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Orthopedics - Knee Pain (Anterior)

Orthopedics & Podiatry Main Menu

Knee Pain - Anterior

Diagnosis/Definition

Knee pain localized to the anterior portion of the knee, either retropatellar or peripatellar.  Usually a gradual, non-traumatic onset aggravated with increased activity, running, squatting, stair climbing or prolonged sitting.  Symptoms normally decrease with rest.

Initial Diagnosis and Management

  • History and physical examination
  • Plain films not required
  • NSAIDs
    • Adults - 200 to 400 milligrams (mg) every four to six hours as needed for up to 2 weeks.  Example: Ibuprofen
    • Take tablet or capsule forms of these medicines with a full glass (8 ounces) of water.
    • Do not lie down for about 15 to 30 minutes after taking the medicine. This helps to prevent irritation that may lead to trouble in swallowing.
    • To lessen stomach upset, these medicines should be taken with food or an antacid.
  • Avoidance of aggravating activities (profile for active duty soldiers)
  • Strengthening exercises for quadriceps, stretching exercises for quads, hamstrings and calf muscle
  • Ice PRN after activities
  • Compression wrap is contraindicated
  • Patient education (refer patient to PT for Retropatellar Pain Syndrome (RPPS) class)
  • Please refer to the Clinical standard on knee pain.

Ongoing Management and Objectives

  • Resolution or decreasing symptoms in three to four weeks
  • If no resolution:
    • Trial of alternate NSAID
    • Trial of neoprene sleeve with patella opening
    • Obtain plain films with sunrise views
    • Do not order an MRI.  Orthopedic clinic will order, or recommend,  if patient meets pre-surgery criteria

Indication a profile is needed

  • Any limitations that affect strength, range of movement, and efficiency of feet, legs, lower back and pelvic girdle.
  • Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent moderate marching, climbing, timed walking, or prolonged effect.
  • Defects or impairments that require significant restriction of use.

Specifications for the profile

  • Months 1-3
    • No running, jumping, marching, squatting.
  • Months 4-6
    • Gradual transition into own pace and distance

Patient/Soldier Education or Self care Information

  • See attached sheet
  • Demonstrate deficits that exist
    • Describe/show soldier his/her limitations
  • Explain injury and treatment methods
    • Use diagram attached to describe injury, location and treatment.
  • Instruct and demonstrate rehab techniques
    • Demonstrate rehab exercises as shown in attached guide
    • Warm up before any sports activity
    • Participate in a conditioning program to build muscle strength
    • Do stretching exercises daily
  • Ask the patient to demonstrate newly learned techniques and repeat any other instructions.
  • Fine tune patient technique
    • Correct any incorrect ROM/stretching demonstrations or instructions by repeating and demonstrating information or exercise correctly.
  • Encourage questions
    • Ask soldier if he or she has any questions
  • Give supplements such as handouts
  • Schedule follow up visit with Primary Care
    • If pain persists
    • The pain does not improve as expected
    • Patient is having difficulty after three days of injury
    • Increased pain or swelling after the first three days
    • Patient has any questions regarding care

Indications for Specialty Care Referral

  • History of joint locking and giving way
  • Question of underlying instability
  • Prolonged effusion > 10 to 14 days
  • R/O fractures, septic joints, rheumatoid arthritis, etc. should be referred to appropriate specialty clinic (Orthopedics or Rheumatology)
  • Refer to Physical Therapy if none of the above but progression of atrophy or persistent symptoms despite initial management.
  • Completed full course of rehabilitation and have any of the following concerning symptoms:  catching, locking, effusions, instability, warmth or erythema (Orthopedics referral indicated).

Criteria for Return to Primary Care

  • Resolution of symptoms
  • If persistence of anterior knee pain > 6-12 months, without concerning symptoms as described above, consider permanent profiling with patient specific limitations.
  • If meets criteria for P3 profile, referral to MAMC MEB section for MEB is appropriate.  MEB can be initiated by primary care.

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