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How To Determine Knee Pain

Posterior Cruciate Ligament Injuries

How to Tell if Knee Pain is Meniscus or Ligament Injury

The posterior cruciate ligament is often injured from a blow to the front of the knee while the knee is bent. This often occurs in motor vehicle crashes and sports-related contact. Posterior cruciate ligament tears tend to be partial tears with the potential to heal on their own.

Learn more about PCL injuries:

Secondary Service Connection For Knee Pain

A new disability that appears secondary to a service-connected injury or condition may allow veterans to prove secondary service connection. Secondary service connection can also be an aggravation of a non-service connected disability that is caused by a service-connected condition or incidence. In other words, your knee pain may not have happened while you were in the service, but it could be a symptom that shows up much later that is the result of a service-connected incident.

Knee pain can appear as a secondary service connection related to:

  • Osteoarthritis
  • Hip injuries
  • Partial or total joint replacements of either knee

For example, if a veteran injured their right foot during service, they may have started favoring their left leg while walking. This may have put strain on the left knee, resulting in knee pain. The same can apply to the left foot and right knee.

You Experience Greater Than Normal Movement

If you feel like your range of motion in the knee is higher than usual, something might be out of place or injured. This is known as joint instability.

You may feel like your knee will buckle or fold with walking, twisting, or weight-bearing.

The sensation of the knee giving away may occur with simple daily activities or upon return to sport following what was thought to be a minor injury, explains Dr. Brown.

Additional episodes of joint instability may worsen the condition of a knee after an injury. Tears of the ACL or MCL and patellar dislocations could also create joint instability, he says.

Hundreds of thousands of exercise injuries occur each year. Among these, knee injuries are the most common.

The best plan of action is to make an appointment with an orthopedic surgeon.

Wear a compression-sleeve-type brace or a knee brace with hinges in the interim, says Dr. Brown.

This may provide some comfort or level of support. Use crutches if you feel like you could fall and suffer additional injury because of knee joint instability.

Another type of hypermobility can occur when the kneecap moves out of place. This condition is called a patella dislocation. Its usually painful when it happens, and it might be sore the next day. If it pops back in by itself, the injury might not be serious. The true test is whether you feel confident that you can resume regular activity later that day or the next day.

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Compensation & Pension Exams For Knee Pain

When you dont have sufficient medical evidence to support your veterans disability claim, the VA may require a Compensation & Pension exam for your knee pain. This exam generally happens at a VA hospital or clinic and is conducted by VA medical staff. The purpose of the C& P exam is to support or refute your claim. You will need to submit all medical records to the VA prior to the exam, as your provider will not be able to review any new information once you are there.

During your exam, the doctor will not treat you, provide referrals, or write prescriptions. They are simply there to gather information. They may do any of the following:

  • Review your file with you
  • Ask questions based on the medical records you have previously provided.
  • Do a basic physical exam
  • Ask you to have other tests done, like x-rays or blood draws, if necessary

Keep in mind that the doctor that performs your C& P exam is there to evaluate your injury or condition, not provide information about your claim. It is possible they may not even physically examine you if the documentation you have provided is sufficient for them to evaluate your condition. Once they have finished the C& P exam, they will write a report and send it to the VA claims processor in charge of your case.

How Long Does Meniscus Repair Recovery Take

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Because the incision is small and the repair is relatively simple, most patients recover in a week or two.

The RICE method is important for the first few days after surgery. Your knee will probably be a little swollen for a couple of days, but following the RICE steps will help with that. In addition, you may be a little more tired than usual. After just a couple of days, you will see improvement in both the swelling and energy levels.

If the knee is not feeling better after several days of rest, it is important to contact your doctor.

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What Does A Meniscus Tear Feel Like

Symptoms of a meniscus tear include:

  • Pain in the knee
  • A popping sensation during the injury
  • Difficulty bending and straightening the leg
  • A tendency for your knee to get stuck or lock up

At first, the pain may not be bad. You might even play through the injury. But once the inflammation sets in, your knee will probably hurt quite a bit.

To diagnose a meniscus tear, your doctor will give you a thorough exam. He or she will want to hear details about how you got your injury. X-rays may be necessary, to rule out broken bones and other problems. You may also need an MRI scan, which allows a more detailed evaluation of knee cartilage.

Service Connection By Aggravation

What if you were diagnosed with knee pain before service?

It is possible that you entered the service with a previous injury that resulted in knee pain. Even if that pain was not service-connected, it is possible that military service aggravated that condition. For example, you might have had knee arthritis prior to service that worsened during active duty. Mild discomfort may have turned into severe pain and limitation of motion due to the physical demands of service.

In this case, you will need to provide documentation that you had knee pain or a knee disability prior to your military service, as well as documentation that your military service made that knee pain worse. This documentation includes:

  • A current diagnosis of your condition
  • Documentation of your condition prior to military service, including x-rays, imaging scans, chart notes, surgical documentation, etc.
  • Documentation of your condition after military service, including comparable x-rays, imaging scans, chart notes, surgical documentation, etc.
  • A medical nexus connecting your aggravated knee pain to your military service.

This evidence can help prove that your knee pain is connected to aggravation during service, which can help support your VA disability claim.

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What Are The Causes Of Knee Sprain Injuries

A knee sprain is a painful injury that can happen to anyone. Your ligaments stretch or tear the easiest when you suddenly pivot or turn your leg in an unnatural way. The ligament affected depends on the direction your leg is pulled. Knee sprains often happen during activities like sports, where direct force or a sudden movement occurs.

How Is It Diagnosed

How to Test your knee pain

Your physical therapist will perform an initial evaluation. The goals are to assess the condition of your knee and to determine the cause of your pain. They will ask you questions about your medical history and your current condition, such as:

  • How did your injury occur?
  • Were there previous injuries to your knee earlier in your life?
  • What are your current symptoms? How have they affected your daily activities?
  • Where is your pain located? How intense is your pain? Does your pain vary during the day?
  • Are there any activities that you are unable to do? Is it hard for you to complete any activities due to your injury?
  • How have you taken care of your knee condition so far? Have you seen other health care providers or had imaging tests ? What are the results of any tests that you have had?

Activities that aggravate your symptoms will be noted as well as any ways that help you reduce your symptoms. Some patients have difficulty with activities at work or with activities such as shopping, cooking, and walking. More active patients may have symptoms during higher levels of activity, like running or other sports. Pain may cause them to stop their desired activity.

Gathering this information allows your physical therapist to understand your condition better. It will help them determine the course of a physical examination, which will include various tests and measures.

  • Low back.

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How Does The Va Rate Knee Pain

The VA will rate knee pain and conditions under many different diagnostic codes, depending on the specific problem, or problems, caused by a knee condition. For example, there are ratings available for instability of the knee, limitation of extension, knee replacements, etc. It is important to be aware of all the different ratings, and whether you are entitled to compensation for multiple ratings. This way, you can make sure the VA is giving you the proper percent rating and all of the compensation youre entitled to for your knee disability.

Below is a list of ratings that can potentially be assigned to the same underlying disability:

Rating decisions for one disability can be complicated. The general rule regarding multiple ratings for the same disability is, the evaluation of the same disability under various diagnoses is to be avoided. However, VA regulations specifically provide that the knee joint can be evaluated under multiple diagnostic codes where there are different manifestations of the same disability. So, as long as the knee disability affects you in separate and distinct ways, you can receive multiple ratings.

Remember that instability of the knee is a rating that is often overlooked. However, if you have problems with your knee dislocating or giving out because of a service-connected disability, instability of the knee can be rated in addition to other ratings for the same knee.

How To Measure Knee Range Of Motion

The most accurate way to measure knee range of motion is to use a goniometer. A goniometer is essentially a specially designed protractor that measures joint angles.

There is a circle in the middle of a goniometer representing 360o of motion, out of which come two extending arms: a stationary arm and a moveable arm.

When measuring knee range of motion, you need to identify three landmarks on the leg:

  • Knee: Lateral Epicondyle the midpoint of the outer knee
  • Ankle: Lateral Malleolus the bony lump on the outer side of the ankle
  • Hip: Greater Trochanter a bony lump just below the hip joint on the outer side of the thigh.

Ideally, you will need someone to do the measuring for you it is hard to get an accurate measurement of knee ROM if you try and do it yourself.

To find the greater trochanter, find the midpoint of the bony ridge on the top of your pelvis and bring your fingers down 15-20cm until you feel a bony lump. The greater trochanter is more towards the back of the thigh than the front due to the large muscle bulk of the quads on the front of the thigh. You will have to press in through the soft tissues of the thigh to feel it.

The best way to measure knee range of motion is to:

  • To measure knee extension, gently push your knee down into the floor so the knee is as straight as it goes and measure
  • To measure knee flexion, bend the knee as far as you can, by sliding your foot up towards your buttocks, keeping the arms and axis of the goniometer in place, then measure

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Evaluation Of Patients Presenting With Knee Pain: Part I History Physical Examination Radiographs And Laboratory Tests

WALTER L. CALMBACH, M.D., University of Texas at Austin, Austin, Texas

Am Fam Physician. 2003 Sep 1 68:907-912.

Family physicians frequently encounter patients with knee pain. Accurate diagnosis requires a knowledge of knee anatomy, common pain patterns in knee injuries, and features of frequently encountered causes of knee pain, as well as specific physical examination skills. The history should include characteristics of the patient’s pain, mechanical symptoms , joint effusion , and mechanism of injury. The physical examination should include careful inspection of the knee, palpation for point tenderness, assessment of joint effusion, range-of-motion testing, evaluation of ligaments for injury or laxity, and assessment of the menisci. Radiographs should be obtained in patients with isolated patellar tenderness or tenderness at the head of the fibula, inability to bear weight or flex the knee to 90 degrees, or age greater than 55 years.

Knee pain accounts for approximately one third of musculoskeletal problems seen in primary care settings. This complaint is most prevalent in physically active patients, with as many as 54 percent of athletes having some degree of knee pain each year.1 Knee pain can be a source of significant disability, restricting the ability to work or perform activities of daily living.

FIGURE 1.

Anatomy of the knee.

FIGURE 1.

Anatomy of the knee.

How Do Doctors Diagnose Knee Injuries

ACL vs MCL Tear: Know the Differences

The initial evaluation by the health care professional will begin with a medical history. Whether the evaluation is occurring immediately after the injury or weeks later, the physician may ask about the mechanism of injury to help isolate what structures in the knee might be damaged. Is the injury due to a direct blow that might suggest a fracture or contusion ? Was it a twisting injury that causes a cartilage or meniscus tear? Was there an injury associated with a planted foot to place stress and potentially tear a ligament?

Further questions will address other symptoms. Was swelling present, and if so, did it occur right away or was it delayed by hours? Did the injury prevent weight-bearing or walking? Does going up or down steps cause pain? Is there associated hip or ankle pain? Is this an isolated injury, and have there been other occurrences?

Past medical history and information on medications and allergies will be helpful information to learn about the patient.

Sometimes X-rays of the knee are required to make certain there are no broken bones, but often with stress or overuse injuries where no direct blow has occurred, plain X-rays may not be initially needed and imaging of the knee may wait until a later date. Standing X-rays of the knees are used to assess the joint space and compare the injured knee to the uninjured one. An MRI might be considered to evaluate the ligaments and cartilage within the knee joint.

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What Other Symptoms Are Linked With Knee Joint Pain

Symptoms of osteoarthritis of the knee are generally limited to the joint itself, whereas inflammatory arthritis causes a wider array of issues. Unlike OA, inflammatory arthritis is a systemic disease, which means it affects the whole body, says CreakyJoints Medical Advisor Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida.

In fact, it would be less common for someone with a form of inflammatory arthritis to experience pain in just one knee. Thats because symptoms are usually symmetrical whats more, inflammatory arthritis symptoms usually dont start in the knee.

For example, rheumatoid arthritis generally strikes the small joints in the fingers and toes first, while someone with ankylosing spondylitis is more likely to complain of low back and buttock pain, with knee arthritis pain developing later.

Depending on the type of inflammatory arthritis you have, you may experience other symptoms beyond knee joint pain. People with psoriatic arthritis exhibit the telltale scaly rash and plaques of psoriasis eye inflammation can be a problem for those with psoriatic arthritis as well as ankylosing spondylitis, and people with rheumatoid arthritis may experience weight loss and fevers.

Potential Causes For Knee Pain

Knee Osteoarthritis

Osteoarthritis is the most common type of arthritis and is frequently seen in the knees. It is generally a result of wear and tear and age. Women 55 and older are more likely to develop knee osteoarthritis than men. Osteoarthritis can also be the result of genetics and is seen in patients who are overweight. Furthermore, it is more likely to occur in those constantly lifting heavy weights or athletes who have had knee injuries.

Treatment for osteoarthritis focuses on reducing pain and regaining mobility. If the patient is overweight, your doctor may first recommend weight loss. Exercise will also help strengthen the joint. Your doctor may also prescribe anti-inflammatory medications or recommend injections or a brace. We believe in conservative treatment, so while Mountainstate Orthopedic Associates has some of the most qualified and experienced doctors in the region, surgery is usually a last resort. There is no need to operate if, for example, the knee responds well to physical therapy and corticosteroid injection.

Knee Effusion

A knee effusion occurs when fluid increases in the tissues surrounding the joint. It can happen to any joint but is particularly common in the knee. A knee effusion can result from anything that injures or inflames the knee. Knee effusions are often seen in those with arthritis . Gout can also cause knee effusion.

ACL Strain or Tear

Meniscus Tear

Knee Bursitis

Patellar Tendonitis

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How Is The Cause Of Knee Pain Diagnosed

A thorough examination is necessary for an accurate determination. The examination should include an assessment of whether the pain actually stems from the knee. Sometimes knee pain can be referred pain from another source, such as a hip injury. ââ¬ÅReferred painââ¬ï¿½ means that an injury or disease in one part of the body is causing pain in a different location.

When making a diagnosis, your doctor will consider information that includes the following:

  • Patient characteristics. Some conditions are more likely to occur in individuals with certain characteristics. For example, osteoarthritis is more frequent in older adults, and conditions associated with overuse are more frequent in people who participate in athletic activities. Obesity can also be a factor in some conditions.
  • Patient history. The physician asks questions to determine potential sources of trauma, such as car accidents or sports injuries. The physician will also ask where and when you feel the pain.
  • Results of a physical examination. The physician moves and probes your knee for signs of damage to the muscle, tendon, or cartilage. This includes exploring the location of the pain, such as behind the knee, in front of the knee, or inside of or on top of the knee.
  • Results of imaging and other tests. Sometimes X-rays, MRIs, or other diagnostic tests are needed to identify structural damage or abnormalities.

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