the inside of your body.  X-rays show bones well and can help us identify things such as fractures. It is also very helpful in identifying things such as dislocations.  It can also help us identify signs of osteoarthritis.  
• MRI Scan: MRI scans use large magnets and radio waves to look at structures inside your body with great detail. It is a helpful imaging study to visualize soft tissues such as muscles and ligaments, as well as give an additional evaluation of bones.

• CT Scan: A CT scan is an imaging tool that combines x-rays with computer technology to produce a detailed cross-sectional image of your body.  In our field, it is helpful sometimes for further evaluation of bony structures.
• Ultrasound: Ultrasound uses high-frequency sound waves that echo off the body.  It is a non-invasive study that does not use any radiation. It is used in-office to help with the diagnosis of some musculoskeletal conditions.

Treatment for knee and shin injuries

There are many treatment options for knee and shin pain. However, the treatment option varies depending on multiple factors such as age, injury, medical history, etc.

• RICE therapy: RICE is a form of self-treatment or can be done under the guidance of trained physiotherapists. RICE stands for Rest, Ice, Compression, and Elevation. This therapy can help improve the pain and swelling of many knee and shin injuries. 
• Heat therapy: Heat can help relax tense muscles and soothe a stiff knee.  You can use a heated pad or hot water bottle. 
• Physical therapy: Manual therapy and a special exercise routine planned by a physiotherapist, keeping the condition of the patient in mind, can help strengthen the knee and shin muscles and improve their flexibility.
• Medication: Over the counter medications such as acetaminophen or ibuprofen can help ease the pain.  Stronger pain medications and muscle relaxers can also be of help temporarily.
• Steroid injections: Steroid injections, usually in conjunction with physical therapy, can be helpful to reduce inflammation and overall pain.

• Surgery: If conservative treatment does not work, surgery may be needed.  Sometimes surgery needs to be considered sooner depending on the injury itself.

Stephen S. Chen, MD- Sports Medicine Doctor can help you evaluate and treat your knee and shin pain. Contact us using our phone number 925-934-3536 or email us at stephen.chen@eastbaysportsdoc.com to book an appointment.