Painful Knee – Minor/No Trauma

Patient presentation - Knee problem over 1 month * Exclude hip & spine pathology Significant Symptoms Few clinical signs Meniscal Injury? (see Painful Knee – Acute/ significant trauma pathway) Osteoarthritis (OA) of the knee? * Standing X-ray often useful High Suspicion Meniscal Tear Low Suspicion Meniscal Tear • history of anterior knee pain • pain with down stairs or hills • pain with sitting for long time • pain with start up • pain can be all over the knee • non tender joint line • no history of locking or giving way

Yes • Analgesics/NSAIDs • walking aids • advise to stay as active as possible • intra-articular steroid injection

No

MRI

NOT SETTLED

Physiotherapy Assess/Rehab
Normal MRI Abnormal MRI

Physiotherapy Rehab 6 weeks

FAILURE TO ACHIEVE REHABILITATION MILESTONES

Physiotherapy Assess/Rehab

NOT SETTLED

Orthopaedic

Orthopaedic

Orthopaedic

Orthopaedic

KNEE PAIN PRIMARY CARE MUSCULOSKELETAL PATHWAYS

Compiled by: Tendayi Mutsopotsi

November 2011

Acknowledgements: www.pathways.scot.nhs.uk

Painful Knee – Acute / Significant Trauma
Patient presentation – Acute Knee Pain Hot swollen joint ? infection, inflammatory disease including gout/ pseudogout

Fracture (#) Query? (See Ottawa guidelines below, As to whether to X-ray a knee injury) X-ray Yes # No #

Soft tissue injury?

Haemarthrosis Locked Knee

Significant ligament injury?

Rest Ice Compression Eleveation (RICE) Review at 48 hrs, then 1 week

OTTAWA GUIDELINES X-ray only required for knee injury patients with any of these findings: • Age 55 or older • Tenderness at head of fibula • Isolated tenderness of the patella (that is, no bone tenderness of the knee other than patella) • Inability to flex knee to 90 degrees • Inability to walk 4 weight-bearing steps immediately after injury & in emergency dept.

Physiotherapy/ MSK assessment
Re-examine (4-6 weeks)

No progress/ diagnostic doubt

MRI
Osteochrondral injury Meniscal Tear Normal Moderate OA Patella Tendonitis Bone Bruising OA Advanced/Moderate

Physiotherapy

Physiotherapy/ MSK assessment
IF FAILS

Urgent Orthopaedic

Orthopaedic

Orthopaedic

Urgent Orthopaedic

Orthopaedic

Secondary Care

KNEE PAIN PRIMARY CARE MUSCULOSKELETAL PATHWAYS

Compiled by: Tendayi Mutsopotsi

November 2011

Acknowledgements: www.pathways.scot.nhs.uk

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