MSK - Knee Pain Assessment 'remember one up one down'
Nov 18, 2023
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Join Richard and Emma as they discuss knee pain assessment with FCP physio Ed Baker, covering history taking, examination findings, and when to investigate knee pain. They dive into a case study on osteoarthritis, differentiate between OA and RA based on pain patterns, and explore red flags in knee assessment, emphasizing the 'one up one down' approach.
Observing patient movement and history aids in knee pain assessment.
Special tests like Thessaly test provide diagnostic insights for meniscal injuries.
Accurate diagnosis and management of knee pain require comprehensive assessments and appropriate imaging criteria.
Deep dives
Key Points on Knee Pain Assessment
When assessing knee pain patients, observing their movement and functional range is crucial for initial insights into severity and interpretation of pain. Subjective history focusing on mechanisms of injury helps differentiate cases, like trauma in younger versus gradual progression in older patients. Pre-medical history, aggravating factors, and social context play a significant role in considering differential diagnoses and red flags.
Assessment of Knee Injuries: Visual Inspection and Special Tests
Visual inspection for knee swelling, redness, or unusual heat, coupled with assessing active movements like flexion and extension, aids in determining any internal derangement or meniscal issues. Special tests like the Thessaly test for meniscal injuries and Valgus or Varus stress testing for collateral ligament integrity provide additional diagnostic insights.
Knee Pain Differential Diagnosis and Referral Protocol
Understanding pain referral patterns is essential, with hip or lumbar spine pathologies often mimicking knee pain. Differentiating knee-related nerve pains and correlating with mechanisms of injury guide accurate assessments. Referral considerations for ACL, meniscal, or ligament injuries are determined by history, instability, and urgency, with surgical outcomes and rehabilitation strategies well-aligned to patient preferences.
Evaluation and Assessment of Knee Pain in a 61-Year-Old Male
In this podcast episode, the discussion centers around the evaluation and assessment of a 61-year-old male named John who presents with left knee pain. John, a plumber who smokes and binge drinks, has a history of knee pain attributed to his work. Various factors like family history of arthritis, lifestyle habits, and work nature are considered in assessing his condition. Insights are shared on differentiating osteoarthritis from rheumatoid arthritis based on pain patterns, stiffness, and joint involvement, emphasizing the importance of a comprehensive assessment to guide diagnosis and management.
Imaging and Referral Criteria for Knee Pathologies
The podcast highlights the significance of appropriate imaging and referral criteria for knee pathologies. X-rays are recommended for confirming arthritis in candidates considering surgical interventions. MRI is identified as the gold standard for soft tissue injuries like meniscal tears or ligament issues, aiding in treatment decisions. The discussion stresses on clinical indicators like range of motion, pain patterns, and functional limitations to guide imaging and referral decisions, emphasizing the need for a clear diagnosis to optimize patient outcomes.
Richard and Emma welcome back Ed Baker who is a FCP - MSK physio in general practice and a FCP ambassador at Coventry and Warwickshire Training Hub. During the episode we discuss the approach to patients that present with knee pain and how to carry out a effective knee assessment. Including, history taking, common examination findings and knee pathology. Ed discus's when we should be investigating knee pain and what investigations should requested. Ed then relates his assessment to discuss a case related to osteoarthritis presenting in general practice.
Please feel free to rate the podcast and comment, follow us on twitter @FCPParamedicpod.
As always thank you to Scott and Martin for you input on developing the podcast.
Anterior Drawers Test https://www.youtube.com/watch?time_continue=2&v=X2sDFK76xNo&embeds_referring_euri=https%3A%2F%2Fwww.bing.com%2F&embeds_referring_origin=https%3A%2F%2Fwww.bing.com&source_ve_path=Mjg2NjY&feature=emb_logo
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