Common knee complaints
The biggest complaint we
hear is the knee hurts.
and usually it hurts
with more activity.
Sometimes it's secondary to hip problems,
sometimes it's secondary to ankle problems
but paying attention and ruling
out intrinsic knee issues,
structural knee issues of the
bone, muscles or ligaments
are critical in knowing what you can do or what you can't do
in treating the knee.
You'll also hear stiffness, locking, clicking,
and other difficulties with using the knee
People say they feel
unsteady or unstable,
and with increased muscle use, the risk of injury may
increase or decrease,
depending on how the surrounding muscles are being
We know with fatiguing of muscles, such as climbing a lot of
steps, you're more likely to trigger knee pain
If you do a lot of
exercises that use the knee,
you're more likely to have issues in other areas as well
because you can't effectively stabilize the knee or use it
So swelling or other common knee
complaints - difficulty walking, standing,
I think the issue that people
come to DO's for the most
are usually locking, clicking, or
motion-related issues with the knee
Knee complaints can be due to
a sprain or strain of the knee,
you have multiple ligaments that can get pulled out
of place that can get pushed out of place by a bursa
and may need to be monitored and of course osteopathic
manipulation is one technique that can be used to treat it,
but so can removal of
fluid from the bursa
or other manipulations that aren't
just musculoskeletal in nature.
Bursas and tendons are two areas that tend
to get treated a lot in knee complaints,
tendonitis either with manipulation, moving,
understanding which part of the tendon is involved.
Fractures are something you need to be aware of,
whether they are microfractures, major fractures
and whether fractures that could be
noted on x-ray or need further imaging.
On occasion, you will notice
dislocation particularly of the patella
where it falls outside the femur's grooves
and needs to be put back into place
and they need to be monitored
for a muscle tear as well
or other issues, and meniscial injuries.
Meniscial injuries are different than muscle injuries or
if you tear a tendon,
you'll have swelling up right away,
if you injure a meniscus, the swelling
will usually be delayed by 8-12 hours
so you'll be able to function right
away but develop the symptoms later on.
That's all part of the
history that will focus you
on what area of the musculoskeletal
system you need to work on.
Things to think about, with knee
pain, what where they doing?
Was it sports-related?
Was it a contact sport
or a non-contact sport?
Did the person hear a pop?
or a click? or a tear?
People tend to know when
they break something,
they know when they tear
something and they'll tell you.
So if they had a contact sport, if they were
playing soccer, or football and they hear a pop,
you are gonna worry
about the MCL or LCL,
sure could be the meniscus,
meniscus you're less likely to hear a pop
although it is possible.
A fracture - they hear a
crack different than a pop.
If the person has acute swelling,
they swell up right away.
We worry about the ACL or PCL, the anterior
cruciate or the posterior cruciate.
You will notice some laxity
and freeing of motion on exam.
Were they hit on the side?
you worry about the MCL
If they had a blow to the inside of their knee, you worry
about the lateral collateral ligament
but if the knee gave out or buckles,
you're worried about an ACL tear,
a patellar dysfunction,
dislocation, or a meniscal injury,
An old meniscal injury, we have a
piece of meniscus getting caught,
will increase the likelihood of a
knee locking, buckling or giving out
And again, you lose some
stability when you bend your knee,
so if somebody falls hard on a flexed knee, like while
playing sports, you worry about a PCL tear
which often occurs with injuries to other structures in the
knee as well, because you no longer have the stability of
muscles protecting the knee.
This is an important issue particularly
for test which is O'Donoghue's triad,
because it gets people to think - you
think about the mechanism of injury,
you think about what
could be going on,
O'Donoghue's triad is the ACL,
MCL and the meniscus that are involved
So check that out.
So O'Donoghue's triad is the "blow knee" and
it's tested a lot because it gets you to think
about how the injury occured - is it the
posterior cruciate? Is it the anterior cruciate?
Is it the lateral meniscus?
and what's happening to the other areas well.
So think about O'Donoghue's triad.
One of the things I do when I examine
the knee is I always get a good sense of
how bad it's been injured, and how bad
t's been used or misused over time.
So I look at all areas of motion, I look
to see if the patella is ballotable,
How much fluid is below it?
How much motion? how much give?
What is the range
of motion you have?
We all know if you play with your own knee, you
can get to outside the groove very easily,
particularly if you
bend it a little bit.
If you put your thumb on the superor portion of the
patella, and push it over, you'll get the most motion,
doesn't move as well
If you contract your quadriceps, you'll be
able to see that you can move your patella up
so examining the patella even
though we don't have good normals
and we accept it as just sitting there, in a
simple hinge joint, with some modifications,
check it out, I think you can tell with
the person, what's possible, what's doable,
where their comfort will be and what you may
need to do to help them be more comfortable.
In feeling the knee to see where
there's pain, where there's discomfort,
and you'll see if the pain
comes with motion and how much
the quadriceps contribute and how
much the ligaments contribute.
And again, just cause we don't have
all these information fully worked out,
it's still a very common issue and
patients are gonna do this themselves
so guiding them through it
is going to be important,
a lot of what we do with knee injuries
is witness and share what we know
predicting the future for people because if they
get in the emergency room, they may get an x-ray
X-rays are not very helpful, they'll tell you if
something is broken, they'll give you severe injury
If you want to get a good sense of
small internal cracks or dislocations
or there's an accessory sesamoid bone developing, it's
important to get a CAT scan or an MRI,
they'll give you a much better sense.
If you don't see a break
on a CAT scan or an MRI,
but the pain is still there and
it still seems like it's broken,
or there are some separation,
that's when you need a bone scan.
In heavy duty athletes,
high achievers who push themselves,
often the CT and the MRI
are not gonna be enough,
and you are gonna need to go do a bone
scan to figure out what's really going on.
But because of the difficulty
getting one because of the cost,
it tends to be pushed off until
the third or the fourth visit.
We also do some blood work,
looking for other abnormalities,
looking for autoimmune issues,
looking for signs of a break,
so when somebody does
have chronic knee injuries
and chronic knee pain, we will get a
CBC and ESR and a C-reactive protein.