Key Questions for Evaluating New Onset Knee Pain
When evaluating a patient with new onset knee pain, ask targeted questions about pain characteristics, mechanism of injury, associated symptoms, and functional limitations to guide diagnosis and treatment decisions. 1
Pain Characteristics
- Location of pain (anterior, posterior, medial, lateral, or diffuse)
- Onset (sudden vs. gradual)
- Duration (how long has the pain been present)
- Quality (sharp, dull, aching, burning)
- Severity (on a scale of 0-10)
- Timing (constant vs. intermittent)
- Aggravating factors (activities that worsen pain)
- Relieving factors (what makes the pain better)
Mechanism of Injury
- Was there a specific traumatic event?
- Details of any fall or twisting injury
- Position of the knee during injury
- Force and direction of impact
- Activity being performed when pain began
- Any sound heard during injury (pop, snap, crack)
Associated Symptoms
- Swelling (timing, amount, recurrence) 2
- Mechanical symptoms:
- Locking (inability to fully extend the knee)
- Popping or clicking
- Giving way or instability 2
- Ability to bear weight immediately after injury
- Changes in range of motion
- Redness or warmth around the joint
- Fever or systemic symptoms (suggesting infection)
Functional Assessment
- Ability to bear weight currently
- Impact on daily activities
- Difficulty with stairs (ascending vs. descending)
- Problems with walking, running, or standing
- Changes in gait pattern
- Use of assistive devices
Past Medical History
- Previous knee injuries or surgeries
- History of arthritis or other joint conditions
- Recent illnesses or infections
- Current medications
- History of gout or pseudogout
- Recent changes in activity level or exercise routine
Red Flags to Identify
- Inability to bear weight 3
- Gross deformity of the knee 3
- Fever with joint pain (suggesting infection)
- Severe pain unresponsive to rest and over-the-counter medications
- Progressive worsening of symptoms despite conservative measures
- Neurological symptoms (numbness, tingling)
- History suggesting increased risk of fracture 3
Physical Examination Focus Points
- Compare with the uninjured knee 4
- Inspect for swelling, erythema, deformity
- Palpate for point tenderness along joint lines 2
- Assess range of motion (active and passive) 4
- Evaluate ligament stability (collateral and cruciate) 4
- Perform special tests based on suspected pathology:
- McMurray's test for meniscal injuries
- Lachman test for anterior cruciate ligament
- Valgus/varus stress tests for collateral ligaments 4
Common Pitfalls to Avoid
- Failing to obtain weight-bearing radiographs when evaluating for osteoarthritis 1
- Neglecting to assess hip and spine as potential sources of referred knee pain 3
- Overlooking the importance of weight management in overweight patients 1
- Delaying appropriate imaging in cases of significant trauma 1
- Not re-examining the knee after acute pain subsides (3-5 days post-injury) 1
By systematically addressing these questions, you can efficiently evaluate new onset knee pain and determine appropriate next steps for diagnosis and management.