Knee Pain

Question 1

Knee Pain:

Key history with knee pain?

Answer 1

Mechanism of injury

• was the joint weight bearing at time injury
• could they weight bear post injury
• type of force/impacts
• point of impact (direction)
• sounds/feelings (“pop” = ACL, feeling of instability descending stairs = PCL)
• time to swelling (quick minutes = haemarthrosis = ACL, slow hours = synovitis)
• locking (meniscal injury)

Question 2

Knee Pain:

GP indications for MRIs?

Answer 2

-Inability to extend the knee suggesting the
possibility of acute meniscal tear
-Clinical findings suggesting acute anterior
cruciate ligament tear

Question 3

Knee Pain:

Common causes of pain?

Answer 3

Injuries:

• ACL (surgery and rehab - emerging evidence that physio may be suitable alone also)
• PCL (generally uncomplicated)
• Collateral ligaments - MCL (rehab), LCL (ortho opinion as could have ACL/PCL involvement)
• Meniscus (medial vs Lateral)
• patellar dislocation (Vastus medialis strengthening)

Inflammation:
Osteoarthritis
Gout/pseudogout
Iliotibial band syndrome (lateral knee pain)
Patellar tendinopathy
bursitis
-prepatellar
-infrapatellar
-anserine (medial)
-semimembranosus (posteromedial)

Referred:

• hip referred pain
• L3/4 spinal referral

Question 4

Knee Pain:

If x-ray required what is requested?

Answer 4

Knee radiograph series (weight bearing AP and lateral, skyline view, horizontal beam view)