Painful knee joint

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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130 Painful knee joint

Instruction

Examine this patient’s leg.

Examine this patient’s joints.

Examine this patient’s knee joint.

Salient features

History

• Painful knee joint

• Take a history of trauma and fever

• History of rheumatoid arthritis, gout or haemophilia.

Examination

• Pain on movement of the joint (take care not to hurt the patient)

• Swelling of the joint (you must demonstrate fluid in the joint, see Fig. V.3)

• Check both active and passive movements

• Look for disuse atrophy of the muscles around the joint

• Tell the examiner that you would like to:

• examine other joints
• radiograph the knee (anteroposterior and lateral views)
• analyse the joint fluid for cells, sugar, protein and culture.

Diagnosis

This patient has a painful knee joint with restricted movement (lesion and functional status) following trauma while playing rugby (aetiology).

Questions

What are the common causes of a painful knee joint?

• Rheumatoid arthritis

• Osteoarthrosis

• Trauma

• Septic arthritis (will require emergency removal of the pus to prevent joint damage)

• Viral infection

• Gout

• Pseudogout

• Haemophilia.

Advanced-level questions

What is palindromic rheumatoid arthritis?

Palindromic onset of rheumatoid arthritis refers to acute recurrent arthritis, usually affecting one joint, with symptom-free intervals of days to months between attacks. This term was introduced by PS Hench (p. 477) and EF Rosenberg.

A patient with a painful knee joint and an unilateral facial nerve palsy is seen by you in the outpatient department. Six weeks before this she developed an annular rash after a camping trip in Europe. What is your diagnosis and what confirmatory test would you carry out?

The diagnosis is Lyme disease and the confirmatory test is an antibody titre against Borrelia burgdorferi. The disease was first recognized in Lyme, Connecticut, USA.

What are the causes of acute monoarticular arthritis?

The causes of acute-onset monoarticular or pauciarticular arthritis includes bacterial infections (e.g. with Staphylococcus aureus, Neisseria gonorrhoeae and Streptococcus pneumoniae), reactive arthritis, sarcoidosis, fracture, hemarthrosis, gout, pseudogout and monoarticular rheumatoid arthritis.

What are the causes of acute polyarticular arthritis?

The causes acute polyarticular arthritis (involvement of more than just a few joints) includes endocarditis, serum sickness, acute hepatitis B infection, HIV infection, parvovirus infection, rheumatic fever, rheumatoid arthritis and SLE.

[/level-membership-for-internal-medicine-category][not-level-membership-for-internal-medicine-category]

130 Painful knee joint

Instruction

Examine this patient’s leg.

Examine this patient’s joints.

Examine this patient’s knee joint.

Salient features

History

• Painful knee joint

• Take a history of trauma and fever

• History of rheumatoid arthritis, gout or haemophilia.

Examination

• Pain on movement of the joint (take care not to hurt the patient)

• Swelling of the joint (you must demonstrate fluid in the joint, see Fig. V.3)

• Check both active and passive movements

• Look for disuse atrophy of the muscles around the joint

• Tell the examiner that you would like to:

• examine other joints
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