الفهرس 
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Abstract
Osteoarthritis (OA) is a common joint disorder, with the knee being one of the most frequently involved sites. Knee OA causes pain and stiffness and can lead to considerable disability and consequently to a reduced quality of life.
Osteoarthritis is most often affects middle-age to elderly people. It is commonly referred to as ”wear and tear” of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone.
This arthritis tends to occur in the hand joints, spine, hips, knees, and great toes. The lifetime risk of developing OA of the knee is about 46%, and the lifetime risk of developing OA of the hip is 25%.
The goal of osteoarthritis treatment is to reduce pain and improve function. There is no cure for the disease, but some treatments attempt to slow disease progression.
Causes of osteoarthritis is Primary (idiopathic) osteoarthritis, osteoarthritis not resulting from injury or disease, is partly a result of natural aging of the joint or Secondary osteoarthritis is a form of osteoarthritis that is caused by another disease or condition like ( obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth, gout, diabetes, and other hormone disorders).
The cause of pain in knee OA is not well understood.
The level of radiographic knee OA is, at most, moderately associated with the level of pain. Therefore, it is unlikely that pain is predominantly caused by only bone and cartilage pathology. Mechanical, structural, inflammatory, bone-related, neurological and psychological factors play a role in the process that results in painful knee OA.
Musculoskeletal ultrasonography (US) is a relatively new imaging tool that is non-invasive, safe and relatively inexpensive and is able to create static as well as dynamic images. In addition, it has been shown to be more sensitive than clinical examination in picking up peri- and intra-articular soft tissue lesions.
This provides the possibility of visualizing structural/mechanical (e.g. cartilage and meniscal tissue) as well as inflammatory properties (e.g. synovial proliferation and effusion) with the same instrument. Ultrasonography in knee OA has proved feasible and shows moderate to good validity and inter-observer reliability in an attempt to contribute to the body of knowledge about the pathophysiology of pain in knee OA.
As OA is a disease of the entire joint that is characterized by cartilage breakdown, subchondral bone alterations and formation of osteophytes, as well as soft tissue abnormalities including meniscal degeneration, bursitis, tendonitis, Baker’s cyst and synovial inflammation; information about these soft tissue structures might provide more insight in their potential role in the complex process of pain in knee OA.
Our study was designed for Comparison between sonographic finding in painful osteoarthritic knee and controls (non painful osteoarthritic knee) to detect the cause of pain in OA.
Our study included 95 knee osteoarthritis patients, fulfilling the ACR clinical criteria divided. They were divided into two groups. group A (53) patients with knee pain during physical activity once at least in the previous 3 days prior to inclusion. Another (42) patients without knee pain from at least 1 month prior to inclusion (VAS 0 mm) were included as a control group. Both groups were age and sex matched, with nonsignificant difference between the two groups.
Our study showed that the painful OA group are more obese, showed significantly more varus deformities, more effusion incidence, more synovial hypertrophy, more cartilage changes, and higher degrees of osteophytes than the control group (non painful OA group). On the other hand, Baker cyst and menischial protrusion showed non significant difference between the two groups.
The mean age of the study groups were around 54-55 years, with non significant difference between the two groups. Female were more predominant among cases (64%) than among controls (50%). On the other hand, cases had significantly higher BMI (25.9) than controls (23.6), with more obese persons among cases (24.5%) compared to only 2.4% among controls.
The right knee was slightly more affected than the left in both groups (painful OA and painless OA). On the other hand, alignment showed significantly more varus and valgus malalignment among cases compared to controls.
The most important factors associated with higher VAS scores are cartilage changes and grade of osteophytes, these are followed by erosions, menischial protrusion, bursitis and affection of the right rather than the left knee. All other factors showed non significant relation to VAS.
Conclusion
our study found that cartilage changes and grade of osteophytes, these are followed by erosions, menischial protrusion and bursitis are the main cause of the pain in the osteoarthritic knee.