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Knee Pain

Knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is a common presentation to primary care physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship. The diagnosis can be challenging as the pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways may arise from the joint, surrounding tissues, or referred to the joint from distant structures. The differential diagnosis of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is broad and categorizing the various diagnoses related to the timing (acute or chronic) is useful. A thorough understanding Understanding Decision-making Capacity and Legal Competence of pertinent anatomy, appropriate physical examination, and common problems of the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy are essential for diagnosis and proper management of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways. Exercise-based therapy is often the 1st-line management of many knee disorders, but surgical intervention is warranted for specific diagnoses.

Last updated: 21 Jun, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Overview

Epidemiology

  • Prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways with increasing age 
  • Prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways with increasing BMI BMI An indicator of body density as determined by the relationship of body weight to body height. Bmi=weight (kg)/height squared (m2). Bmi correlates with body fat (adipose tissue). Their relationship varies with age and gender. For adults, bmi falls into these categories: below 18. 5 (underweight); 18. 5-24. 9 (normal); 25. 0-29. 9 (overweight); 30. 0 and above (obese). Obesity
  • The knee is the most common joint affected by osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis ( OA OA Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis). 
  • Osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis is the most common cause of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways in people 50 years of age or older.
  • Women > men
  • A common complaint of runners and athletes

Anatomy of the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy

  • Largest and most complex joint of the human body
  • Synovial hinge joint
  • Supporting structures include:
    • Joint capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides
    • Lateral and medial menisci Menisci Meniscus Tear
    • Multiple ligaments for mobility Mobility Examination of the Breast and stability of the knee

Categories of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways

  • Acute knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
    • Trauma
    • Acute exacerbation of chronic knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Infection
    • Rheumatological problem
  • Chronic knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
    • Overuse
    • OA OA Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
    • Tendinopathies
    • Patellar instability
    • Patellofemoral pain syndrome Patellofemoral pain syndrome A syndrome characterized by retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. The pain is most prominent when ascending or descending stairs, squatting, or sitting with flexed knees. There is a lack of consensus on the etiology and treatment. The syndrome is often confused with (or accompanied by) chondromalacia patellae, the latter describing a pathological condition of the cartilage and not a syndrome. Examination of the Lower Limbs (PFPS)
  • Knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways without trauma:

Clinical Presentation and Diagnosis

History

Obtaining a clear history is essential to making the correct diagnosis and guiding the examination:

  • Location for common problems:
    • Anterior: 
      • PFPS
      • Patellofemoral compartment osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
      • Patellar tendonitis Tendonitis Reactive Arthritis
      • Osgood-Schlatter disease Osgood-Schlatter Disease Osgood-Schlatter disease, or apophysitis of the tibial tubercle, is a common orthopedic condition seen in children between 10 and 15 years of age. The disease is caused by the repetitive application of mechanical forces on the knee, leading to microtrauma on the ossification center at the site of insertion of the distal patellar ligament. Osgood-Schlatter Disease
    • Medial: 
      • Medial collateral ligament Medial collateral ligament Knee Joint: Anatomy ( MCL MCL Knee Joint: Anatomy) sprain
      • Medal compartment osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis (most commonly affected compartment)
      • Medial meniscus tear Meniscus tear The menisci are fibrocartilaginous wedge-shaped structures between the distal femur and proximal tibia that stabilize and dissipate weight-bearing forces at the knee joint. A meniscus tear is an injury to the meniscus caused by rotational or shearing forces across the tibiofemoral joint. Meniscus Tear
      • Pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura anserine bursitis
    • Lateral: 
      • Lateral meniscus tear Meniscus tear The menisci are fibrocartilaginous wedge-shaped structures between the distal femur and proximal tibia that stabilize and dissipate weight-bearing forces at the knee joint. A meniscus tear is an injury to the meniscus caused by rotational or shearing forces across the tibiofemoral joint. Meniscus Tear
      • Lateral compartment osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
      • Iliotibial band Iliotibial band Thigh: Anatomy syndrome (ITBS)
  • Exacerbating and alleviating factors
  • Presence of swelling Swelling Inflammation/effusion
  • Mechanical symptoms (consider meniscus or cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology lesion):
    • Clicking/popping
    • Catching/locking
  • Previous surgery/procedures
  • Systemic signs/symptoms:
    • Fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever
    • Chills Chills The sudden sensation of being cold. It may be accompanied by shivering. Fever
    • Erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion
  • Remember: Knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways may be referred from hip pathology (especially in children).

Physical examination

The exam is directed by the duration and type of injury (acute or chronic) and the age of the individual. Comparison of the healthy knee is important:

  • Observation:
    • Previous surgical scars
    • Stance and gait Gait Manner or style of walking. Neurological Examination:
      • Limp
      • Inability to bear weight
    • Angular deformities:
      • Genu varum Genu varum Genu varum is a deformation of the knee joint(s) that creates angulation of the lower limb(s) away from the midline in the coronal plane. Children ages 1-5 years are commonly affected. Genu Varum (bowleg)
      • Genu valgum Genu valgum Genu valgum is a deformation of the knee joint(s) that creates angulation of the lower limb(s) toward the midline in the coronal plane. Children ages 1-5 years are commonly affected. Genu Valgum (knock-knee)
    • Swelling Swelling Inflammation, erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion, ecchymosis Ecchymosis Extravasation of blood into the skin, resulting in a nonelevated, rounded or irregular, blue or purplish patch, larger than a petechia. Orbital Fractures
    • Ability to perform a deep squat
    • Muscle atrophy Atrophy Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. Cellular Adaptation
  • Range of Motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs (ROM): 
  • Palpation Palpation Application of fingers with light pressure to the surface of the body to determine consistency of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. Dermatologic Examination:
    • Generally performed with the knee at 90 degrees of flexion Flexion Examination of the Upper Limbs while seated or supine with 20–30 degrees of flexion Flexion Examination of the Upper Limbs
    • Joint line palpation Palpation Application of fingers with light pressure to the surface of the body to determine consistency of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. Dermatologic Examination:
      • Meniscus injury
      • Collateral ligaments
      • OA OA Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
      • Fat pad
    • Anterior:
    • Medially: 
      • MCL MCL Knee Joint: Anatomy
      • Pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura anserine tendons
      • Pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura anserine bursitis 
    • Laterally: 
    • Posterior:
    • Crepitus Crepitus Osteoarthritis
    • Excessive warmth
    • Effusion:
      • Ballottement of the patella Patella The flat, triangular bone situated at the anterior part of the knee. Knee Joint: Anatomy
      • “Fluid wave” for smaller effusions
    • Strength and neurovascular testing:
      • Lower extremity neurological exam
      • Assessment of distal pulses
Table: Special exam maneuvers when examining an individual with knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
Injury Maneuver
ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy injury
  • Anterior drawer test:
    • Flex knee to 90 degrees and translate the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy with anteriorly directed force.
    • Laxity in anterior translation Translation Translation is the process of synthesizing a protein from a messenger RNA (mRNA) transcript. This process is divided into three primary stages: initiation, elongation, and termination. Translation is catalyzed by structures known as ribosomes, which are large complexes of proteins and ribosomal RNA (rRNA). Stages and Regulation of Translation indicates ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy injury.
  • Lachman test Lachman Test Knee Ligament Injuries:
    • Most sensitive test for ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy rupture
    • Flex knee to 30 degrees and translate the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy with anteriorly directed force.
    • Laxity in anterior translation Translation Translation is the process of synthesizing a protein from a messenger RNA (mRNA) transcript. This process is divided into three primary stages: initiation, elongation, and termination. Translation is catalyzed by structures known as ribosomes, which are large complexes of proteins and ribosomal RNA (rRNA). Stages and Regulation of Translation indicates ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy injury.
  • Pivot shift Pivot Shift Examination of the Lower Limbs:
    • Individual supine with fully extended knee
    • Place an internal rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays and valgus force on the proximal tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy while flexing the knee.
    • “Clunk” with flexion Flexion Examination of the Upper Limbs indicates ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy injury.
PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy injury
  • Posterior drawer test Posterior Drawer Test Knee Ligament Injuries:
    • Flex the knee to 90 degrees and translate the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy with posteriorly directed force.
    • Laxity in posterior translation Translation Translation is the process of synthesizing a protein from a messenger RNA (mRNA) transcript. This process is divided into three primary stages: initiation, elongation, and termination. Translation is catalyzed by structures known as ribosomes, which are large complexes of proteins and ribosomal RNA (rRNA). Stages and Regulation of Translation indicates PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy injury.
  • Quadriceps active test Quadriceps Active Test Knee Ligament Injuries:
    • With the knee extended, ask the individual to raise the leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy off the table while supine.
    • Assess for posterior subluxation Subluxation Radial Head Subluxation (Nursemaid’s Elbow) of the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy as the upper leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy moves anteriorly (indicates injured PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy).
MCL MCL Knee Joint: Anatomy injury Valgus stress test for MCL MCL Knee Joint: Anatomy instability:
LCL injury Varus stress test Varus Stress Test Knee Ligament Injuries for lateral instability:
Meniscal tear
ITBS
PFPS
ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy: anterior cruciate ligament Anterior Cruciate Ligament A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy
PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy: posterior cruciate ligament Posterior Cruciate Ligament A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy
MCL MCL Knee Joint: Anatomy: medial collateral ligament Medial collateral ligament Knee Joint: Anatomy
LCL: lateral collateral ligament Lateral collateral ligament Knee Joint: Anatomy
ITBS: iliotibial band Iliotibial band Thigh: Anatomy syndrome
ITB: iliotibial band Iliotibial band Thigh: Anatomy
PFPS: patellofemoral pain syndrome Patellofemoral pain syndrome A syndrome characterized by retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. The pain is most prominent when ascending or descending stairs, squatting, or sitting with flexed knees. There is a lack of consensus on the etiology and treatment. The syndrome is often confused with (or accompanied by) chondromalacia patellae, the latter describing a pathological condition of the cartilage and not a syndrome. Examination of the Lower Limbs
Four exams used to determine the cause of knee pain

Four exams to determine the cause of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways: anterior drawer test, Lachman test Lachman Test Knee Ligament Injuries, pivot test, and McMurray test Mcmurray Test Meniscus Tear

Image by Lecturio.

Imaging

  • Used as an adjunct to the history and physical examination
  • Plain X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests clinical decision-making tools:
    • The Ottawa knee rules and the Pittsburgh knee rules are helpful in the acute care setting to decide if an individual should receive imaging of the knee.
    • Ottawa knee rules apply to individuals > 2 years of age with knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways/tenderness in the setting of trauma (images not needed if all negative):
    • Pittsburgh knee rules apply to all individuals with an acute injury in the past week, without prior knee surgery or ED evaluation (images not needed if all negative):
      • < 12 years of age
      • > 50 years of age
      • Inability to walk 4 weight-bearing steps
  • MRI:
  • Ultrasound: 
    • Assess soft tissues around the knee (e.g., tendons, collateral ligaments).
    • May be helpful for aspiration/injections

Related videos

Differential Diagnosis of Knee Pain

The assessment of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is challenging. One approach to the differential diagnosis is to group the various conditions based on the acuteness of the presentation, the presence or absence of effusion, and the precipitating activities.

Traumatic knee injuries

Table: Causes of traumatic knee injuries with significant swelling Swelling Inflammation
Condition Mechanism Features Diagnosis
ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy tear
  • Sudden change in direction
  • Rapid deceleration Deceleration A decrease in the rate of speed. Blunt Chest Trauma
  • Landing from a jump
  • Frequently noncontact
  • Audible “pop” at the time of injury
  • Rapid swelling Swelling Inflammation ( hemarthrosis Hemarthrosis Bleeding into the joints. It may arise from trauma or spontaneously in patients with hemophilia. Hemophilia)
  • Joint instability
PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy tear
  • Direct blow to the proximal anterior tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy
  • E.g., dashboard injury, landing on a flexed knee
  • Hyperextension injury
Meniscus tear Meniscus tear The menisci are fibrocartilaginous wedge-shaped structures between the distal femur and proximal tibia that stabilize and dissipate weight-bearing forces at the knee joint. A meniscus tear is an injury to the meniscus caused by rotational or shearing forces across the tibiofemoral joint. Meniscus Tear
  • Twisting mechanism with the foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy planted
  • Associated meniscus cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology degeneration
  • Tearing/popping sensation
  • Locking/catching
  • ↓ ROM
Patellar dislocation Pivoting or sudden change in direction
  • Apprehension
  • Laxity
  • Effusion
  • Clinical diagnosis
Patellar ligament Patellar ligament A band of fibrous tissue that attaches the apex of the patella to the lower part of the tubercle of the tibia. The ligament is actually the caudal continuation of the common tendon of the quadriceps femoris. The patella is embedded in that tendon. As such, the patellar ligament can be thought of as connecting the quadriceps femoris tendon to the tibia, and therefore it is sometimes called the patellar tendon. Osgood-Schlatter Disease tear
  • Sudden, forceful stop or start (eccentric mechanism)
  • Trying to prevent a fall
  • Inability to extend
  • Infrapatellar swelling Swelling Inflammation
  • Superior patella Patella The flat, triangular bone situated at the anterior part of the knee. Knee Joint: Anatomy displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms
  • Clinical diagnosis
  • Ultrasound or MRI to confirm
Quadriceps tendon Quadriceps tendon Knee Joint: Anatomy tear
  • Sudden forceful stop or start (eccentric mechanism)
  • Trying to prevent a fall
  • Inability to extend
  • Suprapatellar swelling Swelling Inflammation
  • Inferior patella Patella The flat, triangular bone situated at the anterior part of the knee. Knee Joint: Anatomy displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms
  • Clinical diagnosis
  • Ultrasound or MRI to confirm
Intra-articular fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures
  • High-speed trauma
  • Contact sports
  • Large effusion
  • Lipohemarthrosis
  • X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests
  • CT for further evaluation
ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy: anterior cruciate ligament Anterior Cruciate Ligament A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy
PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy: posterior cruciate ligament Posterior Cruciate Ligament A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy
Table: Causes of traumatic knee injuries with minimal swelling Swelling Inflammation
Condition Mechanism Features Diagnosis
MCL MCL Knee Joint: Anatomy sprain
  • Valgus force to the knee
  • Most commonly injured knee ligament
  • Medial knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Feeling of instability
  • Positive valgus stress test
  • MRI to confirm
LCL sprain Varus force to the knee
  • Lateral knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Feeling of instability
MCL MCL Knee Joint: Anatomy: medial collateral ligament Medial collateral ligament Knee Joint: Anatomy
LCL: lateral collateral ligament Lateral collateral ligament Knee Joint: Anatomy

Atraumatic knee injuries

Table: Causes and features of atraumatic knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways with significant effusion
Condition Features
Knee osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
  • Articular cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology loss and bone remodeling Bone remodeling The continuous turnover of bone matrix and mineral that involves first an increase in bone resorption (osteoclastic activity) and later, reactive bone formation (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium homeostasis. An imbalance in the regulation of bone remodeling’s two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as osteoporosis. Bones: Remodeling and Healing
  • Risk factors:
    • > 50 years of age
    • Women > men
    • BMI BMI An indicator of body density as determined by the relationship of body weight to body height. Bmi=weight (kg)/height squared (m2). Bmi correlates with body fat (adipose tissue). Their relationship varies with age and gender. For adults, bmi falls into these categories: below 18. 5 (underweight); 18. 5-24. 9 (normal); 25. 0-29. 9 (overweight); 30. 0 and above (obese). Obesity
    • Previous injury or infection
  • History:
    • Insidious onset of activity-related pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Brief stiffness after inactivity or in the morning (gelling)
    • Slowly ↓ ROM
  • Exam:
  • Diagnosis:
    • Clinical diagnosis
    • X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests confirmation
  • Radiographs: joint-space narrowing, sclerosis Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Wilms Tumor, osteophytes, and subchondral cysts Subchondral Cysts Osteoarthritis
Crystal arthropathy Arthropathy Osteoarthritis
  • Acute episode of:
    • Severe pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Swelling Swelling Inflammation
    • Potentially large effusion
    • Erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion in 1 or more joints
  • Diagnosis by synovial fluid analysis Synovial Fluid Analysis Rheumatoid Arthritis:
    • Gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout: urate crystals (negative birefringence)
    • CPPD or pseudogout:
      • CPPD crystals
      • Chondrocalcinosis Chondrocalcinosis Presence of calcium pyrophosphate in the connective tissues such as the cartilaginous structures of joints. When accompanied by gout-like symptoms, it is referred to as pseudogout. Gitelman Syndrome on X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests
Septic arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis
  • Infection of 1 or more joints
  • Most commonly bacterial, but includes fungal and viral infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease
  • Risk factors:
    • ↑ Age
    • IV drug abuse
    • DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
    • Immunosuppression
    • Prosthetic joint
    • Previous surgery
  • Most common organisms:
    • Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess
    • Streptococcal species
  • Presentation:
    • Acute pain Acute pain Intensely discomforting, distressful, or agonizing sensation associated with trauma or disease, with well-defined location, character, and timing. Pain Management
    • Large effusion
    • ↑ Warmth
    • ↓ ROM without a history of trauma
    • Systemic signs and symptoms
  • Diagnosis:
    • Arthrocentesis Arthrocentesis Puncture and aspiration of fluid (e.g., synovial fluid) from a joint cavity. It is used sometimes to irrigate or administer drugs into a joint cavity. Septic Arthritis:
    • Blood cultures Cultures Klebsiella
    • CBC and inflammatory markers
Rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis
  • Presentation:
  • Involves the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy in ⅓ of individuals
  • Exam:
    • Large effusions
    • Thickening of the synovium
ROM: range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
CPPD: calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes pyrophosphate dihydrate deposition disease
DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus: diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
CBC: complete blood count
Table: Atraumatic knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways presenting without significant joint effusion Joint Effusion Septic Arthritis (by location)
Condition Features
Anterior knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
Tibial tubercle Tibial Tubercle Osgood-Schlatter Disease apophysitis Apophysitis Osgood-Schlatter Disease (Osgood-Schlatter)
  • Apophysitis Apophysitis Osgood-Schlatter Disease of the developing tibial tuberosity Tibial tuberosity Leg: Anatomy
  • Presentation:
  • Exam: tenderness and prominence at the tibial tubercle Tibial Tubercle Osgood-Schlatter Disease, no effusion
  • X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests not routinely indicated
SCFE SCFE Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis
  • Slippage of the proximal femoral epiphysis Epiphysis The head of a long bone that is separated from the shaft by the epiphyseal plate until bone growth stops. At that time, the plate disappears and the head and shaft are united. Bones: Structure and Types on the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess at the proximal femoral physis (growth plate)
  • Common in children with endocrine disorders and obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity
  • Referred pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways to the ipsilateral knee, limp
Prepatellar bursitis
  • Inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation and swelling Swelling Inflammation of the prepatellar bursa Prepatellar bursa Knee Joint: Anatomy
  • Etiology: pressure from excessive kneeling (“housemaid’s knee”)
  • 3 primary categories:
    • Traumatic: acute or chronic trauma ( noninfectious Noninfectious Febrile Infant)
    • Infectious Infectious Febrile Infant: Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess most common
    • Crystal disease: gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout
Patellofemoral pain syndrome Patellofemoral pain syndrome A syndrome characterized by retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. The pain is most prominent when ascending or descending stairs, squatting, or sitting with flexed knees. There is a lack of consensus on the etiology and treatment. The syndrome is often confused with (or accompanied by) chondromalacia patellae, the latter describing a pathological condition of the cartilage and not a syndrome. Examination of the Lower Limbs
  • Common
  • Seen in runners/cyclists
  • Other risk factors:
    • Women
    • Dynamic valgus
    • Patellar instability
  • Presentation:
    • Dull
    • Vague pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways under the patella Patella The flat, triangular bone situated at the anterior part of the knee. Knee Joint: Anatomy
    • Occurs climbing stairs or after prolonged sitting
  • Diagnosis: based on clinical presentation
  • Radiographs: generally not indicated
Medial knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
Pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura anserine bursitis
  • Inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the bursa between the tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy and the 3 tendons of the pes PES Removal of plasma and replacement with various fluids, e.g., fresh frozen plasma, plasma protein fractions (ppf), albumin preparations, dextran solutions, saline. Used in treatment of autoimmune diseases, immune complex diseases, diseases of excess plasma factors, and other conditions. Thrombotic Thrombocytopenic Purpura anserine region:
  • Seen with obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity and overuse
  • Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways along the anteromedial tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy
Lateral knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
ITBS
  • Insidious onset of lateral knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Related to overuse
  • Primarily in runners, but also with exercise
  • Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways when the ITB crosses over the lateral femoral condyle
Posterior knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
Popliteal (Baker) cyst
  • Most common mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in popliteal fossa Popliteal fossa The popliteal fossa or the “knee pit” is a diamond-shaped, fat-filled, shallow depression on the posterior aspect of the knee joint. The popliteal fossa is located at the dorsal aspect of the knee and contains an increased number of lymph nodes as well as structures of the neurovascular system that travel from the thigh to the lower leg. Popliteal Fossa: Anatomy
  • Cyst arises in association with OA OA Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis or inflammatory arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis of the knee.
  • Result of extrusion of fluid from the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy space into the semimembranosus Semimembranosus Thigh: Anatomy and gastrocnemius Gastrocnemius Leg: Anatomy bursa
  • Presentation:
  • Diagnosis made on clinical exam (US or MRI)
  • Complications include:
    • Pseudothrombophlebitis: acute cyst rupture resembling DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis
    • US can rule out DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis and confirm a popliteal cyst Popliteal cyst A synovial cyst most commonly at the back of the knee. Osteoarthritis.

SCFE SCFE Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis: slipped capital femoral epiphysis Slipped Capital Femoral Epiphysis Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis
ITBS: iliotibial band Iliotibial band Thigh: Anatomy syndrome
ITB: iliotibial band Iliotibial band Thigh: Anatomy
OA OA Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis: osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
US: ultrasound
DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis: deep vein thrombosis Thrombosis Formation and development of a thrombus or blood clot in the blood vessel. Epidemic Typhus

Referred pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways

  • Individual presents with:
    • Vaguely localized knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • No focal tenderness
    • No inflammatory signs
  • Associated with disorders affecting the lumbar spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy, sacroiliac joint Sacroiliac Joint The immovable joint formed by the lateral surfaces of the sacrum and ilium. Pelvis: Anatomy, or hip joint Hip joint The hip joint is a ball-and-socket joint formed by the head of the femur and the acetabulum of the pelvis. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several ligaments, allowing the joint to sustain forces that can be multiple times the total body weight. Hip Joint: Anatomy:
    • Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is referred from the hip (i.e., OA OA Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis in adults, slipped capital femoral epiphysis Slipped Capital Femoral Epiphysis Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis ( SCFE SCFE Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis) in adolescents).
    • Radicular pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways: most commonly the L5, S1 S1 Heart Sounds nerve roots
  • Uncommon causes of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
    • Benign Benign Fibroadenoma and malignant bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types tumors
    • The knee is a common site.
    • Presentation: 
    • The main determinants in the analysis of bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types tumors include:
      • Morphology of bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types lesion:
        • Well or ill-defined
        • Presence of sclerosis Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Wilms Tumor
      • Age of individual
    • Benign Benign Fibroadenoma bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types tumors:
    • Malignant bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types tumors: 
      • Uncommon
      • Causes significant morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status and mortality Mortality All deaths reported in a given population. Measures of Health Status
      • Osteosarcoma Osteosarcoma Osteosarcoma is a primary malignant tumor of the bone characterized by the production of osteoid or immature bone by the tumor cells. The disease is most common in children and young adults and most frequently affects growth plates of the long bones, although it can involve any bone. Osteosarcoma is the most common bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types cancer.
      • Bone-marrow cancers include multiple myeloma Multiple myeloma Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies. Multiple Myeloma, lymphoma Lymphoma A general term for various neoplastic diseases of the lymphoid tissue. Imaging of the Mediastinum, and leukemia.

Management

  • Effective management of knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is dependent on the correct diagnosis. 
  • Many disorders causing knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways can be treated nonoperatively.
  • Some injuries require operative management.
Table: General guidelines for managing knee pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
Condition Management
ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy injury
  • Initial management: RICE
  • Consider nonoperative management in:
    • Older, sedentary individuals
    • Individuals willing to modify activity
  • Consider operative management:
    • Associated injuries
    • Active young adults
    • Individuals with recurrent instability after a trial of PT
  • Both autograft Autograft Transplant comprised of an individual’s own tissue, transferred from one part of the body to another. Organ Transplantation and processed allograft tissues are used for reconstruction.
PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy injuries
  • Frequently injured in combination with other ligaments
  • Initial management: RICE therapy
  • Lesser-grade and partial tears are nonoperative.
  • Higher-grade and full-thickness tears need surgery.
Meniscal injuries
  • Initially: ROM, ice/elevation, and crutches to limit Limit A value (e.g., pressure or time) that should not be exceeded and which is specified by the operator to protect the lung Invasive Mechanical Ventilation weight bearing
  • Arthroscopic evaluation for persistent symptoms, “locked” knee, a large/complex tear, and other associated injuries
MCL MCL Knee Joint: Anatomy injury
  • Most commonly injured knee ligament
  • Isolated MCL MCL Knee Joint: Anatomy injury is often treated nonoperatively:
    • RICE initially with weight bearing as tolerated
    • Hinged knee brace with protected motion
  • Often associated with other ligamentous injuries ( ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy tear)
Osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
  • Exercise therapy (preferably non-weight bearing) is the cornerstone to management (e.g., swimming, water aerobics, cycling).
  • Weight loss Weight loss Decrease in existing body weight. Bariatric Surgery (if overweight)
  • Glucosamine/chondroitin (limited evidence of efficacy)
  • Topical treatments: NSAIDs NSAIDS Primary vs Secondary Headaches, capsaicin
  • Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways management: NSAIDS NSAIDS Primary vs Secondary Headaches, acetaminophen Acetaminophen Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen
  • Intra-articular glucocorticoids Glucocorticoids Glucocorticoids are a class within the corticosteroid family. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily benefit from the antiinflammatory and immunosuppressive effects of this class of drugs. Glucocorticoids (limited length of benefit)
  • Biologics (limited evidence)
  • Surgical intervention
Crystal arthropathy Arthropathy Osteoarthritis: gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout and CPPD Gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout management:
  • Patient education:
  • Manage acute attacks:
    • Colchicine Colchicine A major alkaloid from colchicum autumnale l. And found also in other colchicum species. Its primary therapeutic use is in the treatment of gout. Gout Drugs or other NSAIDs NSAIDS Primary vs Secondary Headaches
    • Consider glucocorticoids Glucocorticoids Glucocorticoids are a class within the corticosteroid family. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily benefit from the antiinflammatory and immunosuppressive effects of this class of drugs. Glucocorticoids: oral or intra-articular
  • Urate lowering therapy: long-term prophylactic medications for recurrent attacks:
    • Allopurinol Allopurinol A xanthine oxidase inhibitor that decreases uric acid production. It also acts as an antimetabolite on some simpler organisms. Gout Drugs
    • Febuxostat Febuxostat A thiazole derivative and inhibitor of xanthine oxidase that is used for the treatment of hyperuricemia in patients with chronic gout. Gout Drugs
    • Uricosuric agent: probenecid Probenecid The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. Gout Drugs
CPPD (pseudogout):
  • Initial treatment: aspiration and intra-articular glucocorticoids Glucocorticoids Glucocorticoids are a class within the corticosteroid family. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily benefit from the antiinflammatory and immunosuppressive effects of this class of drugs. Glucocorticoids
  • Oral glucocorticoids Glucocorticoids Glucocorticoids are a class within the corticosteroid family. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily benefit from the antiinflammatory and immunosuppressive effects of this class of drugs. Glucocorticoids may be considered.
  • NSAIDs NSAIDS Primary vs Secondary Headaches
  • Prophylaxis Prophylaxis Cephalosporins:
    • Colchicine Colchicine A major alkaloid from colchicum autumnale l. And found also in other colchicum species. Its primary therapeutic use is in the treatment of gout. Gout Drugs
    • NSAIDs NSAIDS Primary vs Secondary Headaches
    • Methotrexate Methotrexate An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of tetrahydrofolate dehydrogenase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. Antimetabolite Chemotherapy
Septic arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis
  • Emergent aspiration
  • Debridement Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. Stevens-Johnson Syndrome and irrigation of the joint
  • IV antibiotics
PFPS
  • Exercise therapy (quadricep and hip strengthening)
  • Avoid pain-aggravating activities.
  • Adjuncts to exercise therapy:
    • Patellofemoral bracing
    • Kinesiotaping (limited evidence)
  • Surgical interventions lack evidence.
Popliteal (Baker) cyst
  • Cyst arises secondary to underlying joint disease.
  • If no response to intra-articular injection, consider direct cyst aspiration and injection.
  • Surgical excision: very rare
ACL ACL A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy: anterior cruciate ligament Anterior Cruciate Ligament A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Knee Joint: Anatomy
RICE: rest, ice, compression Compression Blunt Chest Trauma, and elevation
PT: physical therapy Physical Therapy Becker Muscular Dystrophy
PCL PCL A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy: posterior cruciate ligament Posterior Cruciate Ligament A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. Knee Joint: Anatomy
ROM: range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
MCL MCL Knee Joint: Anatomy: medial collateral ligament Medial collateral ligament Knee Joint: Anatomy
NSAIDs NSAIDS Primary vs Secondary Headaches: non-steroidal anti-inflammatory drugs
CPPD: calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes pyrophosphate dihydrate crystal deposition disease
PFPS: patellofemoral pain syndrome Patellofemoral pain syndrome A syndrome characterized by retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. The pain is most prominent when ascending or descending stairs, squatting, or sitting with flexed knees. There is a lack of consensus on the etiology and treatment. The syndrome is often confused with (or accompanied by) chondromalacia patellae, the latter describing a pathological condition of the cartilage and not a syndrome. Examination of the Lower Limbs

Clinical Relevance

  • The knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy is made up of articulations between the femur, tibia Tibia The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. Knee Joint: Anatomy, and patella Patella The flat, triangular bone situated at the anterior part of the knee. Knee Joint: Anatomy bones. The knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion Flexion Examination of the Upper Limbs and extension Extension Examination of the Upper Limbs. The supporting structures include a joint capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides, the lateral and medial menisci Menisci Meniscus Tear, and multiple ligaments, which help to ensure the mobility Mobility Examination of the Breast and stability of the knee.
  • Osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis is due to cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology destruction and changes of the subchondral bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types. The risk of developing the disorder increases with age, obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity, and repetitive joint use or trauma. Individuals have joint pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, stiffness, and decreased ROM. Physical exam may reveal crepitus Crepitus Osteoarthritis with joint motion and osteophyte Osteophyte Bony outgrowth usually found around joints and often seen in conditions such as arthritis. Osteoarthritis formation. The diagnosis is clinical and supported with radiographic joint findings. Management is conservative.
  • Rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis is a symmetric, inflammatory polyarthritis Polyarthritis Rheumatoid Arthritis. Rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis is a chronic, progressive, autoimmune disorder Autoimmune Disorder Septic Arthritis most commonly presenting in middle-aged women with joint swelling Swelling Inflammation, pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, and morning stiffness. The diagnosis is by the presence of rheumatoid factor Rheumatoid factor Antibodies found in adult rheumatoid arthritis patients that are directed against gamma-chain immunoglobulins. Autoimmune Hepatitis, anti-cyclic citrullinated peptide antibodies Antibodies Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution. Immunoglobulins: Types and Functions, and image findings. Management involves antirheumatic drugs, biologic agents Biologic Agents Immunosuppressants, and physical therapy Physical Therapy Becker Muscular Dystrophy
  • Gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout is a metabolic disease associated with elevated serum uric acid Uric acid An oxidation product, via xanthine oxidase, of oxypurines such as xanthine and hypoxanthine. It is the final oxidation product of purine catabolism in humans and primates, whereas in most other mammals urate oxidase further oxidizes it to allantoin. Nephrolithiasis levels and abnormal deposits of monosodium urate in tissues. Gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout is often familial and initially characterized by painful, recurring, monoarticular swollen joints, followed by chronic deforming arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis. Management is with NSAIDs NSAIDS Primary vs Secondary Headaches, steroids Steroids A group of polycyclic compounds closely related biochemically to terpenes. They include cholesterol, numerous hormones, precursors of certain vitamins, bile acids, alcohols (sterols), and certain natural drugs and poisons. Steroids have a common nucleus, a fused, reduced 17-carbon atom ring system, cyclopentanoperhydrophenanthrene. Most steroids also have two methyl groups and an aliphatic side-chain attached to the nucleus. Benign Liver Tumors, or urate-lowering therapy.
  • Calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes pyrophosphate crystal deposition disease (CPPD) occurs secondary to the deposition of calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes pyrophosphate dihydrate crystals in the periarticular tissues of joints and soft tissues. The disease, also known as pseudogout, can produce joint inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation similar to gout Gout Gout is a heterogeneous metabolic disease associated with elevated serum uric acid levels (> 6.8 mg/dL) and abnormal deposits of monosodium urate in tissues. The condition is often familial and is initially characterized by painful, recurring, and usually monoarticular acute arthritis, or “gout flare,” followed later by chronic deforming arthritis. Gout. Management is with colchicine Colchicine A major alkaloid from colchicum autumnale l. And found also in other colchicum species. Its primary therapeutic use is in the treatment of gout. Gout Drugs, NSAIDS NSAIDS Primary vs Secondary Headaches, and methotrexate Methotrexate An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of tetrahydrofolate dehydrogenase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. Antimetabolite Chemotherapy.
  • Slipped capital femoral epiphysis Slipped Capital Femoral Epiphysis Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis ( SCFE SCFE Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis) is an orthopedic disorder of early adolescence characterized by the pathological “slipping” or displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms of the femoral head, or epiphysis Epiphysis The head of a long bone that is separated from the shaft by the epiphyseal plate until bone growth stops. At that time, the plate disappears and the head and shaft are united. Bones: Structure and Types, on the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess. The disorder is due to a combination of biomechanical and endocrine factors. Diagnosis is made with an X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests of the hip. Treatment ranges from conservative to surgical and prognosis Prognosis A prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas depends on the severity of the slip or displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms.

References

  1. Covey, C. (2020). Approach to the adult with unspecified knee pain. UpToDate. Retrieved June 9, 2021, from https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-knee-pain
  2. Beutler, A. & Fields, K. (2021). Approach to the adult with knee pain likely of musculoskeletal origin. UpToDate. Retrieved June 9, 2021, from https://www.uptodate.com/contents/approach-to-the-adult-with-knee-pain-likely-of-musculoskeletal-origin
  3. Modarresi, S. & Matilda C. (2020). Radiologic evaluation of the acutely painful knee in adults. UpToDate. Retrieved June 9, 2021, from https://www.uptodate.com/contents/radiologic-evaluation-of-the-acutely-painful-knee-in-adults
  4. Evans, J., & Nielson, J. L. (2021). Anterior cruciate ligament knee injuries. StatPearls. Retrieved June 9, 2021, from http://www.ncbi.nlm.nih.gov/books/NBK499848/
  5. Naqvi, U., & Sherman, A. L. (2021). Medial collateral ligament knee injuries. StatPearls. Retrieved June 9, 2021, from http://www.ncbi.nlm.nih.gov/books/NBK431095/
  6. Yaras, R. J., O’Neill, N., & Yaish, A. M. (2021). Lateral collateral ligament knee injuries. StatPearls. http://www.ncbi.nlm.nih.gov/books/NBK560847/
  7. Martin, S. N., & DeWeber, K. (2019). Lateral collateral ligament injury and related posterolateral corner injuries of the knee. UpToDate. Retrieved June 10, 2021, from https://www.uptodate.com/contents/lateral-collateral-ligament-injury-and-related-posterolateral-corner-injuries-of-the-knee
  8. MacDonald, J. & Rodenberg, R. (2019). Posterior cruciate ligament injury. UpToDate. Retrieved June 10, 2021, from https://www.uptodate.com/contents/posterior-cruciate-ligament-injury
  9. McQuillen, K. K. (2018). Musculoskeletal disorders. In R. M. Walls MD, R. S. Hockberger MD & Gausche-Hill, Marianne, MD, FACEP, FAAP, FAEMS (Eds.), Rosen’s emergency medicine: Concepts and clinical practice (pp. 2201-2217.e2).

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