DipMSK Revision Guide · Chapter 10 of 18

Knee Region Conditions

Knee OA, patellofemoral pain, the Ottawa Knee Rules and the acute hot knee.

Syllabus: Knee Region Conditions

Written by Dr David Palethorpe, MBBS, BSc (Hons), MRCGP · NHS GP PartnerReviewed 14 September 202617 min readChapter 10 of 18

Before you start

Try this first

Why should you not request MRI for suspected knee osteoarthritis?

AoMRC Evidence-Based Interventions says it is not required, and it finds degenerate meniscal change that drives needless arthroscopy. If you image at all, use weight-bearing views.

2 more warm-up questions in the full chapter.

What this chapter covers

  • 10.1Knee osteoarthritisThree bedside criteria: 45 or over, activity-related pain, and morning stiffness of no more than 30 minutes. The commone…Preview below
  • 10.2Load-related knee pain — patellofemoral, tendon, ITB and bursaMembers
  • 10.3Acute knee injury and the Ottawa Knee RulesMembers
  • 10.4The acute hot knee — septic arthritis versus crystal arthropathyMembers
  • 10.5Lower-leg pain — MTSS, stress fracture and exertional compartment syndromeMembers
  • —Referral, by timeframeRed flags below

Knee osteoarthritis

Core Lens — the takeaway

Three bedside criteria: 45 or over, activity-related pain, and morning stiffness of no more than 30 minutes. The commonest trap is ordering the radiograph anyway.

Recognise

  • NG226: diagnose clinically without imaging if the person is 45 or over, has activity-related joint pain, and has either no morning joint-related stiffness or stiffness lasting no longer than 30 minutes.
  • Loaded pain: stairs, slopes, standing, rising from a low chair; early on it settles with rest.
  • Gelling after sitting clears in minutes. Stiffness taking an hour to clear is not osteoarthritis.

The rest of this chapter is in the DipMSK guide

4 more topics, every section opened up, the recall questions and the guidance summaries — written and reviewed by practising UK doctors.

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Referral, by timeframe

Same day · Emergency
  • Hot swollen knee with systemic upset, a prosthesis or immunosuppression — suspected septic arthritis
  • Sepsis physiology — hypotension, tachycardia, confusion, escalating NEWS2
  • Suspected knee dislocation or a pulseless, cold limb — dislocations often reduce spontaneously
  • Locked knee, tense haemarthrosis or inability to straight-leg raise
  • Any hot painful prosthetic joint — never community antibiotics
  • Severe leg pain out of proportion after trauma, with pain on passive stretch or tense compartments
  • A limping child or adolescent with knee pain and a painful hip
  • Unilateral calf swelling with thrombotic risk factors — same-day DVT pathway

Also in the full chapter: Cancer pathway · Urgent · Routine.

← Chapter 9Hip Region Conditions

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