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INTRODUCTION

Knee pain is a common problem, accounting for several million visits per year to primary care practitioners and emergency departments. By following a systematic approach in evaluating knee pain, physicians can establish the correct diagnosis in an efficient manner and formulate an appropriate therapeutic strategy.

OVERVIEW OF THE CLINICAL ASSESSMENT

The first step in the evaluation of knee pain is a thorough history that includes the core elements outlined in Table 10–1. While obtaining a history, the following key questions should be addressed:

  • How long has the pain been present?

  • Was there an acute injury?

  • Does the pain localize to a specific part of the knee?

  • Are there mechanical symptoms?

  • Is a joint effusion present?

  • Is there evidence of systemic disease?

Table 10–1.Knee pain: core elements of the history.

The answers to these questions help the clinician narrow the differential diagnosis and develop a strategy for additional evaluations of the knee pain.

The examiner should take into account the age and sex of the patient, both of which can influence the differential diagnosis. Finally, the clinician should bear in mind that pain can be referred to the knee from other sites, most notably the ipsilateral hip. Every patient with knee pain should have a careful examination of the hip.

Approach to the Physical Examination of the Knee

Examination of the knee has five major components: observation of stance and gait, range of motion, palpation, examination for a knee effusion, and stability tests. The clinician can generate a differential diagnosis and then focus the workup accordingly after taking a careful history and then performing a history-guided examination. Examination of the knee is guided by an understanding of the knee’s anatomy (Figure 10–1).

Figure 10–1.

Functional anatomy of the knee.

A. Observation of Stance and Gait

Physical examination should start with observation of stance and gait. Can the patient bear weight on the affected leg? Is there a limp? Attention should be paid to medial or lateral translation of the knee upon heel strike. Angular deformities (varus = bow-legged; valgus = knock-kneed) can identify bone and cartilage erosion with secondary ...

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