During a consultation, your doctor will use various techniques in his assesment of the symptom: Knee pain. These may include a physical examination or other medical tests. Your doctor may ask several questions when assessing your condition. It is important to remember that your consultation is a two-way process and any extra information you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
Why: to determine if acute or chronic.
Why: may be due to rheumatic fever, sarcoidosis, relapsing rheumatoid arthritis or trauma.
Why: Unilateral knee pain would suggest gout, septic arthritis, bursitis, hemophilia, pseudogout, osteogenic sarcoma (bone cancer around the knee) and traumatic conditions such as torn meniscus, hemarthrosis (accumulation of blood in the knee joint), sprain of collateral ligaments of the knee and fracture.
Why: would suggest sprain, torn meniscus, bruise or fracture.
Why: e.g. did you land awkwardly after a leap in the air?; did your knee get a direct blow?; did your leg twist during the injury?; did you hear a "pop" or "snap"?
Why: Younger people are more likely to have traumatic conditions such as fracture, sprains, bruises or a torn meniscus. Osgood Schlatter disease would be more typical of people in their teen years. People in their twenties are more likely to have Rheumatoid arthritis, Reiter's disease and systemic lupus erythematosus. People in the forth or fifth decade and older would be more likely to have osteoarthritis, gout and pseudogout.
Why: e.g. scrubbing floors or cleaning carpets - may help determine likelihood of bursitis such as "housemaid's knee" ( swelling gradually developing over days and confined to the front of the knee).
Why: e.g. throbbing pain may suggest inflammation of the joints and suggests Rheumatoid arthritis, psoriatic arthritis, Reiter's disease, ankylosing spondylitis; severe episodic pain may suggest gout.
Why: Inflammatory pain is worse at night and in early morning; mechanical joint pain due to injury or osteoarthritis is worse at the end of the day and after activity; Continuous pain present day and night is suggestive of infection or bone tumor.
Why: may indicate inflammation, bursitis or bone tumor.
Why: inflammatory joint pain causes pain at rest , relieved by activity ; mechanical joint pain due to injury is exacerbated by activity and relieved by rest ;osteoarthritis causes pain with or after activity and relieved with rest.
Why: may suggest Lyme disease (may present months or even years after a tick bite).
Why: systemic diseases that may predispose to or present with joint pain include psoriasis, ulcerative colitis, Crohn's disease, systemic lupus erythematosus, scleroderma, dermatomyositis, bleeding disorders, rheumatic fever, tuberculosis, hepatitis B, diabetes mellitus, Wegener's granulomatosis, HIV infection, lung cancer, hemochromatosis, sarcoidosis, hyperparathyroidism, Paget's disease.
Why: e.g. previous knee surgery.
Why: e.g. certain medications may precipitate gout including frusemide and thiazide diuretics; some medications may induce a Lupus syndrome including hydralazine, procainamide, phenytoin, chlorpromazine, isoniazid and methyldopa; other medications that may cause joint pain include cotrimazole, amoxicillin, mianserin, carbimazole and nitrofurantoin.
Why: may suggest septic arthritis, hepatitis B or C, HIV-associated joint disease, subacute bacterial endocarditis and serum sickness reactions.
Why: can determine risk of Reiter's syndrome, gonococcal arthritis, Hepatitis B or HIV viral arthritis.
Why: e.g. osteoarthritis, rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, psoriasis, gout, pseudogout, hemophilia.
Sometimes, other symptoms may be present and may help your doctor analyse your condition. These may include:
Why: if knee swelling is present, how would you explain the joint swelling? - e.g. acute joint swelling (1-4 hours) with intense pain would suggest blood (hemarthrosis), infection or gout; subacute (1-2 days) soft joint swelling would suggest synovial fluid effusion; chronic and bony joint swelling would suggest osteoarthritis; chronic and soft/boggy joint swelling would suggest synovial proliferation such as rheumatoid arthritis.
Why: suggests torn meniscus, loose body, torn anterior cruciate ligament, avulsed anterior tibial spine, dislocated patella.
Why: suggests subluxing patella, loose bodies, torn meniscus, torn anterior cruciate ligament, avulsed anterior tibial spine, dislocated patella.
Why: (e.g. weight loss, fever, malaise) - should consider systemic lupus erythematosus, Reiter's disease, Rheumatoid arthritis, scurvy and rheumatic fever.
Why: may suggest septic arthritis, rheumatic fever, gonococcal arthritis, Reiter's syndrome, lupus erythematosus, Lyme arthritis, polymyalgia rheumatica, Still's disease and rheumatoid arthritis.
Why: would suggest Reiter's syndrome or gonococcal arthritis.
Why: may suggest enteropathic arthritis (such as due to Ulcerative colitis or Crohn's disease) or Reiter's syndrome.
Why: may suggest psoriatic arthritis, gonococcal arthritis or HIV infection.
Why: may suggest Reiter's disease.
Why: e.g. usually symmetrical and can affect many joints. Pain is worse at the end of the day and aggravated by use and cold weather, relieved by rest. Usually associated with pronounced stiffness, especially after activity.
Why: e.g. usually starts with the gradual onset of pain and stiffness of the small joints of the hands and feet. Joint pain is worse on waking, nocturnal pain with disturbed sleep, pain is relieved with activity. Morning and rest stiffness can last for hours. May be associated with weakness, weight loss, malaise and fatigue.
Why: e.g. often excruciating pain in the great toe starting in the early hours of the morning, skin over the joint may be red, shiny, swollen and hot, joint is very tender to touch. Pain may be precipitated by alcohol excess, surgical operation, starvation and certain medications.
Why: e.g. typically occurs in children and young adults, migratory polyarthritis (many joints are involved, joints affected alter with time), involves large joints sequentially, one becoming hot, red, swollen and very painful as the other subsides. It rarely lasts more than five days in any one joint. Associated with acute fever.
Why: e.g. conjunctivitis, urethritis (painful urination, penile discharge, vaginal discharge). The arthritis tends to affect the larger peripheral joints especially the ankle and knees.
Why: e.g. months or years after a tick bite develop joint pain, usually of the large joints such as knee; typical rash (a dough-nut shaped red rash about 6cm in diameter) at the bite site; heart disorders (especially abnormal rhythms of the heart) or disease of the central nervous system (including weakness of the muscles in the limbs, muscular pain or evidence of meningitis).
Why: e.g. occurs in children aged 10-14 commonly in those involved in sports involving running, kicking and jumping. Localised pain in region of the tibial tubercle (bony protuberance at front of knee below knee cap) during and after activity, aggravated by kneeling down and going down stairs. Associated with the development of a lump and tenderness in the area.
Why: e.g. Often caused when there is history of injury with twisting movement with the foot firmly fixed on the ground. Present with pain over the joint line, locking of the knee, swelling of the knee and pain worse with activity.
Why: e.g. onset of pain after a sporting injury such as landing from a jump or a forced rotational strain of the knee when another player falls across the knee. Results in immediate swelling of the knee due to accumulation of blood in the knee joint. Problems after the injury of knee pain and knee "giving way".
Why: e.g. often caused by a direct blow to the front of the tibia in a flexed knee or from a severe hyperextension injury. Causes pain in the back of the knee radiating into the calf, especially running down hill. Usually causes little swelling and little disability except for limitation of running and jumping.
Why: e.g. often caused by a direct force to the outer side of the knee. Causes pain and localized swelling on the inner side of the knee which is aggravated by twisting of the knee.
Why: e.g. usually nil specific history of trauma to the knee. Causes pain behind the knee cap or deep in the knee which is aggravated during activities that require flexion of knee under loading (e.g. climbing stairs, walking down slopes, squatting or prolonged sitting).
Why: e.g. intense joint pain, feeling unwell, fever. The joint is usually held rigid.
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