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Approach to the adult with unspecified knee pain

Authors
Carlton J Covey, MD
Robert H Shmerling, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

The knee has the largest articulating surface of any joint. Depending on the activity, this weight-bearing joint can support two to five times a person's body weight. Chronic knee pain affects 25 percent of adults and has a deleterious effect on daily function and quality of life [1,2].

The general evaluation of the adult presenting with undifferentiated knee pain is discussed here, including details about differentiating among the causes of knee pain based upon the history and examination findings. For cases where knee pain develops following acute, low-energy trauma or chronic overuse, often in athletes or active adults, and is most likely musculoskeletal in origin, a separate in-depth discussion of how to approach such patients is provided. (See "Approach to the adult with knee pain likely of musculoskeletal origin".)

BASIC KNEE ANATOMY AND BIOMECHANICS

The anatomy and basic biomechanics of the knee are reviewed separately. (See "Physical examination of the knee", section on 'Anatomy'.)

HISTORY OVERVIEW AND DIAGNOSTIC CATEGORIES

History-taking for the active adult presenting with knee pain is discussed in detail separately, but several aspects of the history warrant emphasis. (See "Approach to the adult with knee pain likely of musculoskeletal origin", section on 'History'.)

First, the differential diagnosis for knee pain is complex and obtaining a clear history remains essential for diagnosis. The following flow chart provides an overview of how to approach the diagnosis of knee pain in the adult (algorithm 1). Information from the history helps the clinician to distinguish among four diagnostic categories:

                          

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Literature review current through: Apr 2017. | This topic last updated: Feb 07, 2017.
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References
Top
  1. Jinks C, Jordan K, Croft P. Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain 2002; 100:55.
  2. Nguyen US, Zhang Y, Zhu Y, et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med 2011; 155:725.
  3. Razek AA, Fouda NS, Elmetwaley N, Elbogdady E. Sonography of the knee joint(). J Ultrasound 2009; 12:53.
  4. National Clinical Guideline Center. Osteoarthritis: care and management in adults. National Institute for Health and Clinical Excellence: Guidance, London 2014. http://www.ncbi.nlm.nih.gov/pubmed/25340227 (Accessed on September 24, 2016).
  5. Zhang W, Doherty M, Peat G, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 2010; 69:483.
  6. Subhawong TK, Eng J, Carrino JA, Chhabra A. Superolateral Hoffa's fat pad edema: association with patellofemoral maltracking and impingement. AJR Am J Roentgenol 2010; 195:1367.
  7. Dragoo JL, Johnson C, McConnell J. Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med 2012; 42:51.
  8. Schindler OS. 'The Sneaky Plica' revisited: morphology, pathophysiology and treatment of synovial plicae of the knee. Knee Surg Sports Traumatol Arthrosc 2014; 22:247.
  9. Pihlajamäki HK, Kuikka PI, Leppänen VV, et al. Reliability of clinical findings and magnetic resonance imaging for the diagnosis of chondromalacia patellae. J Bone Joint Surg Am 2010; 92:927.
  10. Behrens SB, Deren ME, Matson A, et al. Stress fractures of the pelvis and legs in athletes: a review. Sports Health 2013; 5:165.
  11. Morganti CM, McFarland EG, Cosgarea AJ. Saphenous neuritis: a poorly understood cause of medial knee pain. J Am Acad Orthop Surg 2002; 10:130.
  12. Rajasekaran S, Finnoff JT. Exertional Leg Pain. Phys Med Rehabil Clin N Am 2016; 27:91.
  13. Georgoulis AD, Papageorgiou CD, Moebius UG, et al. The diagnostic dilemma created by osteoid osteoma that presents as knee pain. Arthroscopy 2002; 18:32.
  14. Chan KL, Mok CC. Glucocorticoid-induced avascular bone necrosis: diagnosis and management. Open Orthop J 2012; 6:449.
  15. Pujalte GG, Acosta L. Bilateral knee and intermittent elbow pain in a competitive archer/hunter: phosphodiesterase-5-inhibitor-statin interaction? Clin J Sport Med 2014; 24:e52.
  16. Gough AW, Kasali OB, Sigler RE, Baragi V. Quinolone arthropathy--acute toxicity to immature articular cartilage. Toxicol Pathol 1992; 20:436.
  17. Luthi F, Eggel Y, Theumann N. Premature epiphyseal closure in an adolescent treated by retinoids for acne: an unusual cause of anterior knee pain. Joint Bone Spine 2012; 79:314.
  18. Vasudev M, Zacharisen MC. New-onset rheumatoid arthritis after anthrax vaccination. Ann Allergy Asthma Immunol 2006; 97:110.
  19. Sahin N, Salli A, Enginar AU, Ugurlu H. Reactive arthritis following tetanus vaccination: a case report. Mod Rheumatol 2009; 19:209.
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