Differential Diagnosis for Bilateral Knee Pain
Single Most Likely Diagnosis
- Osteoarthritis (OA): The patient's age, symptoms of bilateral knee pain (left worse than right), and history of kneeling and hearing cracking noises are consistent with OA. The presence of minor superior spurring on the left knee X-ray also supports this diagnosis.
Other Likely Diagnoses
- Meniscal Tear: The patient's symptoms of cracking noises and difficulty getting up after kneeling could be indicative of a meniscal tear, especially given the chronic nature of the symptoms.
- Patellofemoral Pain Syndrome: The patient's ability to walk fine but experiencing pain when kneeling or getting up suggests patellofemoral pain syndrome, which is characterized by pain around or behind the patella.
- Ligamentous Sprain: Although less likely given the chronic nature of the symptoms, a ligamentous sprain could still be considered, especially if the patient has a history of trauma or overuse.
Do Not Miss Diagnoses
- Septic Arthritis: Although the patient's symptoms do not suggest an acute infection, septic arthritis is a potentially life-threatening condition that requires prompt diagnosis and treatment. A high index of suspicion is necessary, especially if the patient has a fever, redness, or swelling around the knee.
- Bone Tumor or Cancer: A bone tumor or cancer, such as osteosarcoma or multiple myeloma, could present with chronic knee pain and should be considered, especially if the patient has a history of cancer or unexplained weight loss.
- Neurogenic Claudication: This condition, caused by spinal stenosis or other neurologic disorders, could present with knee pain and should be considered, especially if the patient has a history of back pain or neurologic symptoms.
Rare Diagnoses
- Hemochromatosis: This genetic disorder can cause joint pain and arthritis, including knee pain, due to iron accumulation in the joints.
- Wilson's Disease: This rare genetic disorder can cause joint pain and arthritis, including knee pain, due to copper accumulation in the joints.
- Gout or Pseudogout: Although less likely given the patient's symptoms, gout or pseudogout could still be considered, especially if the patient has a history of sudden, severe joint pain or kidney stones.