diagnosis of knee pain

Last reviewed 01/2018

A thorough and detailed history will aid the physician in diagnosing the cause of knee pain. Inquire about:

  • any event resulting in trauma to the knee
    • a direct blow to the knee -
      • to the anterior aspect of the knee -
        • to the proximal tibia with the knee in flexion (e.g., during vehicle accident where the knee hits the dashboard) results posterior cruciate ligament injury
      • to the lateral aspect of the knee - medial collateral ligament injury
      • to the medial aspect of the knee - lateral collateral ligament injury (1) (one of the most commonly injured ligaments in the knee) (2)

    • noncontact forces
      • significant deceleration forces (sudden stops and sharp cuts or turns) can cause anterior cruciate ligament injury
      • hyperextension - injury to the anterior cruciate ligament or posterior cruciate ligament
      • sudden twisting or pivoting movements - can cause meniscal injury (1)

  • characteristics of the pain e.g. - onset, location, duration, severity, quality (dull sharp achy) of pain
    • spontaneous onset of severe pain can be due to trauma, osteonecrosis, infection (3)
    • pain at rest, unchanged by activity or worse at night should prompt for an investigation of an underlying serious condition (3)
    • in an acute injury, ask whether the patient was able to continue activity or bear weight after the injury or was forced to cease activities immediately (1)

  • aggravating and alleviating factors (1)
    • sporting activities (running, jumping) act as a precipitating factor in patellofemoral pain
    • pain aggravated by kneeling specially in older adults indicate prepatellar bursitis or patellofemoral osteoarthritis (3)

  • symptoms such as locking, popping, or giving way of the knee at the time of injury
    • locking episodes suggests a meniscal tear
    • sensation of popping during the time of the injury suggests ligamentous injury (complete rupture of a ligament)
    • episodes of giving way may be due to patellar subluxation or ligamentous rupture

  • swelling of the knee joint - the amount and speed of onset
    • rapid onset (within 2 hours) of a large and tense effusion - rupture of a ligament (anterior cruciate) or fracture of the tibial plateau hemarthrosis
    • slower onset (over 2-36 hours) of a mild to moderate effusion - meniscal injury or ligamentous sprain
    • recurrent knee effusion after activity - meniscal injury (1)
    • in patients without a history of trauma
      • acutely knee swelling with symptoms of less than 24 hours - septic arthritis, crystal arthritis, haemarthrosis, rheumatoid arthritis (3)

  • of previous injuries, surgery, or medical conditions (gout, pseudogout, rheumatoid arthritis, or other degenerative joint disease) (1)

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