Inner knee pain, also called medial knee pain, is common in walkers, runners, and sportspeople. Symptoms can occur gradually or suddenly and may present with or without injury. So, what causes inner side knee pain, and how do we find the correct diagnosis?
Symptoms of inner knee pain
Generally, people point to the inner side of their knees across from the kneecap. Medial knee pain usually occurs during or after running or sports.
Depending on the cause of medial knee pain, other symptoms that may be present include:
- swelling in the knee
- an inability to bend or flex your knee
- a feeling of instability or giving way
- the knee locking or getting stuck in one position
Common causes of Inner knee pain
Medial Meniscal tear
Menisci are the shock absorbers of the knee joint. You can rip your meniscus during an injury, such as a twist during a sport. You can also tear your meniscus as you get older due to degeneration. Generally, a tear of the inner or medial meniscus causes medial knee pain at the joint line. Often, a tear is associated with knee swelling and restriction in movement. Sometimes, giving way or locking of the knee can occur in more severe cases.
Osteoarthritis
Osteoarthritis is associated with erosion of the cartilage lining the joint’s surface. Over time, due to past trauma or other factors such as obesity, the cartilage wears away completely, producing inflammation and swelling in the joint. Often, the medial compartment is affected. Usually, people with osteoarthritis report generalised inner knee pain with puffiness or swelling. Sometimes, knee movement is restricted, and walking for long distances can be difficult.
In general, treatment consists of exercise therapy, weight loss, medications, and injections for knee arthritis.
Patellofemoral pain syndrome
Pain from this condition arises from the patellofemoral joint between the kneecap and the distal thigh (femur). Ususally, pain is triggered by excess pressure in the kneecap joint arising from mal-tracking and excessive sport or running. Generally, pain can occur at the front of the knee. However, in many cases, pain is located one or two fingers from the kneecap.
Ususally, patellofemoral pain settles with physiotherapy to change the lower leg and pelvic biomechanics.
Pes Anserine bursitis
The tendons of the inner thigh muscles move across the medial joint and attach to the top of the lower leg bone (tibia). At the attachment, a sac of fluid called the bursa becomes swollen and inflamed from too much sport. It is common to develop tendon inflammation with other problems such as osteoarthritis or a meniscal tear. Often, people report inner knee pain just below the medial joint line. In addition, the tendon is tender to touch and also hurts with activating the hamstring muscles.
In general, treatment is similar to patellofemoral pain.
Medial Collateral ligament (MCL) sprain
The MCL is a large ligament from the femur that attaches to the tibia. It helps to stabilise the knee. Often, injury to the MCL occurs during a twisting injury. Most commonly, the ligament is injured at the top attachment to the femur, although damage at the middle or lower part can also occur. Generally, people report pain above the medial joint line. Usually, there is restricted knee movement combined with localised swelling in the inner knee. Sometimes, other structures are damaged, such as the ACL or PCL, so it is essential to see a doctor to get a definite diagnosis.
Less common causes of inner knee pain include medial plica, fat pad impingement, and referred pain from the hip or spine.
Diagnosis of inner knee pain
Getting a precise diagnosis can be challenging as often knee pain can be due to more than one cause.
It would help if you saw a specialist doctor who would ask questions about your problem. For example, during a clinical examination, your doctor will assess various structures of the knee, including tender areas, how well the knee moves, and how stable the ligaments are. Also, your doctor may examine other sites above and below the knee, such as your foot biomechanics, gait, and pelvic control.
Generally, we perform investigations based on clinical assessment. For example, weight-bearing X-rays can show evidence of arthritis in the inner knee compartment and the alignment of the knees. MRI scan, which uses magnets to make a picture, will show surface cartilage damage, a meniscal tear,r or tendon inflammation. Sometimes, we use imaging such as ultrasound or CT scan to confirm a structural problem.
When to see a doctor
Although not all cases of medial knee pain are severe. In some cases, you need to see a doctor for assessment. You should consider seeing a doctor if:
- you have experienced trauma to your knee
- pain is limiting your ability to move around properly
- the knee locks or gives way
- inner knee pain lasts for more than a few weeks
Other frequently asked questions and inner knee pain:
Are there simple treatments that can reduce medial knee pain and swelling?
Yes. Anti-inflammatory treatments can help settle inner knee pain and swelling. Icing the knee for 10-15 minutes three to four times daily is adequate. Topical and oral NSAIDs such as ibuprofen alleviate swelling and pain. A knee brace will provide support and reduce swelling.
Injections for inner knee pain: Are they effective?
Maybe. It depends on the cause of inner knee pain. Cortisone injections can help relieve swelling associated with a meniscal tear or pes bursitis. Hyaluronic acid or PRP injections are helpful for knee osteoarthritis. Ususally, we perform injections with ultrasound.
Final word from Sportdoctorlondon about inner knee pain
Inner knee pain can be complex and often related to more than one problem. You should see a specialist doctor to get a proper diagnosis and management plan early.
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