Management of Knee Pain

Question 1

Presentation of knee pain?

Answer 1

• Pain:

• Anterior
• Often localised
• Stiffness
• Swelling/lump
• Giving way
• Deformity
• Loss of sleep
• Loss of function, e.g: trouble walking, cannot kneel

Question 2

Hx of knee pain?

Answer 2

Ask about injuries (recent or old), previous surgery

Consider hip pain (can refer to the knee)

Question 3

Examination of knee pain?

Answer 3

Look - deformity, swelling, scars, gait

Feel - bony landmarks, tenderness, effusions, knee stability, patellar apprehension test

Move- extension, flexion, quads strength

Question 4

Ix for knee pain?

Answer 4

Usually, no Ix but can do:

• X-ray
• MRI
• ESR/PV
• Urate

Question 5

Management of knee pain?

Answer 5

Question 6

Common causes of knee pain?

Answer 6

Ligament strain (often medial collateral)

Bursitis, e.g; in a carpenter

Osgood-Schlatter’s disease (inflammation of the bone, cartilage, and/or tendon at the superior tibia, where the patella articulates; tends to occur in adolescents)

OA (remember there are 2 joints in the knee, patellofemoral and tibiofemoral)

Question 7

Less common causes of knee pain?

Answer 7

Chondromalacia patellae

Meniscus injury

Cruciate damage

Gout

RA

Patellar subluxation/dislocation

Question 8

Typical Hx of an ACL rupture?

Answer 8

TWIST injury + “POP” feeling

Swelling occurs due to HAEMARTHROSIS (there is a blood vessel in the ACL)

Question 9

Why are ACL ruptures more common in females?

Answer 9

Physiologically, females are more knock-kneed (valgus)