Getting Ahead of Knee Pain (Part 1)

Knee pain produces mind-boggling symptoms for patients and clinicians alike. For a treatment to be effective, an accurate diagnosis is crucial. This requires accurate clinical history, thorough examination and appropriate imaging.

More often than not, the clinical history points to the most obvious diagnosis.

Pain occurring acutely after sporting activity often points to a ligament, cartilage or meniscal injury. Knee swelling often confirms this diagnosis. Associated symptoms of instability – often described as a wobbly knee – denotes severe injury and warrants immediate specialist consultation. The inability to straighten the knee adequately is also a worrying symptom – the locked knee and is a surgical emergency.

Knee pain progressing and worsening over a longer duration, especially in the older age group, particularly if associated with stiffness during inactivity, points to arthritis as a possible cause of the problem. Pain associated with stair climbing or standing up from a seated position suggests the patella femoral (knee-cap joint) as a target pain generator.

Inability to place one’s weight (weight-bearing) on the painful limb warrants immediate medical attention. However, in children, any type of knee pain would warrant an early visit to the treating physician.

It is also prudent to keep in mind that knee pain can even result from problems of the lower back or hip joint.

A good examination of the patient in general and knee in particular is done to evaluate the severity of the knee pain or injury, confirm the structures involved and rule out possible associated conditions which modify treatment decisions.

Imaging is guided by a clinical diagnosis and is best done after history taking and clinical evaluation. Radiographs are particularly effective in picking up fractures, evidence of overuse injuries and arthritis. The magnetic resonant imaging (MRI) allows for better delineation of cartilage, ligament and meniscal pathology.

Management of knee pain depends on diagnosis. Self-care techniques can be undertaken if the injury is mild.