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Sports Medicine

Shooting knee pain

04/16/2007

Question:

About a week ago I noticed sharp pain in my right knee when I kneel down. What usually happens is that when I kneel I feel an acute, somewhat burning pain and sensation to the right of my kneecap. I had went on a 5-mile walk the day before and am not sure if I injured it in the process.

As a general rule I am moderately active, and I also enjoy running. As the spring allows for more running I want to be sure to prevent furthering any possible injury so that I can run this season.

I appreciate your help.

Answer:

As you are no doubt aware, a diagnosis cannot be made over the Internet; if your symptoms remain bothersome, examination by a sports medicine physician is advisable. In the meantime, hopefully the following information may be of some benefit.

Your description of pain suggests a possible "patellofemoral" pain problem, meaning a problem involving the kneecap and/or the surrounding tissues. For example, pain and tenderness below the kneecap could be due to patellar tendinitis (usually where the tendon attaches to the inner or medial aspect of the patella), or perhaps to superficial or deep infrapatellar bursitis (inflammation of the small sac superficial, or deep, to the patellar tendon). Pain to the right of the kneecap can also be caused by an injury to the internal cartilages of the knee (menisci) or from an inflammation of the iliotibial band (a large band of fibrous tissue that crosses over the knee on the outside).

There are several main structures in the back of the knee that can cause pain. The calf and the hamstring muscles attach behind the knee and strains of these musculotendinous attachments can cause pain behind the knee. Cysts (Baker's cyst) behind the knee can cause posterior knee pain. Also, occasionally injuries to the joint capsule of the knee can cause knee pain behind the knee. Less likely causes can be from aneurysms of the artery behind the knee or blood clots in the leg (although the latter usually does not cause pain just behind the knee).

If you are continuing to have pain, a physician evaluation is essential and further testing may be warranted including x-rays or possibly MRI of the knee to elucidate the cause of your pain. I hope this helps.

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Response by:

Charles Webster, MD
Assistant Professor
College of Medicine
University of Cincinnati