The specific joints involved, as well as the presence or lack of certain systemic symptoms fatigue, weight loss, lack of appetite, fever, malaise, are primarily what is considered to distinguish or differentiate osteoarthritis. Patient supine, knee flexed 90, attempt to displace tibia from femur in backward direction. Chondral injury abbasi d, mri findings in adolescent patients with acute traumatic knee hemarthrosis. Red flag rules for knee and lower leg differential diagnosis. Acute knee effusion 1 pts wacute knee effusion 1018 y. Knowing what typically causes pain in each area of the knee makes it easier to reach an accurate knee pain self diagnosis. It is usually associated with palpation on the medial patellofemoral joint.
Perform all knee ligament and meniscal tests to rule out any other cause. Symptoms locking of joint or sensation of popping, clicking, or snapping. Additional diagnoses to consider in children include slipped capital femoral epiphysis and septic arthritis. Evaluation of knee injury differential diagnosis of. Differential diagnosis of lesions at the knee disorder diagnosis treatment anterior knee pain patellar bursitis inspection and palpation aspirationinfiltration or surgery subsynovial haematoma history of local blow aspiration marked limitation of flexion normal extension suprapatellar tendinitis painful resisted extension deep friction or. Inspect your knee for swelling, pain, tenderness, warmth and visible bruising. By most definitions, acute knee injuries are defined as being diagnosed within the first 30 to 42 days of the injury or onset of symptoms.
For example, a noncapsular pattern could be indic ative of serious pathology 1 or could represent a nonthreatening, asymptomatic extraarticular lesion, such as a ligamentous adhesion 1. A twisted knee is one of the most common knee injuries. A noncap sular pattern, however, may indicate a variety of conditions, thus making interpretation difficult. Blazina et al first used the term jumpers knee patellar tendinopathy, patellar tendinosis, patellar tendinitis in 1973 to describe an insertional tendinopathy seen in skeletally mature athletes, although sindinglarson, johansson, and smillie once described this condition. The complexity of the design of the knee joint and the fact that it is an active weightbearing joint are factors in making the. Most patients are able to localize the pain in their knees to either the medial or lateral. Then next one, further down, looks at pain behind the knee. Depending on how the knee twists, it places stress through different structures of the knee so accurate knee pain diagnosis is vital. Emphases in the differential diagnosis for this disease. Push on or pull the joint to evaluate the integrity of the structures in your knee. Information from the history helps the clinician to distinguish among five diagnostic categories. Tests and diagnosis discussion for knee conditions. The differential diagnosis for chronic knee pain, including a description of distinguishing features, is provided in the accompanying tables table 2 and table 3.
Knee pain can be a result of injury or disease of the knee joint. Differential diagnosis of knee pain commonly encountered in clinical practice article pdf available in the journal of the korean rheumatism association 143 january 2007 with 284 reads. Injury can also affect the ligaments, cartilage, menisci plural for meniscus, and bones within the joint. However, as the differential diagnosis for knee pain is complex, a more. On radiographs of joints affected by osteoarthrosis, there are signs of destruction of articular cartilage and an increased reparative response. Differential diagnosis if a patient has the typical symptoms and radiographic features described above, the diagnosis of oa is relative straightforward and is unlikely to be confused with other entities. Sep 01, 2003 determining the underlying cause of knee pain can be difficult, in part because of the extensive differential diagnosis. After an injury, the synovial membrane responds by producing liquid. Inflammation or fibrotic thickening of plica synovial folds in the knee dressendorfer and granado, 2011. Treatment of knee bursitis depends on whether infection is involved. Differential diagnosis of osteoarthritis competently. Differential diagnosis knee diagnoses acute knee injury.
Apr 19, 2020 a definitive diagnosis depends on distinguishing osteoarthritis from those other types of arthritis. A differential diagnosis is a way to rule out injuries based on observations, testings, and facts learned throughout the assessment. Jumpers knee paradoxjumping ability is a risk factor for developing jumpers knee. Compare the condition of both knees, particularly if only one is painful. Objectives at the end of this lecture you will know 1. A knee pain diagnosis chart can be a really useful tool to help you work out why you have pain in your knee. Pain with neither apparent swelling nor stiffness is called arthralgia. Assess leg length due to differential diagnosis of hip dysplasiadislocation postural compensations common with decreased ankle df rom. Adequate healing time by modification to training regimen, using ultrasound and. Radiograph of the knee nplease identify ten anatomical structures of the knee.
Knee pain can be the initial complaint of hip pathology not uncommon for a patient with hip arthritis to present with knee pain. This first knee pain diagnosis chart focuses on pain at the front of the knee. A definitive diagnosis depends on distinguishing osteoarthritis from those other types of arthritis. Assessing the risk of ovarian cancer heart failure. It is a congenital disorder in which the thin wall of fibrous tissue extends from the synovial capsule of the knee. Performing a thorough differential diagnosis will allow the examiner to determine a probable clinical impression. Illustrate synovial pathology of the knee withmristudies. Niams excerpt doctors use several methods to diagnose knee problems.
Pain usually occurs when the synovial capsule becomes inflamed. Differential diagnosis and therapeutic possibilities. Knee dislocation is a relatively rare injury but an important one to recognize because coexistent vascular injury, if missed, often leads to limb loss. Location of pain and tenderness can often be very helpful in establishing an. The differential diagnosis for a patient with atraumatic monoarticular. Inflammatory arthritis is a common term for several conditions that manifest as joint pain, swelling, and stiffness with varying degrees of functional impairment. Some patients describe the pain as being all around. Approach to the adult with knee pain likely of musculoskeletal origin. Knee flexion with tibial internal rotation in prone with added knee flexion resistance may produce pain leading to the diagnosis of popliteus tendinitis. Popliteus tendonitis differential diagnosis of the knee. Evaluation of inflamed joint differential diagnosis of. Patient reports anterior knee pain as well as clicking, catching, locking, or pseudolocking of the knee, and it may even.
Knee pain is a common presenting complaint with many possible causes. Symptoms include pain, swelling, warmth, tenderness, and redness. Therefore, in this article, the differential diagnostic criteria and standards for assessing the arthrological status in patients with osteoarthrosis including questionnaires sf36, haq, aims, euroqol5dhflp. A differential diagnosis of knee pain is very extensive, but it can be considerably narrowed down with a detailed history, a focused examination. Adjunct associate professor of bioengineering, department of mechanical and materials. Providing an effective therapy for osteoarthritis and recurrence of the disease depends largely on the use of standardized approaches to its diagnosis and differential diagnosis. First, the differential diagnosis for knee pain is complex and obtaining a clear history remains essential for diagnosis. Table 415 shows the differential diagnosis of knee pain. Differential diagnoses by location location of pain and tenderness can often be very helpful in establishing an initial differential diagnosis. Dec 10, 2019 knee dislocation is a relatively rare injury but an important one to recognize because coexistent vascular injury, if missed, often leads to limb loss. For the purposes of this topic, chronic knee pain associated with overuse is pain occurring during or after specific activities that has persisted for approximately six weeks or longer. Differential diagnosis of lesions at the heel and ankle.
This type of injury most commonly occurs during sports or by falling awkwardly. Knee dislocation differential diagnoses medscape reference. Bursitis of the knee results when any of the three fluidfilled sacs bursae become inflamed due to injury or strain. Damage to the quadriceps tendon causing pain above the kneecap that is worse with activity. Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Evaluation of the knee nwhat type of injuries should we consider with our differential diagnosis of the knee.
Broadening the differential carlin senter, md primary care sports medicine departments of medicine and orthopaedics december 12, 2015 abcs of musculoskeletal care i have no disclosures. The differential diagnoses for osteoarthritis will depend on which area of the body is affected. The patients description of knee pain is helpful in the differential diagnosis. If a patient has the typical symptoms and radiographic features described above, the diagnosis of oa is relative straightforward and is unlikely to be confused with other entities. Recent history of trauma, such as motor vehicle accident, crush injury, sportsrelated injury, and a fall, as a mechanism of injury is a major red flag for suspicion of a fracture of the knee and lower leg. The pages that follow contain general guidance on the diagnosis and treatment of chronic nontraumatic knee pain. Differential diagnosis of knee pain commonly encountered in clinical practice article pdf available in the journal of the korean rheumatism association 143. Some patients describe the pain as being all around their knee or on the anterior aspect. Differential diagnosis of knee pain november 11, 2016. Make sure you rule out the back and hip unless there is a clear mechanism of injury as the knee can be a referred site of pain for both these areas. Any diagnosis for the pain is, essentially, via exclusion due to the numerous possible conditions, where patella abnormality or muscular imbalances are important factors, determined by a thorough history and patient examination.
Background according to medical disability guidelines, synovitis is described as irritation and inflammation of the joint lining, anatomically called synovium. Training volume and body composition as risk factors for developing jumpers knee among young elite volleyball players. The patients description of knee pain is helpful in focusing the differential diagnosis. External rotation of the foot knee hyperextension in stance phase lower extremity external rotation, external tibial torsion. Your doctor may first recommend having an xray, which can help detect bone.
The anatomy of the medial knee has been divided into 3 layers, consisting of the deep fascia of the thigh, the superficial medial collateral ligament mcl and the deep mcl and posteriomedial joint capsule1. In some cases, your doctor might suggest tests such as. The conditions are presented anatomicallyanterior, lateral, medial, or posteriorwith common etiologies, history and physical exam findings, and diagnosis and treatment options for each see table, page 28. However, some universal conditions include inflammatory arthropathies e. Jumpers knee differential diagnoses medscape reference. Gently press on areas of your knee to detect warmth, swelling and the source of pain. Differential diagnosis of lesions at the heel and ankle disorder diagnosis treatment posterior pain achilles tendinitis pain during rising on tiptoe differentiate 4 types by palpating insertion, localizing sign and passive plantiflexion deep transverse friction alternative. The american college of rhematological classification criteria for oa of the knee includes radiographic evidence for osteophytes and at least one of the following three items.
There are lots of different structures in and around the knee that can cause pain. Jumpers knee usually affects the attachment of the patellar tendon. Inspect the skin over the tender area for redness or other signs of infection. Immediate swelling and bruising usually indicates significant trauma and may require xray to rule out tibial plateau fractures, bone bruises or an mri to investigate the integrity of the ligaments. Adequate healing time by modification to training regimen, using ultrasound and performing transverse friction massage dutton. The following flow chart provides an overview of how to approach the diagnosis of knee pain in the adult algorithm 1.
Dressendorfer and granado, 2011 tests of joint integrity. Joint specific differential diagnoses for osteoarthritis. Diagnosis and management pelvic pain in transgender men taking testosterone. Muscles of the thigh and knee nplease name the muscles of the thigh and knee. Of great importance in the differential diagnosis of osteoarthritis and rheumatoid arthritis is xray examination. Differential diagnosis osteoarthritis rheumatoid arthritis avascular necrosis trochanteric pain syndrome femoralacetabular impingement labral tear. Acute knee swelling due to hemarthrosis within 2 hours may indicate ligament injuries or patellar dislocation or fracture. Differential diagnosis of osteoarthritis competently about. The palpation of the painful cord on the anteromedial knee is the most characteristic sign of plica syndrome. Chronic knee injuries are due to residual old trauma or surgery, existing degenerative diseases, or previous conditions not resolved within the first 30 to 42 days after the onset.
Location is based on both subjective pain have the patient point to the pain during the history and objective findings e. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest. It is important to bear in mind the possibility of referred pain either from the spine or the ipsilateral hip. Two panels of rheumatologists and orthopaedic surgeons issued recommendations for the diagnosis and initial treatment of patients with acute and recentonset swelling of the knee. As discussed in part i of this twopart article,1 the family physician. Doctors often can make a diagnosis of knee bursitis with a medical history and physical exam. Determining the underlying cause of knee pain can be difficult, in part because of the extensive differential diagnosis. Medical historythe patient tells the doctor details about symptoms and about any injury, condition, or general health problem that might be causing the pain. In addition, knee dislocation often presents in the context of multisystem trauma or spontaneous relocation, which makes detection more difficult.
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