Painful Knee Joint


Examine this patient's leg.

Examine this patient's joints.

Examine this patient's knee joint.



· Painful knee joint.

· Take a history of trauma and fever.

· History of rheumatoid arthritis, gout or haemophilia.


· Pain on movement of the joint (take care not to hurt the patient).

· Swelling of the joint (you must demonstrate fluid in the joint).

· Check both active and passive movements.

· Look for disuse atrophy of the muscles around the joint.

Proceed as follows:

Tell the examiner that you would like to investigate as follows:

· Examine other joints.

· Obtain radiographs of the knee (anteroposterior and lateral views).

· Analyse the joint fluid for cells, sugar, protein and culture.


This patient has a painful knee joint with restricted movement (lesion and functional status) following trauma while playing rugby



What are the common causes of a painful knee joint ?

· Rheumatoid arthritis.

· Osteoarthrosis.

· Trauma.

- Septic arthritis (will require emergency removal of the pus to prevent joint damage).

· Viral infection.

· Gout.

· Pseudogout.

· Haemophilia.


What is palindromic rheumatoid arthritis?

Palindromic onset of rheumatoid arthritis refers to acute recurrent arthritis, usually affecting one joint, with symptom-free intervals of days to months between attacks. This term was introduced by P.S. Hench and E.F. Rosenberg.

A patient with a painful knee joint and a unilateral facial nerve palsy is seen by you in the outpatient department. Six weeks before this she developed an annular rash after a camping trip in Europe. What is your diagnosis and what confirmatory test would you carry out?

The diagnosis is Lyme disease and the confirmatory test is an antibody titre against Borrelia burgdorferi. The disease was first

recognized in Lyme, Connecticut, USA.