KNEE PAIN
The main causes of knee pain can best be recalled by utilizing an
etiologic mnemonic such as VINDICATE.
V—Vascular. This brings to mind Aseptic bone necrosis, (Osgood-Schlatter disease)
thrombophlebitis, hemophilia, scurvy, and sickle cell anemia.
I—Inflammatory suggests septic arthritis of gonorrhea, streptococcus, Lyme
disease, and rat bite fever, as well as tuberculosis and syphilis.
Cellulitis may involve the subcutaneous tissue around the joint.
N—Neoplasm raises the possibility of osteogenic sarcoma and giant
cell tumors.
D—Degenerative disorders prompt the recall of osteoarthritis.
I—Intoxication suggests gout, pseudogout, and drugs such as
hydralazine that initiate a lupus syndrome and diuretics that induce gout.
C—Congenital disorders bring to mind alkaptonuria as a cause of
joint pathology.
A—Autoimmune disorders include lupus erythematosus, rheumatic fever,
rheumatoid arthritis, serum sickness, Reiter syndrome, and the arthritis
associated with gastrointestinal disease such as granulomatous colitis.
T—Traumabrings to mind sprains, fractures, dislocations, torn
collateral or cruciate ligaments, laceration of the meniscus, and hematomas.
E—Endocrine disorders causing joint pain include diabetes mellitus
(pseudogout), hyperparathyroidism, and acromegaly.
Approach to the Diagnosis
Many causes of joint pain can be isolated by a careful history and
physical examination. A history of trauma would suggest a sprain, torn
meniscus, or fracture. If there is fever, look for septic arthritis.
Bilateral involvement of the knee joint is typical of osteoarthritis or
rheumatoid arthritis, whereas unilateral involvement would suggest gout,
pseudogout, septic arthritis, and hemophilia. Younger patients are more
prone to a traumatic lesion such as sprain or torn meniscus and
Osgood-Schlatter disease. Older patients are more likely to have
osteoarthritis or gout.
With the history of trauma, the first thing to do is anterior, posterior, lateral, and oblique x-rays of the joint. A
magnetic resonance imaging (MRI) or arthroscopy may be necessary, but
consult an orthopedic surgeon first.
Without a history of trauma, add a laboratory workup including complete
blood count (CBC), sedimentation rate, anti-streptolysin O (ASO) titer,
chemistry panel, arthritis panel, and blood cultures (if there is fever).
Synovial fluid analysis and cultures may need to be done if there is
sufficient joint fluid. A therapeutic trial of colchicine may be diagnostic
of gout.
Other Useful Tests
-
Antinuclear antibody (ANA) (lupus erythematosus)
- Coagulation profile (hemophilia)
- Serologic test for Lyme disease
- Bone scan (osteomyelitis)
- Rheumatology consult
-
Orthopedic consult
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Behind knee pain
Read excerpts from these other book chapters related to Behind knee pain:
Medical Books Excerpts
- KNEE PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- JOINT PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Knee Pain
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Knee Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- KNEE PAIN
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Behind knee pain
» Next page: Knee Pain, Anterior/Patellofemoral Malalignment Syndrome (The 5-Minute Pediatric Consult)
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