Investigating Knee Symptoms

Plymouth Orthopaedic and Sports Injury Clinic

Many knee symptoms will be self limiting or will resolve with simple treatment such as a course of pain killers or anti-inflammatory tablets. This is even the case in osteo-arthritis (wear and tear) which affects a large percentage of people as they get older, but in its mild to moderate state frequently requires no specific treatment.

Following an acute injury or if the symptoms persist, it is probably appropriate to take matters further. Usually your GP or Physiotherapist would see you first but occasionally direct referral to a Consultant is appropriate, particularly after a severe acute injury.

An accurate history of your condition is essential, and may clinch the diagnosis. For example a non contact twisting injury during sport, with the knee collapsing and an audible “pop”, immediate swelling and inability to walk is highly suggestive of an ACL rupture. Arthritic pain is typically worst on first mobilising (“start up pain”).

Simple clinical examination will help to define diagnosis. Swelling, alignment, range of motion, localising tenderness and stability are the important features to define or exclude. Sometimes knee pain can actually be caused by hip joint problems and clinical examination of the hip movements is to be recommended.

Imaging studies may then be used to define or refine the clinical diagnosis. Plain X-rays show the bony architecture, and when examined carefully may give useful information about soft tissue integrity.

MRI scanning is an invaluable investigation, providing accurate images of the bony and soft tissue structures. When appropriate MRI can give a very high degree of diagnostic accuracy, although its findings always need to be correlated with the clinical picture.

Ultrasound can give very useful information on tendons and also allows for the administration of targeted or guided injections.

CT scanning is useful for looking in detail at the bony structures, and is particularly good at picking up suble fractures, defining the extend of fractures. It also has an occasional role in pre operative planning.