Knee Pain Flashcards
Differential diagnoses of Knee Pain
Knee pain - Meniscal Tear injury*
Knee pain - Patellofemoral syndrome*
Probability diagnosis Ligament strains and sprains ± traumatic synovitis Osteoarthritis Patellofemoral syndrome Prepatellar bursitis
Serious disorders not to be missed
Vascular disorders:
•deep venous thrombosis
•superficial thrombophlebitis
Neoplasia/cancer:
•primary in bone
•metastases
Infection: •septic arthritis •tuberculosis Rheumatic fever Rheumatoid arthritis Acute cruciate ligament tear Juvenile chronic arthritis
Pitfalls (often missed) Referred pain: back or hip disease Foreign bodies Intra-articular loose bodies Osteochondritis dissecans Osteonecrosis Synovial chondromatosis Osgood–Schlatter disorder Meniscal tear sFractures around knee Pseudogout (chondrocalcinosis) Gout → patellar bursitis Ruptured popliteal (Baker’s) cyst
Rarities:
•sarcoidosis
•Paget disease
•spondyloarthropathy
Masquerades checklist
Depression
Diabetes
Spinal dysfunction (referred)
Is the patient trying to tell me something?
Psychogenic factors relevant, especially with possible injury compensation.
Knee Pain - Key History
Key history
The history helps diagnosis, especially evaluating the nature of the injury. Define whether the pain is acute or chronic, dull or sharp, continuous or recurring. Keep in mind age-related causes and past history.
Knee Pain - Key PE
Key examination
The provisional diagnosis may be evident from a combination of the history and simple inspection of the joint but the process of testing palpation, movements (active and passive) and specific structures of the knee joint helps pinpoint the disorder.
Knee Pain - Key Investigation
Key investigations
Consider: •FBE/ESR •connective tissue antibodies •blood culture •plain X-ray including special views •bone scan •ultrasound •arthrography: CT scan, MRI (excellent for investigating internal ‘derangement’) •arthroscopy •aspiration of fluid for culture or crystal examination.
Knee pain - Diagnostic Tips
Diagnostic tips
Examine the hip and lumbosacral spine if examination of the knee is normal but knee pain is the complaint
.Acute haemarthrosis following an injury should be regarded as an anterior cruciate ligament tear until proved otherwise
