Acute Knee Pain

00:01 All right.

00:02 So, let's discuss knee pain today.

00:04 I'm sure that a lot of you at some point in your life have experienced knee pain.

00:07 Maybe thought about it.

00:08 Maybe you didn't.

00:09 But it's certainly something we see very commonly in our practices.

00:13 In my practice, a lot of older adults in my brick-and-mortar clinic, and so therefore a lot of those patients have osteoarthritis.

00:20 But the differential for knee pain can be far broader than osteoarthritis.

00:24 We’ll talk about that differential as well as the assessment of patients with knee pain from physical examination and then we’ll go into discussing treatment as well for knee pain.

00:35 All right.

00:36 So, in the history, I think one thing that’s really critical is just getting an idea of the type of pain, its exact location within the knee and how long it's been going on.

00:46 And then, very importantly, other associated mechanical symptoms.

00:51 Does the knee lock or does it give away, which would obviously be a sign of some kind of meniscal damage.

00:58 So, other elements in the history, it's very different, but I don't see a lot of patients.

01:03 My 75-year-olds aren't out there playing tackle football and getting a direct blow to their – over their tibia.

01:10 But certainly if you see that, if you're in sports medicine on the field or in the emergency department, a direct blow to the knee makes you think about a fracture, but probably even more commonly would be a tear of the cruciate ligament, anterior more than posterior.

01:25 Was the foot planted and then a twisting motion was applied and a pop maybe was heard? Certainly, think about meniscal injury.

01:33 And then, getting a history of previous injury is very important because, as I said, this is really common.

01:38 A lot of folks who tear their meniscus or their ACL, anterior cruciate ligament, have done so in the past.

01:44 So, getting an idea of what's happened to them before will give you a stronger inclination as to what's happening now.

01:51 Physical examination, so steps that you're familiar with.

01:54 Inspection of the knee.

01:56 First, looking for any signs of effusion, any abnormal – there’s a displacement of the patella grossly, like a dislocation.

02:04 That's pretty obvious to determine as well.

02:06 Testing range of motion, both actively and passively.

02:10 You're going to to palpate for pain, but you also – and tenderness.

02:13 You also check for warmth of the knee and signs – other signs of an effusion.

02:17 I usually like to milk down the fluid around the joint and see if I can actually draw out any small effusion the patient may have.

02:25 Patellofemoral syndrome is a really common cause of chronic knee pain and we’ll talk about it a bit in-depth.

02:31 But one thing you can notice is when the quadriceps contract against your resistance, you might notice some crepitus over the knee.

02:38 So you can put your hand right over the patella and feel that.

02:41 You’re going to check for the stability of the cruciate and the collateral ligaments.

02:45 And oftentimes, it helps to compare one side to the other.

02:48 And then, there are a lot of different tests for the meniscus.

02:53 There’s a grind test and there's a lot of different things you can try to do.

02:58 They all have a pretty poor sensitivity.

03:01 So, that's not something that you can really hang your hat on, particularly when it’s negative that it rules out in any way a meniscal tear.

03:10 And we’ll talk for a minute about meniscal tears, but the punchline is that if you really are going after and think the patient has meniscal tear, you need to do an MRI because only that test has the sensitivity you need to diagnose it.