This document provides an overview of knee pain, including different causes, symptoms, and diagnostic approaches based on age. It discusses common conditions that cause knee pain in children/adolescents, adults, and older adults. For each, it outlines key symptoms, mechanisms of injury, differential diagnoses, and examination findings. Common ligament injuries, meniscal tears, and overuse injuries in adults are described. Diagnostic tests including imaging and physical exams are also summarized. The document aims to guide physicians in evaluating and diagnosing the underlying cause of a patient's knee pain.
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Approach to Knee Pain I Dr.RAJAT JANGIR JAIPUR
1. Approach to Knee Pain
Dr.RAJAT JANGIR
Consultant Arthroscopy and Sports Injury
MS Ortho (Ahmedabad)
Fellow Arthroscopy( South Korea)
Dip Sports Med IOC (UK)
8. History
MECHANISM OF INJURY
direct blow to the knee
foot was planted
decelerating or stopping suddenly
landing from a jump
Twisting injury
hyperextension
9. Ottawa knee rules
• Age 55 or over
• Isolated tenderness of the patella
• Tenderness at fibular head,
• Inability to flex to 90 degrees
• Inability to bear weight
11. Children and Adolescents
Patellar subluxation
Tibial apophysitis (Osgood- Schlatter lesion)
Patellar tendonitis (Jumper’s knee)
12. PATELLAR SUBLUXATION
Occurs more often in teenage girls
giving-way episodes of knee.
Pain on patellar apprehension test.
13.
14. TIBIAL APOPHYSITIS
• 13-14 year old boy (10-11yr girl)-
growth spurt
• Anterior knee pain TT
• squatting, walking up or down stairs
• TT is tender & swollen
• Radiographs are usually negative, rarely show
avulsion of apophysis at TT.
15.
16. PATELLAR TENDONITIS
Teenage boys- growth spurt.
Vague anterior knee pain persisted for months and worsens
after activities
Patellar tendon tender, and pain is reproduced by resisted
knee extension.
Radiographs are not indicated.
18. Patellofemoral pain syndrome
Anterior knee pain occurs after prolonged periods of sitting
(“theater sign”).
Slight effusion, Patellar crepitus.
Pain may be reproduced by applying direct pressure at anterior
aspect of patella.
Radiographs usually are not indicated.
19.
20. Medial plica syndrome
The plica, a redundancy of the joint synovium medially, can
become inflamed with repetitive overuse
Acute onset of medial knee pain after a marked increase of
usual activities.
Tenderness MFC
Radiographs are not indicated.
21.
22. Iliotibial band tendonitis
Runners & cyclists
Pain at lateral aspect of knee aggravated by activity, particularly
running downhill and climbing stairs.
Tenderness -lateral epicondyle
Noble’s test – supine position, pain when physician places thumb
on lateral epicondyle as the patient repeatedly flexes and extends
the knee.
Radiographs are not indicated.
23.
24. Trauma
ACL
Noncontact deceleration forces
“Pop” at the time of the injury
must cease activity or competition immediately.
Swelling of the knee within two hours.
Joint effusion
Anterior drawer test
Lachman test
25. Anterior Cruciate Ligament
Most common knee injury among
athletes
AM fibers taut in flexion
Check anterior displacement
PL fibers taut in extension
Check rotation
Hyperextension, internal rotation
– rarely isolated injury from
contact force
Intersubstance (70%)
(LEFT KNEE)
26. ACL Diagnosis: Examination
large hemarthrosis
Anterior drawer test
NOT RELIABLE BY
ITSELF
Lachman test
Knee only flexed 30
Pivot shift
27. X-ray
Segond fracture of
lateral tibial condyle
Tibial spine avulsion
in young patients
MRI – 95%
accuracy
Normal ACL Torn ACL
ACL: Diagnosis: Imaging
28. Posterior Cruciate Ligament
Broader, longer, stronger
PM and AL fiber bundles
Receives better vasc. from
MGA, synovial membrane
Tears much less frequently
Only in isolation when
“dashboard knee” injury
Hyperextension in sports,
especially
Posterior view
Anterior view
Medial
femoral
condyle
29. PCL: Diagnosis
Posterior drawer test
Neutral start vital!
Gravity or sag test
X-ray to confirm sag test
MRI
negative positive
30. Trauma
Medial Collateral Ligament Sprain
Collision that places valgus stress on knee
Immediate onset of pain and swelling at medial aspect of
knee
Point tenderness at the medial joint line
Valgus stress test
32. Trauma
Lateral Collateral Ligament Sprain
varus stress to the knee
lateral knee pain that requires prompt cessation of
activity.
Point tenderness
Varus stress test
MRI
33. Trauma
Meniscal Tear
Acute- Twisting injury
Chronic- Degenarative
Recurrent knee pain
catching or locking
especially with squatting or twisting of knee.
Tests
MRI
37. OSTEOARTHRITIS
knee pain aggravated by weight- bearing activities and relieved
by rest.
morning stiffness that dissipates somewhat with activity
Acute flare
Decreased ROM, crepitus, mild joint effusion, and palpable
osteophytes
38.
39. CRYSTAL-INDUCED INFLAMMATORY ARTHROPATHY
Gout or pseudogout presents with pain, and swelling in the
absence of trauma
Redness, warm, tender, and swollen.
Even minimal range of motion is exquisitely painful.
Microscopy
negatively birefringent gout
positively birefringent pseudogout
40. Popliteal cyst -Baker’s cyst
Insidious onset of mild to moderate pain in the popliteal area
palpable fullness
MRI USG