Knee History
From WikiMSK
Groups of Knee Pain
Acute knee pain with history of trauma or overuse Atraumatic knee pain with effusion Atraumatic knee pain without effusion Referred pain Location based
History
- Mechanism
- Trauma vs atraumatic sudden vs insidious
- Pain
- Location and character
- Any neuropathic qualities?
- Pattern
- Inflammatory arthropathy โ morning stiffness, rest pain, relief on movement
- Mechanical โ pain on weightbearing, worse later in day
- Severity โ although limited clinical utility
- Location and character
- Swelling โ immediate vs delayed?
- Locking, giving way, instability โ internal derangement
- Snapping - consider ITB, pes anserine tendons
- Constitutional symptoms โ fever, night sweats, weight loss, rash
- Back pain?
- Other joint involvement
- Previous injuries and treatments
- Medical history โ any systemic or rheumatological disease?
- Occupation and hobbies/sports
- Training history
- Possible differential based on history of trauma
- Flexion, rotation, compression: meniscus
- Valgus force: MCL
- Sudden deceleration or change in direction with planted/fixed foot: ACL
- Landing on flexed knee or MVA with posterior force to tibia: PCL
- Force to anteromedial extended knee or external rotation and hyperextension: posterolateral corner injury
- Swelling in knee with occasional locking and clicking: meniscus or loose body
- Pain on prolonged knee flexion, during squats, up and down stairs: PFS
- Anterior knee pain jumping and on full flexion: patellar tendinitis, PFS
Differential Diagnoses
Anterior, focal or vague
- Patellofemoral Pain Syndrome
- Knee Osteoarthritis
- Patellar Tendinopathy
- Plica Syndrome
- Quadriceps Tendinopathy
- Patellar Instability
- Hoffa's Fat Pad Inflammation
- Prepatellar Bursitis and Infrapatellar Bursitis
- Osgood-Schlatter Disease
- Sinding-Larsen-Johansson Disease
- Referred hip pain
- Avascular necrosis
- Patellar Stress Fractures
- Anterior cruciate ligament tear
- Osteochondral defect
- Posterior cruciate ligament tear
- Tibiofemoral dislocation
- Parameniscal cyst
Medial
- Knee Osteoarthritis
- Medial collateral ligament tear
- Medial meniscal tear
- Medial meniscal cyst
- Bakers cyst
- Medial Plica Syndrome
- Pes anserine bursitis/tendinopathy
- Inflammatory arthritis
- Osteochondral lesion medial femoral condyle (lateral aspect of medial epicondyle most common)
- Saphenous Nerve Entrapment
- Medial friction syndrome
- Medial collateral ligament bursitis
- Osteonecrosis
- Semimembranosus-Tibial Collateral Ligament Bursitis
- Pigmented Villonodular Synovitis
- Synovial Chondromatosis
- Referred Pain - Hip Joint, Lumbosacral spine pathology
- Neoplasm - soft tissue, intraosseous
Lateral
- Lateral meniscus tear
- Posterolateral corner injury
- Patellar dislocation or subluxation
- Lateral collateral ligament tear
- Iliotibial Band Syndrome
- Osteoarthritis exacerbation
- Osteochondral lesion lateral femoral condyle
- Popliteus Tendinopathy
- Biceps Femoris Tendinoapthy
- Semimembranosus Tendinopathy/bursitis
- Fibula head fracture
- Proximal Tibiofibular Joint Instability
- Snapping Biceps Femoris and Popliteus Tendons
- Peroneal Nerve Compression/Neuritis
Posterior
- Baker's or popliteal cyst
- Popliteus Tendinopathy
- Popliteal artery aneurysm
- Popliteal artery entrapment
- Posterior capsule tear
- Posterior cruciate ligament tear
- Tibiofemoral dislocation
Effusion present without trauma
- Osteochondral injury
- Osteoarthritis exacerbation
- Rheumatological disease (gout, RA, psoriatic arthritis)
- Septic arthritis