Carlton J. Covey, MD, FAAFP Matthew K. Hawks, MD Nellis Family Medicine Residency Program, Nellis Air Force Base, Nev (Drs. Covey and Hawks); Uniformed Services University of the Health Sciences, Bethesda, Md (Dr. Covey) carlton.covey@us.af.mil
The authors reported no potential conflict of interest relevant to this article.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Air Force Medical Department or the US Air Force at large.
Little has been written about nontraumatic nonarthritic knee pain in adults. This article seeks to fill that void with practical tips and an at-a-glance resource.
› Consider radiography for a patient with patellofemoral pain syndrome if examination reveals an effusion, the patient is age 50 years or older, or the condition does not improve after 8 to 12 weeks of treatment. C › Order plain radiography for all patients with patellofemoral instability to assess for osseous trauma/deformity; consider magnetic resonance imaging if you suspect significant soft tissue damage or the patient does not respond to conservative therapy. C › Perform joint aspiration with synovial fluid analysis for patients with painful knee effusion, and provide an orthopedic referral without delay when an infectious joint is suspected. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series
CASE › Jane T, age 42, comes to see you because of right knee pain that she’s had for about 6 months. She denies any trauma. Ms. T describes the pain as vague and poorly localized, but worse with activity. She says she started a walking/running program 9 months ago, when she was told she was overweight (body mass index, 29). She has lost 10 pounds since then, Ms. T says, and hopes to lose more by continuing to exercise. upon further review, you find that Ms. T has had increasing pain while ascending and descending stairs and that the pain is also exacerbated when she stands after prolonged sitting.
If Ms. T were your patient, what would you include in a physical examination and how would you diagnose and treat her?
Knee pain is a common presentation in primary care. While traumatic knee pain is frequently addressed in the medical literature, little has been written about chronic nontraumatic nonarthritic knee pain like that of Ms. T. Thus, while physical exam tests often lead to the correct diagnosis for traumatic knee pain, there is limited information on the use of such tests to determine the etiology of chronic knee pain.
This review was developed to fill that gap. In the pages that follow, we provide general guidance on the diagnosis and treatment of chronic nontraumatic knee pain. The conditions are presented anatomically—anterior, lateral, medial, or posterior—with common etiologies, history and physical exam findings, and diagnosis and treatment options for each (TABLE).1-31
