KNEE PAIN
KNEE PAIN: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is it transient? Transient knee pain may be due to rheumatic fever, sarcoidosis, palindromic rheumatism, or trauma.
- Is it unilateral or bilateral? Unilateral knee pain would suggest gout, septic arthritis, bursitis, hemophilia, pseudogout, osteogenic sarcoma, and traumatic conditions such as torn meniscus, hemarthrosis, sprain of collateral ligaments, and fracture.
- Is there a history of trauma? History of trauma would suggest a sprain, torn meniscus, bruise, or fracture.
- Are there prominent systemic symptoms? If there are prominent systemic symptoms, one should consider lupus erythematosus, Reiter's disease, rheumatoid arthritis, other collagen disease, scurvy, and rheumatic fever.
- What is the age of the patient? Younger patients are more likely to have traumatic conditions such as fracture, sprains, bruises, or a torn meniscus. Osgood-Schlatter disease would be more typical of patients in their early teens. Patients in their twenties are more likely to have rheumatoid arthritis, Reiter's disease, and lupus erythematosus, whereas patients in the fourth or fifth decade and older would be more likely to have osteoarthritis, gout, and pseudogout.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, ASO titer, ANA, CRP, urinalysis, chemistry panel, arthritis panel, and x-rays of the involved joint. X-rays may show a fracture, osteoarthritic changes, and punched-out lesion of gout or chondrocalcinosis (suggesting pseudogout). It is also wise to do a bone survey. Synovial fluid analysis and culture may be done if there is sufficient joint fluid. A trial of therapy can be initiated and may be diagnostic.
If further diagnostic workup needs to be done at this point, it is most cost-effective to refer the patient to a rheumatologist or orthopedic surgeon before ordering MRI or other studies. He may want to do an arthroscopic examination before proceeding with other tests for arthritic conditions. For further workup of knee pain, see
page 279
.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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