KNEE PAIN

DIFFERENTIAL DIAGNOSIS:

• Common causes of traumatic Acute Knee Pain

• Anterior cruciate ligament sprain
• Posterior cruciate ligament sprain
• Medial collateral ligament sprain
• Meniscus tear (medial or lateral)
• Bursitis
• Muscle strain (quadriceps, hamstrings, gastrocnemius, soleus)
• Muscle rupture

• Nontraumatic causes of Acute Knee Pain

• Arthritis
• Gout
• Referred pain (nerve root pain, muscle strain, hip injury)
• Septic knee
• Ruptured Baker’s cyst
• Ruptured popliteal aneurysm

• Chronic knee pain

• Arthritis
• Patello-femoral syndrome
• Patellar tendonitis
• Meniscal tears
• Bursitis
• Quadriceps tendonitis
• Iliotibial band syndrome
• Osgood-Schlatter disease
• Joint mice (loose bodies)
• Osteochondritis dissecans, neoplasm

HISTORY:

• Onset of Pain (sudden or gradual onset)
• Mechanism of injury (direct blow, hyperextension, rotational)
• Is there popping of snapping
• Swelling
• Location of pain
• Type of pain
• Buckling
• Locking
• Location of Pain
• Type of Pain (burning, aching, dull, sharp, intermittent, continuous)

CLINICAL FINDINGS:

• Observation (swelling, discoloration, muscle, atrophy, standing position, gait, anatomic alignment)
• Palpation (tenderness, swelling)
• Range of motion (active, passive, resistive)
• Neurologic and vascular examination
• Other anatomical tests

TESTS:

• Radiographs (standard series, weight bearing)
• Magnetic resonance imaging (MRI)
• Computed tomography (CT-scan)
• Bone scan
• Joint aspiration

MANAGEMENT:

• Acute treatment (control pain, minimize swelling, minimize tissue damage) pain medication, ice, compression, elevation, corticosteroid injection as indicated or surgery.
• Intermediate treatment (goal: strengthening, stretching, cardiovascular conditioning, full ROM exercises. 
• Long-term treatment (prevention of injury, control pain, strengthening and stretching exercises).