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| | __NOTOC__ |
| | '''For patient information, click [[Knee pain/swelling (patient information)|here]]''' |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
| Image = Knee swelling in osteosarcoma.jpg| | | Image = Knee swelling in osteosarcoma.jpg| |
| Caption = | | | Caption = | |
| DiseasesDB = |
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| ICD10 = |
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| ICD9 = |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = |
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| }} | | }} |
| {{SI}} | | {{Knee pain/swelling}} |
| {{CMG}} | | {{CMG}} |
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| | ==[[Knee pain/swelling overview|Overview]]== |
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| | ==[[Knee pain/swelling historical perspective|Historical Perspective]]== |
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| The most common reasons of knee pain can include;
| | ==[[Knee pain/swelling classification|Classification]]== |
| ==Differential diagnosis of knee pain/swelling== | |
| ===Common causes===
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| ====Acute knee pain====
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| * Ligament injuries
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| * Tendon injuries ([[tendinitis]])
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| * [[Meniscus injuries]]
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| * Loose body
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| * Dislocated kneecap
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| * [[Osgood-Schlatter disease]]
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| * [[Iliotibial band syndrome]]
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| * Hyperextended knee
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| * [[Septic arthritis]]
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| ====Chronic knee pain==== | | ==[[Knee pain/swelling pathophysiology|Pathophysiology]]== |
| * [[Rheumatoid arthritis]]
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| * [[Osteoarthritis]]
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| * [[Gout]]
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| * [[Chondromalacia]] of the [[patella]], or patellofemoral pain
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| ===Causes by Organ System=== | | ==[[Knee pain/swelling causes|Causes]]== |
| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| [[Erythema nodosum]], [[Sarcoidosis]], [[Psoriasis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Hypophosphatemic rickets]], [[Rickets]], [[Sarcoidosis]], [[Neuropathic (Charcot's) knee joint]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Crohn's disease]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Ankylosing Spondylitis]], [[Epiphyseal dysplasia, multiple]], 2, [[Epiphyseal dysplasia, multiple]], 3, [[Epiphyseal dysplasia, multiple]], 5, [[Fairbanks disease]], [[Handigodu Syndrome]], [[Hemoglobinopathies]], [[Hemophilia]], [[Jaffe-Lichtenstein-Sutro syndrome]], [[Juvenile Paget's Disease]], [[Paget's disease of bone]], [[Paget's disease, type 1]], [[Paget's disease, type 4]], [[Singh-Williams-McAlister, syndrome]], [[Spondyloepiphyseal dysplasia]], [[Talo-patello-scaphoid osteolysis]], [[TAR syndrome]], [[Hypophosphatemic rickets]], [[Rickets]], [[Crohn's disease]], [[Pyrophosphate arthropathy]], [[Trochlear dysplasia]], [[Sarcoidosis]], [[Rheumatoid arthritis]]
| |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Acute leukemia]], [[Bleeding disorders]], [[Hemarthrosis]], [[Leukemia]], [[Hemoglobinopathies]], [[Hemophilia]], [[Henoch-Schönlein purpura]], [[TAR syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Arthroscopic lavage]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Clutton's joints]], [[Congenital syphilis]], [[Knee arthritis]], [[Knee bacterial infection]], [[Knee infection]], [[Knee inflammation]], [[Lyme disease]], [[Neuropathic (Charcot's) knee joint]], [[Pyarthrosis]], [[Pyogenic infection]], [[Septic arthritis]], [[Yersiniosis]], [[Tendinitis]], [[Viral infection]], [[Synovitis]]
| |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Anterior cruciate ligament injury]], [[Arthritis]], [[Baker's cyst]], [[Brodie knee]], [[Bursitis]], [[Chondromalacia patellae]],[[Dislocated knee]], [[Dislocated patella]], [[Fallen arches]], [[Femoral condyle fracture]], [[Fractured patella]], [[Fractured tibial plateau]], [[Gait problems]], [[Gout]], [[Gram's syndrome]], [[Hip dislocation]], [[Hip injury]], [[Hip Replacement]], [[Intermittent hydrarthrosis]], [[Johansson-Sinding-Larsen syndrome]], [[Knee cyst]], [[Knee tumor]], [[Knock knees]], [[Lipoarthritis]], [[Lipoma arborescens]], [[Medial ligament injury]], [[Meniscal cartilage replacement therapy]], [[Meniscal cyst]], [[Meniscus injury]], [[Osgood-Schlatter's disease]], [[Osteoarthritis]], [[Osteochondritis dissecans]], [[Osteochondroma]], [[Osteochondrosis]], [[Osteosarcoma]], [[Patellar tendinitis]], [[Patello-femoral pain syndrome]], [[Pellegrini-Stieda syndrome]], [[Pigmented villonodular synovitis]], [[Plica Syndrome]], [[Popliteal cyst]], [[Prepatellar bursitis]], [[Psoriasis]], [[Pyrophosphate arthropathy]], [[Reactive arthritis]], [[Reiter’s syndrome]], [[Rheumatoid arthritis]], [[Sciatica]], [[Seronegative spondyloarthropathy]], [[Sinding Larsen-Johannson disease]], [[Spinal cord injury]], [[Strength training]], [[Supracondylar femur fracture]], [[Synovial chondromatosis]], [[Synovial osteochondromatosis]], [[Synovial plica syndrome]], [[Synovioma]], [[Synovitis]], [[Tendinitis]], [[Torn ligament]], [[Trauma]], [[Trochlear dysplasia]], [[Viral infection]], [[Weak ankles]], [[Weight training]], [[Ankylosing Spondylitis - knee arthritis]], [[Epiphyseal dysplasia, multiple, 2]], [[Epiphyseal dysplasia, multiple, 3]], [[Epiphyseal dysplasia, multiple, 5]], [[Fairbanks disease]], [[Handigodu Syndrome]], [[Jaffe-Lichtenstein-Sutro syndrome]], [[Juvenile Paget's Disease]], [[Paget's disease of bone]], [[Paget's disease, type 1]], [[Paget's disease, type 4]], [[Singh-Williams-McAlister, syndrome]], [[Spondyloepiphyseal dysplasia tarda]], [[Talo-patello-scaphoid osteolysis]], [[TAR syndrome]], [[Hemarthrosis]], [[Clutton's joints]], [[Knee arthritis]], [[Knee bacterial infection]], [[Knee infection]], [[Knee inflammation]], [[Lyme disease]], [[Pyogenic infection]], [[Yersiniosis]], [[Scurvy]], [[Hypertrophic pulmonary osteoarthropathy periostitis]], [[Inflammatory arthritis]], [[Juvenile chronic arthritis]], [[Juvenile idiopathic arthritis]], [[Juvenile Rheumatoid Arthritis]], [[Still's disease]], [[Hoffa's disease]], [[Housemaid's knee]], [[Knee fracture]], [[Knee overuse]], [[Knee sprain]], [[Knee strain]], [[Knee tendinitis]], [[Orthopedic cast]], [[Hypophosphatemic rickets]], [[Rickets]]
| |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Gait problems]], [[Sciatica]], [[Spinal cord injury]], [[Neuropathic (Charcot's) knee joint]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Scurvy]], [[Gout]], [[Juvenile Paget's Disease]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| [[Congenital syphilis]], [[Clutton's joints]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Malignant bone tumor]], [[Acute leukemia]], [[Leukemia]], [[Gram's syndrome]], [[Knee tumor]], [[Osteochondroma]], [[Osteosarcoma]], [[Synovioma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |- | |
| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Hypertrophic pulmonary osteoarthropathy periostitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Common variable immunodeficiency]], [[Henoch-Schönlein purpura]], [[Inflammatory arthritis]], [[Juvenile chronic arthritis]], [[Juvenile idiopathic arthritis]], [[Juvenile Rheumatoid Arthritis]], [[Still's disease]], [[Erythema nodosum]], [[Osteochondrosis]], [[Psoriasis]], [[Reactive arthritis]], [[Reiter’s syndrome]], [[Rheumatoid arthritis]], [[Seronegative spondyloarthropathy]], [[Synovitis]], [[Crohn's disease]], [[Tendinitis]], [[Ankylosing Spondylitis - knee arthritis]], [[Handigodu Syndrome]], [[Knee arthritis]], [[Gout]], [[Gram's syndrome]], [[Sarcoidosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Hoffa's disease]], [[Housemaid's knee]], [[Iliotibial band friction syndrome]], [[Knee fracture]], [[Knee overuse]], [[Knee sprain]], [[Knee strain]], [[Knee tendinitis]], [[Orthopedic cast]], [[Bursitis]], [[Chondromalacia patellae]], [[Cruciate injury]], [[Dislocated knee]], [[Dislocated patella]], [[Fallen arches]], [[Femoral condyle fracture]], [[Fractured patella]], [[Fractured tibial plateau]], [[Hip dislocation]], [[Hip injury]], [[Hip Replacement]], [[Johansson-Sinding-Larsen syndrome]], [[Medial ligament injury]], [[Meniscus injury]], [[Patellar tendinitis]], [[Patello-femoral pain syndrome]], [[Pellegrini-Stieda syndrome]], [[Prepatellar bursitis]], [[Sinding Larsen-Johannson disease]], [[Supracondylar femur fracture]], [[Torn ligament]]
| |
| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| ===Causes in Alphabetical Order=== | | ==[[Knee pain/swelling differential diagnosis|Differentiating Knee pain/swelling from Other Diseases]]== |
| {{MultiCol}}
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| *[[Acute gouty arthritis]]
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| *[[Acute leukemia]]
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| *[[Adult Still's Disease]]
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| *[[Ankylosing Spondylitis - knee arthritis]]
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| *[[Anterior cruciate ligament (ACL) injury]]
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| *[[Arthritis]]
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| *[[Arthroscopic lavage]]
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| *[[Baker's cyst]]
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| *[[Bleeding disorders]]
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| *[[Bone, ligament or cartilage damage]]
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| *[[Brodie knee]]
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| *[[Bursitis]]
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| *[[Chondromalacia patellae]]
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| *[[Chronic gouty arthritis]]
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| *[[Clutton's joints]]
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| *[[Common variable immunodeficiency]]
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| *[[Congenital syphilis]]
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| *[[Crohn's disease]]
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| *[[Discoid meniscus]]
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| *[[Dislocated knee]]
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| *[[Dislocated patella]]
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| *[[Epiphyseal dysplasia, multiple, 2]]
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| *[[Epiphyseal dysplasia, multiple, 3]]
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| *[[Epiphyseal dysplasia, multiple, 5]]
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| *[[Erythema nodosum]]
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| *[[Fairbanks disease]]
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| *[[Fallen arches]]
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| *[[Femoral condyle fracture]]
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| *[[Fractured patella]]
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| *[[Fractured tibial plateau]]
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| *[[Gait problems]]
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| *[[Gonococcal pyarthrosis]]
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| *[[Gonococcemia]]
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| *[[Gram's syndrome]]
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| *[[Handigodu Syndrome]]
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| *[[Hemarthrosis]]
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| *[[Hemoglobinopathies]]
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| *[[Hemophilia]]
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| *[[Henoch-Schönlein purpura]]
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| *[[Hip dislocation]]
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| *[[Hip injury]]
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| *[[Hip or foot/ankle disease with referred pain to the knee]]
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| *[[Hip Replacement]]
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| *[[Hoffa's disease]]
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| *[[Housemaid's knee]]
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| *[[Hypertrophic pulmonary osteoarthropathy periostitis]]
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| *[[Hypophosphatemic rickets]]
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| {{ColBreak}}
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| *[[Iliotibial band friction syndrome]]
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| *[[Iliotibial Band Syndrome]]
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| *[[Inflammatory arthritis]]
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| *[[Intermittent hydrarthrosis]]
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| *[[Jaffe-Lichtenstein-Sutro syndrome]]
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| *[[Johansson-Sinding-Larsen syndrome]]
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| *[[Joint effusion]]
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| *[[Joint infection]]
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| *[[Juvenile chronic arthritis]]
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| *[[Juvenile idiopathic arthritis]]
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| *[[Juvenile Paget's Disease]]
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| *[[Juvenile Rheumatoid Arthritis]]
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| *[[Knee arthritis]]
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| *[[Knee bacterial infection]]
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| *[[Knee cyst]]
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| *[[Knee fracture]]
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| *[[Knee infection]]
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| *[[Knee inflammation]]
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| *[[Knee overuse]]
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| *[[Knee sprain]]
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| *[[Knee strain]]
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| *[[Knee tendinitis]]
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| *[[Knee tumor]]
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| *[[Knock knees]]
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| *[[Lateral collateral ligament (LCL) injury]]
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| *[[Leukemia]]
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| *[[Lipoarthritis]]
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| *[[Lipoma arborescens]]
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| *[[Lyme disease]]
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| *[[Malignancy]]
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| *[[Malignant bone tumor]]
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| *[[Medial collateral ligament (MCL) injury]]
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| *[[Meniscal cartilage replacement therapy]]
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| *[[Meniscal cyst]]
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| *[[Meniscus tear]]
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| *[[Neuropathic (Charcot's) knee joint]]
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| *[[Orthopedic cast]]
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| *[[Osgood-Schlatter Disease]]
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| *[[Osteoarthritis]]
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| *[[Osteochondritis Dissecans (OCD)]]
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| *[[Osteochondroma]]
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| *[[Osteochondrosis]]
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| *[[Osteomyelitis]]
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| *[[Osteosarcoma]]
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| *[[Paget's disease of bone]]
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| *[[Paget's disease, type 1]]
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| *[[Paget's disease, type 4]]
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| {{ColBreak}}
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| *[[Patellar tendinitis]]
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| *[[Patellofemoral syndrome]]
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| *[[Pellegrini-Stieda syndrome]]
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| *[[Pes anserine bursitis]]
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| *[[Pigmented villonodular synovitis]]
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| *[[Plica Syndrome]]
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| *[[Popliteal cyst]]
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| *[[Posterior cruciate ligament (PCL) injury]]
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| *[[Prepatellar bursitis]]
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| *[[Pseudogout]]
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| *[[Psoriatic arthritis]]
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| *[[Pyarthrosis]]
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| *[[Pyogenic infection]]
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| *[[Pyrophosphate arthropathy]]
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| *[[Reactive arthritis]]
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| *[[Reiter's Syndrome]]
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| *[[Rheumatoid Arthritis]]
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| *[[Rickets]]
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| *[[Sarcoidosis]]
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| *[[Sciatica]]
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| *[[Scleroderma]]
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| *[[Scurvy]]
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| *[[Septic arthritis]]
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| *[[Seronegative spondyloarthropathy]]
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| *[[Sinding Larsen-Johannson disease]]
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| *[[Singh-Williams-McAlister, syndrome]]
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| *[[Spinal cord injury]]
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| *[[Spondyloepiphyseal dysplasia tarda]]
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| *[[Strength training]]
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| *[[Supracondylar femur fracture]]
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| *[[Synovial chondromatosis]]
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| *[[Synovial osteochondromatosis]]
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| *[[Synovial plica syndrome]]
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| *[[Synovioma]]
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| *[[Synovitis]]
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| *[[Systemic Lupus Erythematosus ]]
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| *[[Talo-patello-scaphoid osteolysis]]
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| *[[TAR syndrome]]
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| *[[Tendinitis]]
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| *[[Torn ligament]]
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| *[[Trauma]]
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| *[[Trochlear dysplasia]]
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| *[[Viral infection]]
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| *[[Weak ankles]]
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| *[[Weight training]]
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| *[[Yersiniosis]]
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| {{EndMultiCol}}
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|
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| == Diagnosis == | | ==[[Knee pain/swelling epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| === History and Symptoms === | | ==[[Knee pain/swelling risk factors|Risk Factors]]== |
| * Gait abnormalities
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| * [[Swelling]]
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| * Erythema
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| * Deformity
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| * Muscle atrophy
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|
| |
|
| === Physical Examination === | | ==[[Knee pain/swelling natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Range of motion
| |
| * Palpate area of concern
| |
| * "Milk the joint"
| |
| * McMurray circumduction test
| |
| * Ligament testing
| |
|
| |
|
| == Laboratory Findings == | | ==Diagnosis== |
| * [[Complete blood count]]
| | [[Knee pain/swelling history and symptoms|History and Symptoms]] | [[Knee pain/swelling physical examination|Physical Examination]]| [[Knee pain/swelling laboratory findings|Laboratory Findings]] | [[Knee pain/swelling x ray|X Ray]] | [[Knee pain/swelling CT|CT]] | [[Knee pain/swelling MRI|MRI]] | [[Knee pain/swelling ultrasound|Ultrasound]] | [[Knee pain/swelling other imaging findings|Other Imaging Findings]] | [[Knee pain/swelling other diagnostic studies|Other Diagnostic Studies]] |
| * [[C-reactive protein]]
| |
| * [[Uric acid]]
| |
| * [[Alkaline phosphatase]]
| |
| * [[Erythrocyte sedimentation rate]] ([[ESR]])
| |
|
| |
|
| === X-Ray === | | ==Treatment== |
| * Anteroposterior, lateral and merchant (or sunrise) films of both knees
| | [[Knee pain/swelling medical therapy|Medical Therapy]] | [[Knee pain/swelling surgery|Surgery]] | [[Knee pain/swelling primary prevention|Primary Prevention]] | [[Knee pain/swelling cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Knee pain/swelling future or investigational therapies|Future or Investigational Therapies]] |
| * Tunnel views of knee
| |
| * Merchant and sunrise of the patella
| |
|
| |
|
| === MRI and CT === | | == Case Studies == |
| * MRI for confirmation of suspected diagnosis
| | [[Knee pain/swelling case study one|Case #1]] |
| | | {{WH}} |
| === Other Diagnostic Studies ===
| | {{WS}} |
| * Bone scan
| |
| * Joint aspiration
| |
|
| |
| == Treatment ==
| |
| * Conservative therapy is best
| |
| * Lifestyle changes
| |
| * Physical therapy
| |
| * Exercise
| |
| | |
| == Pharmacotherapy ==
| |
| | |
| === Acute Pharmacotherapies ===
| |
| * Anti-inflammatory medications
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| * Joint medications
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| * Antibiotics
| |
| | |
| == Surgery and Device Based Therapy ==
| |
| * Surgery necessary for most ACL injuries
| |
| * Meniscal tears may require surgical repair
| |
| * Joint infection requires surgery (emergency)
| |
| * Surgery may be necessary for osteoarthritis, if conservative treatment fails
| |
| | |
| == References ==
| |
| {{Reflist|2}} | |
|
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|
| [[Category:Musculoskeletal Disease]] | | [[Category:Musculoskeletal Disease]] |
| | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| | [[Category:Medical signs]] |
| [[Category:Orthopedics]] | | [[Category:Orthopedics]] |
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| {{WikiDoc Sources}}
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