KNEE SWELLING

Ask the Following Questions:

1. Is it painless? Painless swelling of the knee is probably a Charcot's joint.
2. Is it unilateral or bilateral? Unilateral knee swelling is most likely due to trauma, gout, pseudogout, hemophilia, septic arthritis, tuberculosis, osteogenic sarcoma, torn meniscus, or osteomyelitis. Bilateral swelling of the knee is more commonly seen in osteoarthritis, lupus erythematosus, Reiter's disease, and rheumatoid arthritis.
3. Is there fever? The presence of fever suggests septic arthritis, rheumatic fever, rheumatoid arthritis, osteomyelitis, lupus erythematosus, and Reiter's disease.
4. Are there systemic symptoms? Systemic symptoms suggest lupus erythematosus, rheumatoid arthritis, and Reiter's disease, as well as rheumatic fever.
5. What is the age of the patient? Knee swelling in younger patients is more likely to be due to rheumatic fever, septic arthritis, lupus erythematosus, Reiter's disease, and rheumatoid arthritis. Older patients are more likely to be affected with gout, pseudogout, and osteoarthritis. Osteogenic sarcoma seems to occur between the ages of 5 and 25 years in most cases.

DIAGNOSTIC WORKUP

Routine diagnostic tests include CBC, sedimentation rate, urinalysis, chemistry panel, arthritis panel, VDRL test, and x-rays of the involved joint or joints. A bone survey should probably also be done. If there is significant swelling, an arthrocentesis for synovial fluid should be done and the fluid analyzed and cultured. A therapeutic trial may be initiated at this point and can assist in the diagnosis.

If there is still doubt about the diagnosis, referral to a rheumatologist or orthopedic surgeon should be made before ordering MRI or expensive diagnostic tests. An orthopedic surgeon may perform fiberoptic arthroscopy to diagnose the problem. Additional diagnostic tests to order in cases of knee swelling may be found on 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 Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Knee pain

• Back to symptom: Knee pain: Introduction (review 120 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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