Knee Osteoarthritis Part 2: Signs and Symptoms


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Do I Have Knee Arthritis?

In this second part of the blog on knee arthritis, we look at the signs and symptoms, physical examination and diagnosis of knee osteoarthritis (OA) pain.

Patients who present to a physiotherapist with knee OA usually complain of the following symptoms:

  • Increasing pain (which can often be generalised whole knee pain) with weight-bearing activities or activities that involve movement of the knee and leg. This can sometimes progress to pain which also appears appears at rest, such as when sleeping or sitting down watching TV.
  • A general feeling of knee joint stiffness (difficulty in bending and straightening the knee), especially first thing in the morning when getting out of bed or when standing up after sitting down for a while.
  • Mechanical sensations such as knee locking, clicking, grinding can sometimes occur with certain activities. 
  • Difficulty with doing everyday functional tasks, such as walking, climbing stairs, gardening etc.
  • Noticing swelling, tightness and increased heat around the knee joint.
  • Feeling like the knee gives way or is weak.
  • A progressively worsening limp. (1)

"Knee OA is a diagnosis that is made based on the presenting signs and symptoms, not just imaging (e.g. MRI's).

Physical assessment of the knee 

Assessing the knee is important for somebody with knee osteoarthritis.

  • The first step involves inspecting the knee joint, looking for things such as swelling, redness, knee joint deformities (including being knock-kneed or bow-legged) and how the person walks (2).
  • The second step involves palpating (or feeling) the knee joint. This includes feeling for warmth, painful areas such as joint line tenderness, swelling and muscle wasting due to underuse.
  • The third step involves testing other structures around the knee that could be the cause of pain, such as the patella (or kneecap), major ligaments and meniscus (fibrocartilaginous structure which helps to absorb and spread load and stress at the knee joint).
  • The final step involves assessing the function of the knee, such as range of motion, muscle strength, co-ordination, balance, walking, squatting and/or functional tests, including the Timed Up and Go Test (3).

Diagnosis of knee OA 

By the time many patients see a physiotherapist, they have usually already seen a doctor or specialist and have already had some scans, such as x-rays, ultrasound scans or MRI’s performed. While these scans may helpful for giving some baseline information regarding joint space and cartilage thickness, they are not necessary for a diagnosis. Knee OA is a diagnosis that is made based on the persons presenting signs and symptoms and findings from the physical assessment (4). The reason for this is that many people will have the common signs and symptoms but nothing showing up on the scans, meanwhile others can have major narrowing of the joint space in the knee, but have no pain, loss of function or other symptoms.

Next in this series: Knee Osteoarthritis Part 3 - Management


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References:
1. Alshami, A. (2014). Knee osteoarthritis related pain: a narrative review of diagnosis and treatment. International Journal of Health Sciences, 8, 1, 85-104.
2. Heidari, B. (2011). Knee osteoarthritis diagnosis, treatment and associated factors of progession. Caspian Journal of Internal Medicine, 2, 3, 249-255.
3. Lin, Y., Davey, R., & Cochrane, T. (2001). Tests for physical function of the elderly with knee and hip osteoarthritis. Scandinavian Journal of Medicine and Sports Science, 11, 5, 280-286.
4. Rahman, M., Kopec, J., Goldsmith, C., Anis, A., & Cibere, J. (2016). Validation of administrative osteoarthritis diagnosis using a clinical and radiological population-based cohort. International Journal of Rheumatology.



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