Orthopedics - Knee Pain (Anterior)
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Knee Pain - Anterior
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
- Plain films not required
- Adults - 200 to 400
milligrams (mg) every four to six hours as needed for up to 2 weeks.
- 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
- 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
- Do not order an MRI.
Orthopedic clinic will order, or recommend, if patient meets pre-surgery
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,
- Months 4-6
- Gradual transition into
own pace and distance
Patient/Soldier Education or Self care
- See attached sheet
- Demonstrate deficits that
- Describe/show soldier
- Explain injury and
- Use diagram attached to
describe injury, location and treatment.
- Instruct and demonstrate
- Demonstrate rehab
exercises as shown in attached guide
- Warm up before any
- Participate in a
conditioning program to build muscle strength
- Do stretching exercises
- Ask the patient to
demonstrate newly learned techniques and repeat any other instructions.
- Fine tune patient
- 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
- 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
- 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
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.