Knee Pain Diagnosis, Treatment, Causes & Pain Relief|Knee assessment & diagnosis

How to Diagnose Knee Pain

The diagnosis of knee problems focuses on movement tests and imaging examinations such as x-rays, ultrasound or CT of the knee

The starting point of the diagnosis is the medical history (medical history). The patient reports on the current symptoms, where exactly at the knee it hurts (which partially allows conclusions about the cause, see chapter "Knee pain: Overview"), and about possible injuries or past interventions.

This is followed by an in-depth physical examination, which, of course, focuses primarily on the knee-based musculature system. This applies in particular to an injury. The doctor scans the knee for pain points and swelling. He examines how well the kneecap is displace able - which you can even try on the extended knee - and whether the knee and hip joints are sufficiently flexible.

The orthopedist also uses a series of exercise tests to help him identify a variety of conditions. Last but not least, he measures the circumference and length of the legs during the initial examination and checks the leg axis and foot position, muscle reflexes and vascular pulses on the legs - always in a side comparison, of course.

Imaging procedures and articular flexion of the knee

Important information about the knee is given by imaging techniques such as ultrasound (ultrasonography), X-rays, computed tomography (CT), magnetic resonance imaging (MRI, MRI) and, in special cases, a nuclear medicine examination (scintigraphy). More engaging is there already a joint puncture, more still a Gelenkspiegelung (arthroscopy). Both are also used for therapeutic purposes. For very specific questions, an X-ray examination of vessels or a tissue extraction (biopsy) from the bone may be necessary. If necessary, the doctor sends a sample from the patient's blood, urine or synovial fluid to a laboratory laboratory for examination.

X-rays may reveal fractures, broken pieces of bone cartilage or other abnormal bone changes (fracture, thinning, compression, deformation). In addition, X-ray images can be used to determine axial deviations such as X and O legs.

In ultrasound images, the menisci can be seen very well, also changes to the joint capsule, tendon attachments, ligaments, muscles and the synovial membrane (soft tissue), then fluid retention (joint effusion). For example, in case of an unclear swelling, ultrasonically is indispensable.

Magnetic resonance imaging (MRI) provides detailed insights into the interior of the joint. But also the soft tissues surrounding the joints are very easy to see in the MRI images. This can also be useful to plan an intervention exactly.

In computed tomography (CT), an X-ray tube revolving around the body scans the focus of the organ or body area, layer by layer. The pictures are then digitally constructed. Computed tomography has its place in special questions in knee diagnostics, as well as in the planning of operations. For example, a complicated, joint-near fracture including adjacent blood vessels and nerves can be reconstructed three-dimension ally. The surgeon can then proceed safer.

In case of suspected thrombosis of the leg, the doctor examines the appropriate vessels depending on the symptoms. Veins can be visualized today using Doppler sonography. Arteries can be imaged after injecting a contrast agent in X-rays (angiography). An artery must be punctured. Vascular imaging is now possible without direct arterial puncture as Angio-CT or Angio-MRI. X-ray examinations, including CT, especially angiography and angio-CT, are associated with a not inconsiderable dose of radiation and are usually not the focus of attention when it comes to knee pain.

Scintigraphy can help in the search for inflammation or in-depth questions about bone structure and activity, but is rarely necessary at the knee.

Joint punctures are performed by the doctor only for special questions. In acute cases, it may be necessary to relieve a knee from an effusion. This is then a therapeutic and diagnostic measure, because the extracted fluid - the puncture - is usually examined in the laboratory after admixtures such as blood, certain cells, crystals or pathogens. If "fat eyes" and blood are found in them, this is an indication of an injury to cartilage bone tissue, such as a bony band tear or bone cartilage fracture. A residual risk for an infection always exists in spite of a sterile procedure in a joint puncture. An inflammatory thickened synovial membrane, which can be accompanied by an effusion, is primarily no reason for a joint puncture.

A synovial arthroscopy is also used for diagnosis and therapy. Here, the joint interior is viewed through an arthroscope or the corresponding screen projection. It can be introduced finest instruments. They serve to scan the interior of the joint with instruments, to sew cracks or to rebuild ligaments (band platy). In this respect, target structures are above all the menisci (partial menisclectomy) and the ligaments. Arthroscopy is performed under local anesthesia, conduction anesthesia (regional anesthesia) or general anesthesia.

Knee pain: Which specialist is the right one?

For example, if there is a suspicion of rheumatic disease, the internist / hematologist or the rheumatological orthopedist is in demand. In case of a suspected nerve disease, you will turn to a neurologist. He may also determine whether the cause of a painful joint problem and / or concomitant muscular dysfunction may be due to a neuromuscular disorder. Neuromuscular stands for the interaction of nerve and muscle.

If there is evidence of acute nerve damage, such as a feeling of numbness or any other serious injury such as bone fracture, tendon or ligament tear, circulatory disturbance, bleeding or serious infection, the doctor will immediately refer the affected person to a clinic.