General evaluation of the adult with knee pain
- Bruce C Anderson, MD
Bruce C Anderson, MD
- Associate Professor of Medicine
- Oregon Health Sciences University
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
The knee is the largest human joint in terms of its volume and surface area of articulating cartilage. The knee joint has the greatest susceptibility to injury, age-related wear and tear, inflammatory arthritis, and septic arthritis .
This review provides a general approach to the evaluation of knee pain in adults. An in-depth discussion of how to assess knee pain in the active adult or adult athlete, who is more likely to have sustained a musculoskeletal injury, is found separately. More in-depth discussions of the diagnosis and treatment of specific disorders of the knee are also provided separately. (See "Approach to the adult with knee pain likely of musculoskeletal origin" and "Radiologic evaluation of the acutely painful knee in adults".)
BASIC KNEE ANATOMY AND BIOMECHANICS
The anatomy and biomechanics of the knee are reviewed separately. (See "Approach to the adult with knee pain likely of musculoskeletal origin", section on 'Basic knee anatomy and biomechanics'.)
Overview — Knee pain can be broadly categorized as due to one or more of the following:
●An intraarticular process such as a meniscal or ligamentous injury (internal derangement) or fracture
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- BASIC KNEE ANATOMY AND BIOMECHANICS
- Pain patterns
- - Medial knee pain
- - Anterior knee pain
- - Lateral knee pain
- - Popliteal pain or pressure
- - "Noises" arising at the knee
- DIFFERENTIAL DIAGNOSIS
- Knee effusion
- - Synovial effusion
- - Hemarthrosis
- Popliteal cyst
- - Pes anserinus pain syndrome (formerly anserine bursitis)
- - Prepatellar bursitis
- - Bursa adjacent to the medial collateral ligament
- Ligament injury
- - Anterior cruciate ligament
- - Medial collateral ligament
- - Lateral collateral ligament
- - Posterior cruciate ligament
- Meniscal tear
- Patellofemoral pain syndrome
- Iliotibial band syndrome
- Stress fractures
- Referred pain syndromes
- STEPWISE CLINICAL APPROACH
- Step one: Traumatic versus nontraumatic
- Step two: Extrinsic versus intrinsic
- Step three: Periarticular versus articular
- Step four: Structural versus inflammatory
- Knee trauma and Ottawa knee rule
- CONFIRMATORY PROCEDURES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS