Knee pain/swelling

Knee pain/swelling

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The most common reasons of knee pain can include;

Differential diagnosis of knee pain/swelling

Common causes

Acute knee pain

• Ligament injuries
• Tendon injuries (tendinitis)
• Meniscus injuries
• Loose body
• Dislocated kneecap
• Osgood-Schlatter disease
• Iliotibial band syndrome
• Hyperextended knee
• Septic arthritis

Chronic knee pain

• Rheumatoid arthritis
• Osteoarthritis
• Gout
• Chondromalacia of the patella, or patellofemoral pain

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Complete differential diagnosis of causes of knee pain/sweling

• Acute gouty arthritis
• Adult Still's Disease
• Anterior cruciate ligament (ACL) injury
• Baker's cyst
• Bone, ligament or cartilage damage
• Bursitis
• Chondromalacia patellae
• Chronic gouty arthritis
• Discoid meniscus
• Gonococcemia
• Hip or foot/ankle disease with referred pain to the knee
• Iliotibial Band Syndrome
• Joint effusion
• Joint infection
• Lateral collateral ligament (LCL) injury
• Malignancy
• Medial collateral ligament (MCL) injury
• Meniscus tear
• Osgood-Schlatter Disease
• Osteoarthritis
• Osteochondritis Dissecans (OCD)
• Osteomyelitis
• Osteosarcoma
• Patellofemoral syndrome
• Pes anserine bursitis
• Posterior cruciate ligament (PCL) injury
• Pseudogout
• Psoriatic arthritis
• Reiter's Syndrome
• Rheumatoid Arthritis
• Scleroderma
• Systemic Lupus Erythematosus

Diagnosis

History and Symptoms

• Gait abnormalities
• Swelling
• Erythema
• Deformity
• Muscle atrophy

Physical Examination

• Range of motion
• Palpate area of concern
• "Milk the joint"
• McMurray circumduction test
• Ligament testing

Laboratory Findings

• Complete blood count
• C-reactive protein
• Uric acid
• Alkaline phosphatase
• Erythrocyte sedimentation rate (ESR)

X-Ray

• Anteroposterior, lateral and merchant (or sunrise) films of both knees
• Tunnel views of knee
• Merchant and sunrise of the patella

MRI and CT

• MRI for confirmation of suspected diagnosis

Other Diagnostic Studies

• Bone scan
• Joint aspiration

Treatment

• Conservative therapy is best
• Lifestyle changes
• Physical therapy
• Exercise

Pharmacotherapy

Acute Pharmacotherapies

• Anti-inflammatory medications
• Joint medications
• 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

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