Differential Diagnosis for Knee Pain without Acute Trauma
Given the radiology read of mild tricompartmental degenerative disease, the following differential diagnoses are considered:
Single Most Likely Diagnosis
- Osteoarthritis (OA): This is the most likely diagnosis given the radiographic evidence of tricompartmental degenerative disease. OA is a common cause of knee pain in the absence of acute trauma, especially in older adults, and is characterized by progressive wear and tear of the joint cartilage.
Other Likely Diagnoses
- Meniscal tears: Even without acute trauma, meniscal tears can occur due to degenerative changes and are a common cause of knee pain.
- Ligamentous sprains: Chronic or repetitive strain on the knee ligaments can lead to pain without a clear history of acute trauma.
- Bursitis: Inflammation of the bursae around the knee can cause pain and is often related to repetitive motion or chronic irritation.
- Tendinitis: Tendons around the knee can become inflamed due to overuse or degenerative changes, leading to pain.
Do Not Miss Diagnoses
- Septic arthritis: Although less likely, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. It can present with knee pain and may not always have a clear history of trauma.
- Osteonecrosis: Avascular necrosis of the bone can cause knee pain and may not be immediately apparent on X-ray, requiring further imaging like MRI for diagnosis.
- Neuropathic pain: Referred pain from nerve compression or neuropathy can sometimes present as knee pain without a clear musculoskeletal cause.
Rare Diagnoses
- Rheumatoid arthritis (RA): Although RA can cause knee pain, it typically presents with systemic symptoms and involvement of multiple joints.
- Gout or pseudogout: These are forms of arthritis that can cause acute or chronic knee pain but are less common than OA or other degenerative conditions.
- Neoplastic processes: Tumors, either benign or malignant, can cause knee pain but are rare and usually have other associated symptoms or findings.
- Infection: Chronic infections like osteomyelitis or abscesses can cause knee pain and are important to consider, especially in immunocompromised patients.