KNEE PAIN (Referral (Immediate referral as per red flags., Refer urgently…
Immediate referral as per red flags.
Refer urgently (to be seen within 2 weeks of referral) to an appropriate specialist if a tumour is suspected.
Refer any person with suspected persistent synovitis of undetermined cause to a rheumatologist to assess for inflammatory polyarthritis.
Refer a person to an orthopaedic surgeon:
If they present with chronic (present for over a month) knee pain
- If they have chronic knee pain.
such as paracetamol and NSAID for muscle strains, OA, bursitis.
Local causes - bursitis, bakers cyst, osgood-schlatter, tendonitis, OA, tumours, injuries: fractures,, muscle strains, ligament injuries, patellar dislocation, tendon rupture.
Regional causes - referred pain from hip or lumbosacral spine, sceptic arthritis of the hip, perthes disease, OA of the hip, lumber radiculopathy.
Systematic causes - skeletal dysplasias, gout, septic arthritis, pseudogout, RA, reactive arthritis, joint hypermobility syndrome.
Assessment - history of any injury, duration, onset, severity, one or both knees, swelling, stiffness, pain -times & any alleviating/aggravating factors.
Examine and compare both knees and surrounding structures.
Inspect for wounds, erythema, deformity, muscle atrophy and swelling.
Palpate for warmth, swelling (including bony swelling,
effusion and bursal or other soft tissue swelling) and tenderness.
Move the knees by extending and flexing as far as possible.
The normal range is zero degrees of extension to 135 degrees of flexion.
Examine the hips, ankles and spine for other joint pathology
Assess gait and ability to weight bear.
Assess for signs of septic arthritis,
Use the Ottawa knee rules in people over 2 years of age to determine
whether an X-ray is required to assess for fracture.
Ask the person to do an active straight leg raise from the supine position.
Assess for a palpable gap in the quadriceps or patellar tendon.
Assess for ligament tears and laxity bearing in mind the limited
diagnostic accuracy of the following tests:
Valgus and varus stress tests for collateral ligament injuries.
Lachman test and anterior draw test for anterior cruciate ligament injuries.
Posterior draw test for posterior cruciate ligament injuries.
Fracture, Anterior cruciate ligament (ACL) injury,Posterior cruciate ligament (PCL) injury, Patellar dislocation, Quadriceps or patellar tendon rupture -
ALL warrant urgent further investigation, or immediate or urgent referra