Knee Pain - Steps to Diagnosis

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What Type of Injury Do I Have?

One minute you are fully immersed in your sporting endevour and the next minute everything changes. A bad foot plant, a seemingly insignificant twist and loud pop or a sudden collision.  Symptoms can present in an array of ways including pain, knee instability, swelling, locking of the knee, slipping knee cap, popping or none at all.​

It is essential to ensure a full and comprehensive diagnosis before continuing further activities. Being cautionary prevents further damage.  Continuing to participate in sports or returning too soon is the leading cause of compounding injuries and a common cause of long term knee instability, with increased risk of early onset of arthritis.

Immediately after injury, aim to follow the RICE method, followed by diagnosis by a professional.  A physical diagnosis should include testing for the following, depending upon the location of your injury:

  • Body Alignment - Assessment of both posture and lower extremity alignment

  • Palpatation - Feel of the anatomical structures of the knee to identify tenderness.  Locates likely joint issues.

  • Range of Motion - Test knee flexion range using a goniometer (ideal from 120-150 °).  Lock knee or laxity indicates injury.

  • Anterior Drawer - Examines for any tearing or laxity of the anterior cruciate ligament (ACL).  Increased anterior movement of the tibia on the injured side compared to the non-injured side indicates injury but is not always conclusive due to hamstring strength or swelling.

  • Vulgas Test - Assesses the medial joint laxity, for possible injury to the medial collateral ligament (MCL).  Increased medial joint laxity on one side compared to the unaffected side indicates injury.

  • Varus Test - Checks joint laxity on the outside of the knee for possible injury to the lateral collateral ligament (LCL).  Increased lateral joint laxity on one side compared to the unaffected side indicates injury.

  • Posterior Drawer - Examines the Posterior Cruciate Ligament (PCL).  By applying a posterior force to the upper shin, an increase in backwards motion (posterior translation of the tibia) in comparison to the other side, indicates injury.

  • McMurray's Test - Checks for meniscal tears and other internal derangement in the knee.  Painful clicking along the joint line, or any pain over the joint line indicates injury.

  • Thessaly's Test - Identifies possible meniscus tears in the standing position.  Injury is indicated by reproducing a twisting movement where the pain is typically localized to the joint line, and more accute with the knee bent at 20° rather than 5°.

A physical test will typically need to be followed with an x-ray to ensure no bone damage, followed by an MRI to determine soft tissue damage.  

R.I.C.E

Apply the Rest, Ice, Compress, Elevation approach immediately after an injury happens and for the first 24 to 48 hours after the injury, to help reduce the swelling and pain and help you heal faster.  

  • REST for 1-2 days. 

  • Use ICE in a wrap for 15 mins immediately after injury and as often as possible in first 24 hours.

  • Use a bandage to COMPRESS the area to limit swelling and provide additional support to the injured area.

  • ELEVATE your knee above your heart if possible to decrease swelling and help blood back to the heart.

 

Physical Exam

If your injury seems more serious than a sprain you should seek immediate medical help at your local hospital emergency department, where they will be able to compelte a physical exam and do an X-ray to rule out any bone fractures.  Alternatively you might visit a sports physio, who would be able to complete a physical diagnosis, but will likely require you to get X-rays.  Your family doctor may be adept at diagnosis if no other options are available.  

 

X-Ray

X-rays only show bones, so why are they needed when you likely have a soft tissue injury?  There are 3 key reasons:

  1. X-ray findings may make an MRI unnecessary (saving time and money)

  2. X-rays can show unexpected findings important for full diagnosis (tumours)

  3. X-rays show the status of your joint that may indicate any bone degeneration / spurs / bone spacing which could impact surgery.

MRI

A Magnetic Resonance Imaging Scan (MRI) is required to assess structures, such as your tendons that do not show up on x-ray.  If you have a suspected ACL /PCL/ MCL tear, you will require an MRI to determine the exact status and which rehab option would best suit you.  Although physical tests can help determine damage, an MRI is the only way to confirm specific injury.  MRI's are performed in hospitals or specialist clinics and take approximately an hour.  Knee issues are determined as non-critical, which can frequently result in months of waiting on a medical list, depending upon your location and or medical insurance, unless you opt to pay for a private scan.

ACL KNEE INJURY & REHAB

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These statements have not been evaluated by the FDA. This site is not intended to diagnose, treat, or prevent knee Injury. Information is presented for educational purposes only and is not intended to replace the advice of your healthcare professional. Consult your doctor or health professional at time of injury and before starting your rehab or making any changes to your diet. Also note that this page may contain affiliate links.

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