Common Causes, Symptoms And Treatment For Knee Pain In Children

Common Causes, Symptoms And Treatment For Knee Pain In Children

Knee pain in children is a common phenomenon and is usually not a reason for concern. Only when severe pain persists for more than a week, then medical attention is necessary. The physician is to be contacted if the child's movement is restricted, or if the child's knee is red or swollen.

Knee pain is a common complaint in active children who tend to suffer repeated trauma to the legs. But trauma is not the only reason for children to complain of knee pain--it can also be a symptom of a more serious condition. Prompt identification and treatment of these potentially crippling conditions is necessary to avoid long-term disability.

Common Causes of Knee Pain In Children

Common Causes, Symptoms And Treatment For Knee Pain In Children

Juvenile Rheumatoid Arthritis

Juvenile arthritis is an autoimmune disease, and is the most common form of arthritis in children. It may affect children as young as 2 years to as old as 16 years. Due to inflammation and stiffening of the joint, children often experience pain in both knees, especially after waking up in the morning. What causes this condition in children is not known. While some may experience mild pain in the mornings, other may experience severe flare-ups. The course of treatment will depend on the severity of the condition.

Osteochondritis Dissecans

In this condition, a piece of knee cartilage gets separated from the rest of the body. This piece or fragment of loose cartilage causes instability and pain in the knee joint. Children experience locking of the knee, severe pain and swelling. The knee may even give way at times. Diagnosis is done via x-ray. Children with severe symptoms may have to undergo arthroscopic surgery to repair the damage, however, the minor cases heal on their own.

Patellar Dislocation

In this condition, the knee cap or patella gets dislocated, and results in swelling of the knee joint. Pain is experienced around the patella. Moreover, impaired mobility of the knee and conspicuous knee cap displacement is seen. Commonly seen in girls, the displaced patella often slips back into place without any treatment. However, in order to keep the knee cap from slipping in and out, treatment involving immobilization of the knee is required. The immobilization treatment comprises keeping the knee extended for 6 weeks, which is then followed by knee strengthening exercises.

Osgood Schlatters Disease

This disease is a common cause of knee pain in kids and is characterized by a small bump below the knee cap in the leg's anterior region. This disease was described by Osgood and then Schlatter in 1903, hence the name Osgood Schlatters disease. Seen to occur in girls between the ages 8-13 and in boys between 11-15, as a result of a growth spurt. It may affect one or both knees.

Swelling, tenderness, and pain is experienced just below the knee, over the tibia (bone of the lower leg). The condition becomes evident during or after activities such as running, jumping, etc. Commonly seen in young athletes after a game of basketball or soccer or even after ballet dancing, etc. There is no treatment for this disease and usually this condition disappears with time. The pain and swelling recedes as the child stops growing, as the tendons in the patella (knee cap) region become stronger. To minimize the pain, ice and pain relievers can be used. Moreover, elastic bandage can also be used to compress the painful area.

Parapatellar Knee Pain Syndrome

Children with this syndrome experience obscure pain around the patella in both the knees. The pain is aggravated by physical activities such as running, bending the knees, jumping, climbing, etc. This condition results from the damage of the cartilage layer, covering the posterior portion of the patella. Injuries occurring while falling directly on the knee cap and long-standing overuse injury, result in the damage of the knee cartilage. All activities contributing to knee pain aggravation need to be brought to a halt. Anti-inflammatory medicines such as ibuprofen are used to reduce inflammation and pain.

Perthes Disease

In this hip condition, blood supply to the femur head slows down and temporarily stops. The lack of blood supply damages the femur head and it takes several years for the body to repair the damage. Children with this condition may limp, and generally experience pain in the knee, thigh or groin, instead of the hip. This does not mean pain does not occur in the hip. Hip pain is experienced on one side, however, pain in both hips is also observed. If the femoral damage is not severe, the child will recover completely in the next few years. However, severe cases may result in premature hip arthritis. 

Patellofemoral Pain Syndrome

Classified as an overuse injury, this syndrome occurs due to the irritation of soft tissues, situated in the front of the knee. Children experience pain in the anterior portion of the knee, which intensifies after activities such as running, climbing, squatting, etc. Pain is also felt around the knee cap. Abnormal alignment of the kneecap is also known to cause this syndrome. 
Common Causes, Symptoms And Treatment For Knee Pain In Children

Chondromalacia Patella

When the cartilage of the patella gets damaged, the condition is known as chondromalacia patella. Due to overuse or trauma, the knee cartilage softens and then breaks. This condition is mainly seen in teenage girls, who experience structural changes when they reach puberty, however, may occur later in life as well. Pain in felt around the knee cap, especially when the knee is flexed.

Rheumatic Fever

This inflammatory disease is not common in the United States, with the last case being reported in the 1980s. Rheumatic fever is usually caused when strep throat has not been treated correctly. It is seen to affect children between the ages 5 to 15. Joint pain; knee pain is one of the symptoms of rheumatic fever, with the others being shortness of breath, heaviness in the chest, fever, respiratory problems, etc. Though rare, this disease is a life-threatening one.

Meniscal Tears

Also known as 'torn cartilage', meniscal tears are a common type of knee injury, affecting most athletes some time or the other. Injury to either of the two wedge-shaped menisci, due to twisting or stressful activities, can cause them to tear. Pain and swelling is experienced in the knee region. Knee clicking, catching and locking is also seen. The child will find it difficult to extend the leg, however, flexing will be easier. Depending on where the tear has taken place, healing time and treatment method will vary.

Slipped Capital Femoral Epiphysis (SCFE)

In children with SCFE, the femoral head of the thigh bone slides off the growth plate, or the epiphysis. Why this slip takes place is not known, however, a weak growth plate is seen to be responsible. Certain thyroid problems are also seen to lead to this condition. When the slip is mild, the child experiences pain in the knee. Besides knee pain, the child also experiences pain in the hip joint. Often this condition is seen to occur in obese children. Treatment involves surgery, in order to prevent further sliding of the femoral head. This is done by fixing the femoral head with the help of screws, till the growth plate closes for good.

Besides these conditions, cancer, tumors and arthritis are also known to cause knee pain in children. Injury of the collateral and cruciate ligaments in the knee joints, dislocated knees, fractures and torn cartilage and other common knee injuries are also seen to cause knee pain in kids.

Common Signs and Symptoms of Knee Pain In Children

  • Diffuse knee pain, usually in the front half of the knee, behind the kneecap, or in the very back of the knee; pain may also be above or below the kneecap
  • Pain that worsens with sitting for long periods, arising from a sitting position, going up or down stairs or hills, kneeling, squatting, or wearing shoes with heels
  • Often, pain with jumping
  • Usually achy pain but may be sharp
  • Giving way, catching of the knee
  • Minimal or no swelling, no locking

General Treatment For Knee Pain In Children

Initial treatment consists of medications and ice to relieve pain and reduce inflammation, stretching and strengthening exercises, and modification of the activity that produces the symptoms. These may be carried out at home, although occasionally referral to a physical therapist or athletic trainer may be indicated.

Icing the knee after exercise is helpful. Occasionally your physician may recommend bracing with a knee sleeve to help the kneecap track properly. 

Arch supports (orthotics) are helpful for those with flat feet. 

Surgery may be required if symptoms persist despite conservative treatment. This may be done with or without the use of arthroscopy, by cutting the retinaculum on the outer side of the knee (lateral release) with or without tightening the retinaculum on the inner side of the knee. Occasionally surgery to cut the tibial tubercle (insertion of the patellar tendon into bone) and move it may be required.