So, in terms of differential diagnosis,
getting the location of the
pain is very important.
So, anterior knee pain,
you can think about patellar tendinitis,
jumper’s knees, so that's very common among –
particularly among younger athletes.
And if they are doing a lot of jumping –
basketball, volleyball players –
and it is really a pain right over that patellar tendon.
So, it’s pretty easy to find.
we’ll cover in more detail later,
but it is the most common
cause of anterior knee pain.
For medial pain,
you could think of a sprain
of the medial collateral ligament,
think of medial meniscal tears,
and that's also the site
of the pes anserine bursa.
So, those athletes who may be overusing,
particularly in overtraining with running,
you get a pes anserine bursitis.
That's on the medial side.
On the lateral side,
you have, of course, lateral meniscus tear,
but that's where the iliotibial or IT band lives.
So, that’s –
so, a more medial side pain in runners,
pes anserine bursitis;
think of IT band syndrome.
So, let’s work through our differential
diagnosis of knee pain,
particularly among children
and adolescents as well.
So, these are commonly going to
be your athletes that you see.
And I think one thing to remember is
patellar subluxation in itself can be painful.
And females are more likely to have greater
degrees of patellar subluxation versus males.
Tibial apophysitis, or also commonly
known Osgood Schlatter disease,
deserves some calling out specifically as a cause of
knee pain because it happens pretty frequently.
The nice thing is it's almost always
presents the same way,
which is pain over the tibial tuberosity.
It's often associated with a growth spurt among adolescents.
The pain gets worse with squatting,
going upstairs or a strain in the quadriceps.
And that's why having the patient extend their knee against
resistance is a great way to cause the pain and draw it out,
so that can point you in the right direction.
this is below the knee joint,
so you shouldn't see an
effusion with tibial apophysitis.
If there's an effusion within the knee,
that means there’s
something going on as well.
And x-rays don't really help too
much with tibial apophysitis.
They’re often negative.
You can see an avulsion of the apophysis.
If you do or not, the management is
generally going to be conservative.
It’s going to be rest,
analgesics and follow-up.
And another thing that’s
important to remember among
children and adolescents is that
a more serious condition,
slipped capital femoral epiphysis,
can result in referred pain for the knee.
So, this is a condition in the hip,
which is dangerous because of its
associated risk of avascular necrosis,
which can present as a generalized
kind of vague knee pain.
checking the hips are important too.
So, the joints above and the joints below
are always in question when you
see somebody with knee pain.
So, think about ankle and,
in particular, in this case,
hip injuries among children
and adolescents with knee pain.
Whereas among adults,
I mentioned IT band or
iliotibial band syndrome,
this is another one where pain
is worse going up the stairs,
and it has again a
very specific physical finding.
Find your lateral epicondyle of the knee,
about 3 cm above that joint line,
that's where you should –
that's where you should have
tenderness with IT band syndrome.
it’s related to stress on that tendon.
Therefore, it's best to try to
provide some rest for the patient,
some ice and analgesics and monitor.
Meniscal tears, they can be in place for years
before the patient necessarily presents to you.
The classic is that twisting
motion with the foot planted,
tears the meniscus.
This is going to be associated with
an effusion, if it’s at all serious
because of the inflammation within the joint.
And as I mentioned,
you really need an MRI
for a good diagnosis of a meniscal tear.