Knee Pain Differential Diagnoses: Difference between revisions

Revision as of 18:06, 31 July 2020

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

Approach to Knee Pain

Adult with knee pain

Acute high energy trauma

Discrete low energy trauma

No trauma

Send to ED

Generalised pain: ACL tear, osteochondral defect, PCL tear
Medial: MCL or medial meniscal tear
Anterior: Patellar dislocation, subluxation, tendon tear, or quadriceps tendon tear
Lateral: Lateral meniscus, posterior lateral corner, patellar dislocation/subluxation, LCL tear
Posterior: Posterior capsule tear, PCL tear, tibiofemoral dislocation

Knee effusion present?

No effusion

Effusion present

Pain worse with activity

Pain not related to activity

Osteochondral injury or osteoarthritis exacerbation

Rheumatological disease (gout, RA, psoriatic arthritis) or septic arthritis

Maximum area of pain?

Focal anterior

Patellar/quadriceps tendinopathy
Plica
Hoffa's fat pad
Prepatellar/infrapatellar bursitis
Osgood-schlatter

Vague or diffuse anterior

Patellofemoral pain
OA exacerbation
Chronic patellar subluxation
Referred hip pain
Avascular necrosis
Patellar stress fracture

Medial

Degenerative meniscal tear
Pes anserine bursitis
OA exacerbation
Saphenous nerve entrapment

Lateral

Iliotibial band
Degenerative meniscal tear
OA exacerbation

Posterior

Baker's cyst
Popliteus tendinopathy
Popliteal artery aneurysm
Popliteal artery entrapment

@@ Line 1: / Line 1: @@
 {{Template:Knee Pain DDX}}
+==Approach to Knee Pain==
+{{Tree chart/start}}
+{{Tree chart | | | | | A01 | | | | |A01= Adult with knee pain}}
+{{Tree chart | |,|-|-|-|+|-|-|-|.| | }}
+{{Tree chart | B01 | | B02 | | B03 |B01=Acute high energy trauma|B02= Discrete low energy trauma|B03=No trauma}}
+{{Tree chart | |!| | | |!| | | |!| | }}
+{{Tree chart | C01 | | C02 | | C03 |C01= Send to ED| C02=<ul><li>Generalised pain: ACL tear, osteochondral defect, PCL tear</li><li>Medial: MCL or medial meniscal tear</li><li>Anterior: Patellar dislocation, subluxation, tendon tear, or quadriceps tendon tear</li><li>Lateral: Lateral meniscus, posterior lateral corner, patellar dislocation/subluxation, LCL tear</li><li>Posterior: Posterior capsule tear, PCL tear, tibiofemoral dislocation</li></ul>|C03=Knee effusion present?}}
+{{Tree chart | | | | | | | | | |!| | | }}
+{{Tree chart | |,|-|-|-|-|-|-|-|(| | | }}
+{{Tree chart | B01 | | | | | | B02 | |B01= No effusion|B02=Effusion present}}
+{{Tree chart | |!| | | |,|-|-|-|(| | | }}
+{{Tree chart | |!| | | C01 | | C02 | |C01=Pain worse with activity|C02=Pain not related to activity }}
+{{Tree chart | |!| | | |!| | | |!| | |C01=Pain worse with activity|C02=Pain not related to activity }}
+{{Tree chart | |!| | | D01 | | D02 | |D01=Osteochondral injury or osteoarthritis exacerbation|D02=Rheumatological disease (gout, RA, psoriatic arthritis) or septic arthritis }}
+{{Tree chart | |!| | | | | | | | | | | }}
+{{Tree chart | E01 |-| E02 |-| E03 | |E01=Maximum area of pain?|E02=Focal anterior|E03=<ul><li>Patellar/quadriceps tendinopathy</li><li>Plica</li><li>Hoffa's fat pad</li><li>Prepatellar/infrapatellar bursitis</li><li>Osgood-schlatter</li></ul> }}
+{{Tree chart | |!| | | | | | | | | | | }}
+{{Tree chart | |)|-|-| F01 |-| F02 | |F01=Vague or diffuse anterior|F02=<ul><li>Patellofemoral pain</li><li>OA exacerbation</li><li>Chronic patellar subluxation</li><li>Referred hip pain</li><li>Avascular necrosis</li><li>Patellar stress fracture</li></ul>}}
+{{Tree chart | |!| | | | | | | | | | | }}
+{{Tree chart | |)|-|-| G01 |-| G02 | |G01=Medial|G02=<ul><li>Degenerative meniscal tear</li><li>Pes anserine bursitis</li><li>OA exacerbation</li><li>Saphenous nerve entrapment</li></ul>}}
+{{Tree chart | |!| | | | | | | | | | | }}
+{{Tree chart | |)|-|-| H01 |-| H02 | |H01=Lateral|H02=<ul><li>Iliotibial band</li><li>Degenerative meniscal tear</li><li>OA exacerbation</li></ul>}}
+{{Tree chart | |!| | | | | | | | | | | }}
+{{Tree chart | |`|-|-| I01 |-| I02 | |I01=Posterior|I02=<ul><li>Baker's cyst</li><li>Popliteus tendinopathy</li><li>Popliteal artery aneurysm</li><li>Popliteal artery entrapment</li></ul>}}
+{{Tree chart/end}}
 [[Category:Differential Diagnosis Checklists]]
 [[Category:Knee & Leg]]