The aging knee. A task for the practice

Of all peripheral joints the knee is most often affected by degenerative alterations. Visible signs on X-ray examinations are often preceded by clinical symptoms. When complaints occur a distinction must be made between therapy of acute (arthritic attack) and chronic pain. The therapy of acute pain in degenerative diseases of the knee includes temporary immobilization, local application of cooling, administration of non-steroidal anti-inflammatory drugs, puncture of the effusion when needed and possibly local application of corticosteroids (possibly in combination with a local anesthetic). For chronic complaints the results of the manual clinical examination are decisive for the therapeutic approach. This includes treatment via the skin (receptors) but especially the local influence of painful extracapsular structures of the joint, such as ligaments or their attachments, the quadriceps tendon, patellar ligament, patellar retinaculum, collateral ligaments, in particular the coronary ligament, the meniscus retaining ligament. Also important is an area of the medial tibial head, the " tibia head point" according to Tilschner, an entry point of vessels into the head of the tibia. These structures are predominantly treatable with topical injections but also with dry needling. Functional limitations are indications for manual therapy techniques. Further advice for patients is essential.