Knee Pain Evaluation and Diagnosis Quiz

Evaluation of Knee Pain and Diagnosis

• Laboratory examination can play a confirmatory or diagnostic role when initial history and physical examination suggest but do not confirm a specific diagnosis.
• Workup could include serology for suspected inflammatory conditions, autoimmune conditions, or microscopic examination of arthrocentesis fluid for gouty crystals or evidence of bacterial infection.
• A PubMed search was completed using Clinical Queries and the search terms knee pain, evaluation, history, examination, radiographic imaging, laboratory, diagnosis, effusion, gout, and pseudogout.
• The search included meta-analyses, randomized controlled trials, clinical trials, and reviews.
• Increasing prevalence of knee pain and symptomatic knee osteoarthritis has been reported in survey and cohort data.
• General practitioner diagnosis and management of acute knee injuries were summarized in an evidence-based guideline.
• The Thessaly test and a new clinical test (the Thessaly test) were validated for early detection of meniscal tears.
• EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis were provided.
• Epidemiology of osteoarthritis and diagnosis and treatment of gout and pseudogout for everyday practice were discussed.
• Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries was conducted.
• American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships.
• The accuracy of the Ottawa knee rule to rule out knee fractures was systematically reviewed.

Knee Examination and Diagnostic Imaging in Primary Care

• Family physicians should inquire about previous knee or joint pain, injuries, surgeries, systemic medical conditions, and family history of autoimmune and degenerative conditions.
• Established risk factors for knee osteoarthritis include personal history of knee injury or surgery, family history of knee osteoarthritis or joint replacement, age older than 50 years, female gender, and being overweight.
• A systematic approach to knee examination involves inspection, palpation, range of motion and strength evaluation, neurovascular assessment, and special (provocative) tests.
• Specific manifestations of knee conditions, such as pes anserine bursitis and plica, should be noted during palpation.
• Neurovascular examination of the knee includes assessment of sensation, tendon reflexes, and palpation of pulses.
• Special (provocative) tests are used to assess specific structures of the knee and may be limited by pain and effusion in the acute setting.
• Radiography may be necessary for undifferentiated knee pain, but should be reserved for chronic knee pain of more than six weeks duration or acute traumatic pain in specific cases.
• The Ottawa Knee Rule is a validated tool that decreases unnecessary radiography by 28% to 35% in patients with an acutely injured knee.
• The Pittsburgh Knee Rule appears to be more sensitive than the Ottawa rule in reducing unnecessary radiography.
• Recommended radiographic views for knee evaluation include anteroposterior, lateral, and Merchant's views, with additional oblique views for specific assessments.
• Weight-bearing radiographs should be obtained if osteoarthritis is suspected to assess for joint-space narrowing, subchondral sclerosis, osteophytes, and bony cysts.
• Musculoskeletal ultrasonography allows for limited evaluation of effusions, cysts, tendons, ligaments, muscles, vasculature, and nerves, and can assess mechanical complaints.