Knee History

From WikiMSK

This article is still missing information.

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
  • 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

Medial

Lateral

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


Differential Based on Age

  • Children
    • Septic/osteomyelitis
    • Apophysitis
      • Osgood Schlatters
      • Sinding-Larssen- Johanssen
    • Neoplasm
      • Osteosarcoma
      • Ewings sarcoma
    • Referred
      • Perthes, DDH related AVN
      • SUFE
      • Transient synovitis
    • Non accidental injury
  • <50 year old adults
    • Trauma
    • Overuse syndromes
    • Arthritis โ€“ Degenerative vs inflammatory
  • >50 years
    • Trauma
    • Arthritis โ€“ more likely degenerative, consider gout, late onset RA and other autoimmune arthritides

History of Conditions

ACL

Immediate effusion, popping sensation, giving way Sensitivity 0.71; Specificity 0.71; PPV 42%; LR+ 2.5[1]

Meniscal Injury

  • Giving way and locking: PPV 98%, NPV 19%, LR+ 8.3[2]
  • Clicking: LR+ 2.4, LRโ€“ 7.0[3]

Osteosarcoma

In children, distal femur is 75% of cases. In adults, typically occur more in axial locations. However, lower limb long bones are still the most common site (27%)[4]

References

  1. โ†‘ Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Archives of physical medicine and rehabilitation. 2010 Sep 1;91(9):1452-9.
  2. โ†‘ Yan, R., Wang, H., Yang, Z., Ji, Z. H., & Guo, Y. M.. Predicted probability of meniscus tears: Comparing history and physical examination with MRI. Swiss Medical Weekly, 141(DECEMBER 2010). https://doi.org/10.4414/smw.2011.13314
  3. โ†‘ Cleland J, Koppenhaver S, Su J. Netterโ€™s Orthopaedic Clinical Examination: An evidence based approach. 2016
  4. โ†‘ Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 2009; 115:1531.