Knee pain resident survival guide

Revision as of 15:14, 11 February 2021 by TayyabaAli (talk | contribs) (Treatment)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Synonyms and keywords: Knee stiffness, Knee swelling, Hot knee joint

Overview

Causes

Common Causes

Traumatic and activity-related causes of knee pain

Anterior Knee Pain
  • Patellar subluxation or dislocation
  • Tibial apophysitis (Osgood-Schlatter lesion)
  • Jumper's knee (patellar tendonitis)
  • Patellofemoral pain syndrome (chondromalacia patellae)
Medial Knee Pain
  • Medial collateral ligament sprain
  • Medial meniscal tear
  • Pes anserine bursitis
  • Medial plica syndrome
Lateral Knee Pain
  • Lateral collateral ligament sprain
  • Lateral meniscal tear
  • Iliotibial band tendonitis
Posterior Knee Pain
  • A popliteal cyst (Baker's cyst) as a result of sport-related injury
  • Posterior cruciate ligament injury [1]

Non-Traumatic causes of knee pain

Unilateral Knee Pain
  • Septic Arthritis
  • Gout
  • Pseudogout (acute calcium pyrophosphate crystal arthritis)[1]
Bilateral Knee Pain
  • Osteoarthritis [2]
  • Rheumatoid Arthritis [3]
  • Systemic Lupus Erythematosis
  • Baker cyst as a result of Rheumatoid arthritis and Osteoarthritis [2]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according to the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
Seek proper history:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial workup for knee pain:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Knee pain associated with trauma
 
 
 
 
 
 
 
Knee pain not associated with trauma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Significant knee swelling
 
 
 
Limited knee swelling
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Activity related knee pain
❑ Chronic osteochondral defect
❑ Knee osteoarthritis
 
Not activity related knee pain
❑ Crystal arthropathy
❑ Septic arthritis
❑ Systemic rheumatic disease
 
According to the focus of knee pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anterior knee pain
❑ Tibial tubercle apophysitis (Osgood Schlatter)
❑ Hoffa's fat pad syndrome
❑ Quadriceps and patellar tendinopathy
❑ Prepatellar or infrapatellar bursitis
❑ Plica syndrome
 
Vague anterior knee pain
❑ Chronic patella dislocation or subluxation
❑ Patellofemoral pain
❑ Chondromalacia patella
❑ Patella stress fracture
 
Medial knee pain
❑ Degenerative medial meniscal tear
❑ Saphenous nerve entrapment
❑ Pes anserine bursitis
 
Lateral knee pain
❑ Iliotibial band syndrome
❑ Degenerative lateral meniscal tear
 
Posterior knee pain
❑ Popliteal artery aneurysm
❑ Popliteal artery entrapment
❑ Popliteal (Baker's) cyst
❑ Popliteus tendinopathy
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according to the [...] guidelines.

[4]/

'''Pseudogout'''

 
 
 
 
 
 
 
 
 
 
 
 
Life style modification for the knee pain depending on the condition
  • Rest, Ice, Compression, and Elevation (RICE) for ligament injuries
  • Exercise
  • Heat treatment
  • Paracetamol
  • Symptomatic slow-acting drugs for OA (glucosamine, chondroitin, diacerein, and avocado–soya unsaponifiables)
  • Restorative sleep advice
  • Weight loss
Treat the underlying causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Knee pain due to septic arthritis
 
Knee pain due to osteoarthritis
❑ Nonpharmacologic treatment (eg, exercise, weight loss)
NSAIDS as needed (alternate: acetaminophen)
❑ If symtoms persist:
  • Topical agents (eg, NSAIDs, capsaicin)
  • Intra-articular glucocorticoids
  • Intra-articular hyaluronic acid
    ❑ If significant impairment:
  • Surgery (if possible)
  • Chronic pain management (nonsurgical candidates)
  •  
    Knee pain due to crystal arthropathy
    '''Gout'''
    ❑ Acute attack:
  • NSAIDs
  • Glucocorticoids
  • Colchicine
    ❑ Recurrent attacks (Tophi, renal uric acid stones):
  • Allopurinol
  •  
    {{{ C04 }}}
     
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    Do's

    • The content in this section is in bullet points.

    Don'ts

    • The content in this section is in bullet points.

    References

    1. Jump up to: 1.0 1.1 "www.aafp.org" (PDF).
    2. Jump up to: 2.0 2.1 Hussain, SM; Neilly, DW; Baliga, S; Patil, S; Meek, RMD (2016). "Knee osteoarthritis: a review of management options". Scottish Medical Journal. 61 (1): 7–16. doi:10.1177/0036933015619588. ISSN 0036-9330.
    3. Scott, David L; Wolfe, Frederick; Huizinga, Tom WJ (2010). "Rheumatoid arthritis". The Lancet. 376 (9746): 1094–1108. doi:10.1016/S0140-6736(10)60826-4. ISSN 0140-6736.
    4. Neogi, Tuhina (2011). "Gout". New England Journal of Medicine. 364 (5): 443–452. doi:10.1056/NEJMcp1001124. ISSN 0028-4793.