Rheumatology‎ > ‎

Knee Pain

    • Etiology:
      • Atraumatic Anterior Knee Pain:
        • Knee Extensor Tendonitis (Patellar tendonitis (jumpers knee) / Quadriceps tendonitis
          • Worse with descending stairs, running, frequent jumping
        • Pre-patellar Bursitis:
        • PFPS (Patello-fermoral Pain Syndrome or Chondromalacia patella):
          • Risk factor: Genu Valgum or Knock Knees
          • Worse with descending stairs (more knee flexion)
          • Patellar Grind Test
          • J-tracking
          • Patellar apprehension test 
          • Merchant's View or Sunrise View
        • Patello-femoral OA:
          • Any of the 3 compartments of the knee can be affected
          • Medial, Lateral or Patello-femoral
      • Lateral Knee Pain
        • Lateral Meniscal Injury
          • McMurray Test (97% specific for posterior meniscal tear; should be done for both medical and lateral menisci; Sensitivity 17-29%)
        • Lateral Collateral ligament strain
          • Not common 
        • Lateral Compartment OA
        • ITBS (Iliotibial Band Syndrome)
          • Tenderness proximal to lateral joint line
          • Genu Varum makes tight IT band 
          • Noble's test 
      • Medial Knee Pain
        • Medial Meniscal Injury
        • Medial Collateral Ligament Strain
        • Pes anserinus bursitis
        • Medial Compartment OA
      • Posterior Knee Pain
        • Popliteal Cyst (Baker's Cyst)
        • Posterior Cruciate Ligament Injury
            2. Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis AAFP 2003

 Clinical Evaluation of the Knee NEJM 2010 (15:42)
             Dr. Mark Hutchinson's knee exam


Begin to anesthetize the region by placing a wheal of lidocaine in the epidermis, using a small (25-gauge) needle, and then anesthetize the deeper tissues in the anticipated trajectory of the arthrocentesis needle. Intermittently pull back on the plunger during the injection of the anesthe tic to exclude intravascular placement.

Using an 18-gauge needle and large syringe, direct the needle behind the patella and toward the intracondylar notch. Resist the temptation to “walk” the needle along the inferior surface of the patella, since this practice may damage the delicate articular cartilage. Constantly pull back on the plunger while you advance the needle; you will know when the needle enters the synovial cavity, because fluid will enter the syringe. 

You may apply a woven elastic bandage or knee immobilizer to reduce post procedural swelling and discomfort. 

Arthrocentesis of the Knee NEJM 2006 (Video)