What history questions should be asked when evaluating a patient with knee pain?

Essential History Questions for Knee Pain Evaluation

A thorough history focusing on age, pain characteristics, associated symptoms, and trauma history is essential for accurate diagnosis and appropriate management of knee pain. 1

Core History Questions

• Age: Different age groups have different common causes - teenagers and young adults often have patellar tracking issues or extensor mechanism problems, while older adults are more likely to have osteoarthritis 2

• Pain characteristics:

  • Location (anterior, posterior, medial, lateral, or diffuse) 1
  • Onset (sudden vs. gradual) 1
  • Duration (acute vs. chronic) 1
  • Quality (sharp, dull, aching, burning) 1
  • Timing (constant vs. intermittent) 1
  • Aggravating and alleviating factors 1

• Mechanical symptoms:

  • Locking or catching sensations (may indicate meniscal pathology) 3
  • Giving way or instability (may indicate ligamentous injury) 1
  • Stiffness (duration of morning stiffness - less than 30 minutes suggests osteoarthritis) 3

• History of trauma:

  • Specific mechanism of injury (twisting, direct blow, hyperextension) 1
  • Timing of swelling after injury (immediate swelling suggests hemarthrosis) 1
  • Ability to bear weight immediately after injury 1

Additional Important Questions

• Swelling:

  • Presence, timing, and frequency 1
  • Associated with activity or at rest 1

• Activity level:

  • Sports participation and frequency 4
  • Occupational demands 4
  • Changes in activity level prior to pain onset 5

• Previous treatments:

  • Prior medications, physical therapy, injections 3
  • Response to previous treatments 3
  • Prior surgeries to the knee 1

• Associated symptoms:

  • Fever or systemic symptoms (may indicate infection) 1
  • Hip or back pain (may be source of referred pain) 6
  • Other joint involvement (may suggest inflammatory arthritis) 1

Red Flag Symptoms Requiring Urgent Evaluation

• Severe pain with inability to bear weight after acute trauma 1
• Joint swelling with fever, erythema, and limited range of motion (possible infection) 1
• Significant joint instability after trauma 1
• Severe pain with visible deformity 1

Special Considerations

• Referred pain: Always inquire about hip and lower back symptoms, as knee pain may be referred from these areas, especially if knee radiographs are normal 6

• Age-specific concerns:

  • In adolescents: growth plate injuries, Osgood-Schlatter disease 2
  • In young adults: patellofemoral pain, meniscal tears, ligament injuries 2
  • In older adults: osteoarthritis, degenerative meniscal tears 3

• Activity-specific questions:

  • For runners: recent changes in mileage, terrain, or footwear 5
  • For athletes: specific movements that cause pain (cutting, jumping, squatting) 5

• Functional limitations:

  • Difficulty with stairs (especially descending) 5
  • Impact on daily activities and quality of life 3
  • Sleep disturbances due to pain 4

By systematically addressing these history questions, clinicians can more effectively narrow the differential diagnosis and determine appropriate next steps for evaluation and management of knee pain 1, 3.