GP Management of Knee Pain

Question 1

How do patients present?

Answer 1

Pain = anterior, often localised

Swelling/lump, stiffness, giving way, deformity, loss of sleep and function

Question 2

What are common features of the patient’s history?

Answer 2

Injury, previous surgery, consider hip pain

Question 3

What are some features of the examination?

Answer 3

Look = deformity, how patient walks, swelling, scars
Feel = bony landmarks, tenderness, effusions, knee stability, patellar apprehension test
Move = extension, flexion, strength of quads

Question 4

What investigations can be done for knee pain?

Answer 4

Usually none, MRI and x-ray, PV, urate

Question 5

What is the management for mild knee pain?

Answer 5

Explanation, keep mobile, education, exercise, weight loss, appropriate footwear

Question 6

What are the management options for moderate knee pain?

Answer 6

Non-pharmacological = physio, braces
Pharmacological = begin with simple analgesia (e.g paracetamol), NSAIDs (short term), opioids (if effusion present)

Question 7

What is the treatment of severe knee pain?

Answer 7

Surgery = osteotomy, total joint replacement

Question 8

What are some common causes of knee pain?

Answer 8

Ligament strain = often medial collateral
Bursitis
Osgood-Schlatter’s
Osteoarthritis (patella-femoral>knee)

Question 9

What are some less common causes of knee pain?

Answer 9

Chondromalacia patellae
Meniscus injury
Cruciate damage 
Gout
Rheumatoid arthritis
Patellar subluxation/dislocation