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Differential Diagnosis Knee Pain

Submitted by: LT Matthew Armentano matthew.armentano@ihs.gov


Differential Diagnosis of Knee Pain by Age Group Children and adolescents Patellar subluxation Tibial apophysitis (OsgoodSchlatter lesion) Jumpers knee (patellar tendonitis) Referred pain: slipped capital femoral epiphysis, hip fracture Patellofemoral pain syndrome (chondromalacia patellae) Medial plica syndrome Pes anserine bursitis Trauma: ligamentous sprains (anterior cruciate, medial collateral, lateral collateral), meniscal tear, Fractures, muscle strains Inflammatory arthropathy: rheumatoid arthritis, Reiters syndrome, Pigmented Villanodular Synovitis Tendonitis (quadriceps, Patellar tendon, etc) Older adults Osteoarthritis Crystal-induced inflammatory arthropathy: gout, pseudogout Popliteal cyst (Bakers cyst) Metastatic Cancer

Osteochondritis dissecans

Juvenile Rheumatoid Arthritis Trauma: ligamentous sprains (anterior cruciate, medial collateral, lateral collateral), meniscal tear, Fractures to include Epiphyseal Fracture , muscle strains

Septic arthritis

Stress Fracture/Stress Reaction Referred Pain: Neurogenic, Hip and leg pathology

Common Knee pain by Anatomic Site


Anterior knee pain Patellar subluxation or dislocation Tibial apophysitis (Osgood-Schlatter lesion) Jumper's knee (patellar tendonitis) Patellofemoral pain syndrome (chondromalacia patellae) Medial knee pain Medial collateral ligament sprain Medial meniscal tear Pes anserine bursitis Medial plica syndrome Lateral knee pain Lateral collateral ligament sprain Lateral meniscal tear Iliotibial band tendonitis Posterior knee pain Popliteal cyst (Baker's cyst) Posterior cruciate ligament injury

Differential Diagnosis Page two

Mechanism of Injury:
Trauma
Fracture of Femur, Tibia, Fibula, Patella Ligamentous Sprain (ACL, MCL, LCL, PCL) Mensical Tear Patellar subluxation/dislocation Muscle Strain Osteochodral fracture

Atraumatic

- Osteoarthrits - Rheumatoid or other inflammatory Arthritis (Pigmented villonodular arthritis, gout, reiters syndrome) - Septic Arthrits - Popliteal cyst - Stress Fractures/reactions (tibial plateau & shaft, femur, patella) - Tendonitis - Patellofemoral Syndrome - Medial plica syndrome - Referred pain (hip OA, Lumbar radicular sx) - Metastatic cancer

References:
Diagnosis and management of the osteonecrotic triad of the knee. PM Soucacos, et al. Ortho Cl N Am, 35 (2004) 371-381. Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis. WL Calmbach and M. Hutchens, American Family Physician, Volume 68 Number 5 September 1, 2003

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