Most people find it difficult to imagine doing anything without walking. Walking is an essential part of modern life; even the most sedentary office worker must walk to the copier or into the breakroom for lunch. To walk effectively, a person must have two functioning knees or at least one functioning knee and an assistive device such as a crutch or a cane.
Knee pain is a common complaint that can have a significant impact on a person’s quality of life. Injuries to the knee cause acute pain at the time of injury, but also frequently cause chronic pain that can last a lifetime if not treated. Even with proper medical treatment, knee disorders can cause a permanent disruption to a person’s life and their ability to work.
The knee joint is one of the body’s largest and most complex joints. The knee connects the bones of the thigh (femur) to the bones of the shin (tibia) and allows the leg to move freely. Other bones in the knee include the fibula, which lies next to the tibia, and the kneecap (patella). Cartilage and bursae cushion the bones of the knee and allow it to move smoothly and comfortably.
The bones of the knee are connected to muscles by tendons. Ligaments connect the bones of the knee and provide support and stability to the joint. There are four knee ligaments: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). The ACL and the PCL keep the bones of the knee from sliding forward or backward out of position, while the MCL and LCL keep the bones from sliding side-to-side.
Types of Knee Disorders
Knee disorders are classified based on the cause and the part of the knee affected. Knee disorders are the result of arthritis and other inflammatory conditions, genetic conditions, and injuries.
Arthritis and Inflammatory Conditions
Arthritis is the most common cause of knee pain. While arthritis is frequently related to aging, people of all ages can get arthritis and inflammatory knee conditions. Some conditions require immediate treatment to prevent further damage to the knee joint or surrounding tissues.
- Knee osteoarthritis- usually a result of aging, this form of arthritis is the most common and can result in pain, swelling, and stiffness. While knee osteoarthritis is common, it can seriously disrupt someone’s life if it progresses.
- Rheumatoid arthritis- an autoimmune condition that can cause permanent joint damage
- Knee effusion- swelling and fluid buildup in the knee that can cause pain and difficulty moving. Knee effusion is usually a result of another disorder.
- Baker’s cyst- painful fluid deposits in the back of the knee, usually a result of chronic knee effusion, that cause difficulty and pain when moving. Because of the locations of the cysts, it can also be painful to prop up the knee or rest the knee on a surface.
- Gout and pseudogout- Both gout and pseudogout involve buildups of crystals in the joints, which leads to severe pain, swelling, and mobility issues. Gout causes uric acid crystals to form, while pseudogout causes calcium pyrophosphate crystals.
- Septic arthritis- a rare condition caused by a virus, bacteria, or fungus infiltrating and damaging the joint and surrounding tissues. Septic arthritis can cause severe and systemic damage if not treated and requires prompt medical care.
Genetic Conditions Affecting the Knees
Genetic diseases can cause both structural instability and damage to the knee. Genetic conditions that can affect the knees include:
- Osteochondritis dissecans- a disorder that causes cracks to form in the cartilage and the underlying bone, causing the joint to painfully catch and lock during movement. In children, cracks may heal on their own. In adults, medical treatment to repair the damage is necessary.
- Osgood-Schlatter disease- a childhood disease caused by repetitive motion during growth spurts, creating a painful lump under the kneecap that usually heals when the child stops growing. This disease often runs in families.
Knee injuries can cause lasting damage even after the wound has healed. Knee injuries are classified as ligament injuries, cartilage injuries, kneecap injuries, and repetitive strain injuries. While knee injuries are often a result of some trauma, such as an accident or a sports injury, repetitive strain injuries are also common. Repetitive strain injuries are damage caused by repetitive motions across a long time and are usually a result of workplace activities.
Ligament injuries are usually sports injuries. Damage to ligaments causes pain and instability in the joints, which can lead to difficulties in walking, balancing, and supporting the body’s weight. Ligament strains and injuries include damage to:
- Anterior cruciate ligament (ACL)- causes pain, swelling, and severe instability in the knee that can lead to the knee “giving out” and usually requires surgery
- Lateral collateral ligament (LCL)- causes pain, swelling, and instability when moving the knee
- Medial collateral ligament (MCL)- causes pain and weakness in the inner side of the knee
- Posterior cruciate ligament (PCL)- an uncommon injury that causes pain, swelling, and instability and rarely requires surgery
Cartilage injuries generally cause swelling and pain in the joint. People with cartilage injuries in their knee frequently experience the feeling that they cannot move their knee correctly or that the joint is “locking up.” Cartilage injuries include:
- Medial and lateral meniscus tears
- Articular cartilage injuries
Damage and dislocations of the kneecap cause acute pain when the injury occurs and sometimes causes chronic pain, even after the wound has healed. While many kneecap injuries are a result of a traumatic injury, some are a result of repetitive motions or genetic conditions. Chronic dislocations or subluxations may be the result of a connective tissue disorder such as Ehlers-Danlos syndrome or structural defects caused by a genetic disease. Injuries to the kneecap include:
- Patellar dislocation- the kneecap entirely moves out of position and requires some physical manipulation to return to the proper position. Dislocations are painful and can cause damage to the joint, especially if they frequently occur.
- Patellar subluxation- the kneecap slides or partially dislocates during activities, causing pain and some loss of mobility. Subluxations do not generally require a doctor to manipulate the patella into position. Chronic subluxations can cause damage to the joint and may require lateral release surgery to add stability to the knee.
- Patellar fracture- otherwise known as a broken kneecap, a patellar fracture is usually the result of a fall or a car accident. Fractures can cause pieces of bone to chip off, which require surgical removal to avoid further damage and pain.
- Chondromalacia patella- irritation of the cartilage underneath the patella, frequently occurring in young people
Repetitive Strain Injuries
Repetitive strain injuries (RSIs) are a result of repetitive motions that damage the body over time. These injuries are usually caused by work activities such as kneeling, lifting, or jumping. Pain from this type of injury usually worsens when performing the motions that caused the injury, but can persist and worsen over time if the strain is not treated correctly. Usually, RSIs respond well to rest, ice, and conservative treatments such as NSAIDs or steroid injections.
- Bursitis- inflammation of the fluid-filled sacs that cushion the joint. Bursitis causes pain, swelling, and stiffness.
- Tendonitis- inflammation of the tendons causes pain, swelling, and difficulty moving the leg.
Diagnosis of Knee Disorders
Diagnosis of knee disorders usually includes both a clinical exam and some degree of diagnostic testing. A physician usually includes a test of the reflexes and the patient’s range of motion in their clinical exam. They may manipulate the knee or the leg and see which motions increase or decrease pain. These physical manipulations include:
- Drawer test– the doctor pushes and pulls the lower leg while holding the foot to test the stability of the ACL and PCL
- Valgus stress test– the doctor holds the thigh while pushing the calf inwards and outwards to test the stability of the LCL and MCL
If a clinical exam is not enough to diagnose the condition, more extensive testing is used. Other diagnostic testing for knee disorders includes:
- X-rays– tests for multiple knee disorders and shows damage to the bones
- MRIs or CT scans– shows damage to bones and soft tissues
- Arthrocentesis of the knee (joint aspiration)- tests the fluid within the joint for different forms of arthritis
- Arthroscopy- a surgical examination of the knee that often accompanies surgical treatments
- Blood testing- to test for autoimmune, inflammatory, or genetic conditions that may be the cause of the damage
Treatment of Knee Disorders
Treatment varies depending on the condition and its severity. Mild injuries or conditions may improve with rest, stretching, and oral medications such as Ibuprofen. More severe conditions require medical intervention and can include total replacement of the knee joint. Treatments can include:
- Steroid injections
- Physical therapy
- Cartilage restoration
- ACL repair or reconstruction
- Knee arthroscopy (minimally invasive knee surgery)
- Knee arthroplasty (knee implants/knee replacement)
- Unicondylar knee arthroplasty (partial knee replacement)
- Knee revision
- Lateral release
Alternative therapies such as acupuncture, massage, or chiropractor adjustments help some patients. Mindfulness practices such as prayer, meditation, and cognitive-behavioral therapy can help patients live with and reduce their pain.
Since the recovery period for knee surgeries can be up to a year, patients may qualify for long-term disability benefits while recovering from their surgical treatment. Even with treatments, people with knee disorders may not regain full range of motion or use of their knee. These patients must apply for long-term disability benefits if their condition keeps them from working.
Disability Evaluation of Knee Disorders
If your knee disorder keeps you from working and you have a long term disability insurance plan (either individual or group), you may apply for long term disability (LTD) benefits. The insurance company will review the claim to see if you meet the definition of disabled outlined by your plan.
Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to work in almost any job after that. Each LTD plan has a different definition of “disability,” so it is essential to review the criteria your plan uses to determine disability.
Evaluating Disability for People with a Knee Disorder
A functioning knee is crucial for a person to be mobile. Even if a job does not require much walking, a person must still be able to travel to and from their workplace. While not every person with a knee disorder will be considered disabled, many people with knee disorders are disabled by their conditions.
A person that does not have fully functioning knees may not be able to work in a position that requires bending, lifting, or walking. Some people cannot sit at a desk and must elevate the affected knee when sitting. Someone on narcotic pain relievers for their knee pain will be unable to work in a workplace that requires safety equipment, operating dangerous machinery, or in a position that includes tasks supervising others.
Even if your knee disorder is not severe enough to be considered disabling, you may still qualify for long-term disability benefits when all your medical conditions and treatments are considered. Evaluators examine everything from medical conditions to the side effects of medications when deciding. It is important to include information about the full picture of your health when applying.
What the Insurance Company Needs From You and Your Medical Providers
You should tell the insurance company about any doctors you may have seen for your paralysis. The insurance company will need to obtain all relevant medical records to get the full picture of your health. If for any reason they cannot get these records from your doctors, you should request them and provide them to the insurance company yourself. You should include all relevant records, including records of diagnostic testing, office visits, and any ongoing treatments.
You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform.
Working with an Experienced Disability Attorney
Insurance companies often deny claims for knee disorders. Insurance carriers frequently deny patients based on age-related conditions or require patients to return to work before it is safe for them to work.
Working with an experienced disability attorney will put you in the best position to get the benefits you deserve for your knee condition. Even if you have been previously denied disability benefits, that does not mean you are out of options. It is not unusual to be denied the first time you apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.
While the process can be intimidating, your disability attorney is extremely experienced and familiar with the process. You can seek help without worrying about upfront costs or unexpected bills because they are paid out of any awarded funds.
The Ortiz Law Firm has successfully represented people in long-term disability cases across the United States. If you would like to talk to one of our experienced long-term disability lawyers about your knee disorder and its impact on your ability to work, call us at (850) 308-7833. We would be happy to evaluate your case and to discuss how we can help you.