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	Erythema nodosum, Sarcoidosis, Psoriasis
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Hypophosphatemic rickets, Rickets, Sarcoidosis, Neuropathic (Charcot's) knee joint
Environmental	No underlying causes
Gastroenterologic	Crohn's disease
Genetic	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
Hematologic	Acute leukemia, Bleeding disorders, Hemarthrosis, Leukemia, Hemoglobinopathies, Hemophilia, Henoch-Schönlein purpura, TAR syndrome
Iatrogenic	Arthroscopic lavage
Infectious Disease	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
Musculoskeletal / Ortho	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
Neurologic	Gait problems, Sciatica, Spinal cord injury, Neuropathic (Charcot's) knee joint
Nutritional / Metabolic	Scurvy, Gout, Juvenile Paget's Disease
Obstetric/Gynecologic	Congenital syphilis, Clutton's joints
Oncologic	Malignant bone tumor, Acute leukemia, Leukemia, Gram's syndrome, Knee tumor, Osteochondroma, Osteosarcoma, Synovioma
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Hypertrophic pulmonary osteoarthropathy periostitis
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	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
Sexual	No underlying causes
Trauma	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
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Acute gouty arthritis Acute leukemia Adult Still's Disease Ankylosing Spondylitis - knee arthritis Anterior cruciate ligament (ACL) injury Arthritis Arthroscopic lavage Baker's cyst Bleeding disorders Bone, ligament or cartilage damage Brodie knee Bursitis Chondromalacia patellae Chronic gouty arthritis Clutton's joints Common variable immunodeficiency Congenital syphilis Crohn's disease Discoid meniscus Dislocated knee Dislocated patella Epiphyseal dysplasia, multiple, 2 Epiphyseal dysplasia, multiple, 3 Epiphyseal dysplasia, multiple, 5 Erythema nodosum Fairbanks disease Fallen arches Femoral condyle fracture Fractured patella Fractured tibial plateau Gait problems Gonococcal pyarthrosis Gonococcemia Gram's syndrome Handigodu Syndrome Hemarthrosis Hemoglobinopathies Hemophilia Henoch-Schönlein purpura Hip dislocation Hip injury Hip or foot/ankle disease with referred pain to the knee Hip Replacement Hoffa's disease Housemaid's knee Hypertrophic pulmonary osteoarthropathy periostitis Hypophosphatemic rickets

Iliotibial band friction syndrome Iliotibial Band Syndrome Inflammatory arthritis Intermittent hydrarthrosis Jaffe-Lichtenstein-Sutro syndrome Johansson-Sinding-Larsen syndrome Joint effusion Joint infection Juvenile chronic arthritis Juvenile idiopathic arthritis Juvenile Paget's Disease Juvenile Rheumatoid Arthritis Knee arthritis Knee bacterial infection Knee cyst Knee fracture Knee infection Knee inflammation Knee overuse Knee sprain Knee strain Knee tendinitis Knee tumor Knock knees Lateral collateral ligament (LCL) injury Leukemia Lipoarthritis Lipoma arborescens Lyme disease Malignancy Malignant bone tumor Medial collateral ligament (MCL) injury Meniscal cartilage replacement therapy Meniscal cyst Meniscus tear Neuropathic (Charcot's) knee joint Orthopedic cast Osgood-Schlatter Disease Osteoarthritis Osteochondritis Dissecans (OCD) Osteochondroma Osteochondrosis Osteomyelitis Osteosarcoma Paget's disease of bone Paget's disease, type 1 Paget's disease, type 4

Patellar tendinitis Patellofemoral syndrome Pellegrini-Stieda syndrome Pes anserine bursitis Pigmented villonodular synovitis Plica Syndrome Popliteal cyst Posterior cruciate ligament (PCL) injury Prepatellar bursitis Pseudogout Psoriatic arthritis Pyarthrosis Pyogenic infection Pyrophosphate arthropathy Reactive arthritis Reiter's Syndrome Rheumatoid Arthritis Rickets Sarcoidosis Sciatica Scleroderma Scurvy Septic arthritis Seronegative spondyloarthropathy Sinding Larsen-Johannson disease Singh-Williams-McAlister, syndrome Spinal cord injury Spondyloepiphyseal dysplasia tarda Strength training Supracondylar femur fracture Synovial chondromatosis Synovial osteochondromatosis Synovial plica syndrome Synovioma Synovitis Systemic Lupus Erythematosus Talo-patello-scaphoid osteolysis TAR syndrome Tendinitis Torn ligament Trauma Trochlear dysplasia Viral infection Weak ankles Weight training Yersiniosis

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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