Font Size

Knee Pain Overview (cont.)

Physician Diagnosis

History: Even in today's world of technology, physicians rely on a detailed history and examination more than any single test.
- The doctor will typically want to know the exact nature of the pain.
  - Where in the knee is your pain?
  - What does the pain feel like?
  - Has it happened before?
  - What makes it better or worse?
- The doctor will also want to know a bit about you.
  - Do you have any major medical problems?
  - How active is your lifestyle?
  - What are the names of the medications you are taking?
- The doctor will want to know about any related symptoms.
  - Do you still have normal sensation in your foot and lower leg?
  - Have you been having fevers?
Physical examination
- The doctor will likely have you disrobe to completely expose the knee.
- The doctor will then inspect the knee and press around the knee to see exactly where it is tender.
- In addition, the doctor may perform a number of maneuvers to stress the ligaments, tendons, and menisci of the knee and evaluate the integrity of each of these.
X-rays and CT scans
- Depending on your particular history and examination, the doctor may suggest x-rays of the knee. X-rays show fractures (broken bones) and dislocations of bones in the knee as well as arthritic changes and abnormally large or small joint spaces.
- Rarely, the doctor may order a CT scan (a 3-dimensional x-ray) of the knee to precisely define a fracture or deformity.
- Both x-rays and CT scans are excellent for diagnosing fractures. They both are also poor, however, at evaluating soft tissue structures of the knee such as ligaments, tendons, and the menisci.
MRI
- Magnetic resonance imaging (MRI) uses large magnets to create a 3-dimensional image of the knee.
- In contrast to CT scans, MRIs do not image bones and fractures well.
- Also in contrast to CT scans, MRIs are excellent for evaluating ligaments and tendons for injuries.
Fluid removal
- The knee and all bursae of the knee are filled with fluid.
- If your symptoms suggest infection or crystalline arthritis, your physician may remove fluid, with a needle, from the knee.
- This fluid will then be analyzed to better clarify the diagnosis.
- Crystals, which suggest crystalline arthritis, often can be seen under the microscope, and infection can be detected.
Blood tests: The doctor may also elect to perform certain blood tests to evaluate for signs of infection or diseases such as rheumatoid arthritis and diabetes.
Arthroscopy
- The orthopedic surgeon may elect to perform arthroscopy if you have chronic knee pain.
- This is a surgical procedure where the doctor will place a fiber optic camera within the knee joint itself.
- By doing so, the surgeon may be able to see small particles in the knee or to look more closely at damaged menisci or cartilage.
- The doctor may also be able to repair damage by shaving down torn cartilage or removing particles from the knee while the camera shows the inside of your knee.