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