Knee pain/swelling

Knee pain/swelling

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

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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

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

Acknowledgements

The content on this page was first contributed by C. Michael Gibson, M.S., M.D.

List of contributors:

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