Orthopedics - Knee Pain (Traumatic)
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Knee Pain - Traumatic
Knee pain, instability or loss of motion
related to a specific traumatic event.
Initial Diagnosis and Management
- History (special
attention to mechanism of injury) and physical examination.
- Radiographs to rule out
- Obvious fracture,
instability, or motor disruption: refer (see below).
- Initial exam may be
difficult due to pain and/or significant effusion.
- In these cases, treat
w/ice and compression for 4-14 days and reassess.
- Exercises should be
initiated immediately to prevent loss of muscle tone and bulk (*consult PT
for instruction and/or supervision of exercises).
Ongoing Management and Objectives
- Repeat examination at 4
to 14 days for more definitive physical evaluation.
- Medial or lateral
collateral ligament strains (w/o instability): treat with bracing,
activity limitations and appropriate knee rehabilitation exercises. Treat
for 6-8 weeks.
- MRI if effusion or other
symptoms persist beyond 6-8 weeks.
Indications for Specialty Care Referral
- Patients with the
following should be referred to Orthopedics:
- Any patient with obvious
varus or valgus, or anterior or posterior drawer instability.
- All fractures about the
- Inability to perform
straight leg raise or if lock knee inability to move knee passively 30 to 0
or 30 to 90 degrees.
- *Refer to Physical
Therapy for above mentioned acute and rehabilitation exercises.
Criteria for Return to Primary Care
- Patients may be returned
to Primary Care following evaluation, with suggestions for ongoing
- Patients will be returned to Primary Care
following rehabilitation and stabilization of their orthopedic condition if
they require surgical intervention. In such cases, there may be a
necessity for periodic orthopedic evaluation.