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GP triage – Knee Menu

Common Knee Problems

OA knee
Usually >45yrs
Bulky joint + crepitus
May show Valgus/ Varus
Effusion +/- bakers cyst
Persistent knee pain
Limited ROM
Knee stiffness (30minutes after prolonged activity)
Reduced function, crepitus, restricted movement and bony enlargement
Education & advice
Exercise
Simple analgesics
NSAIDS
Walking aid as required
Physio/ OT referral
Consider 1 steroid injection
X-ray: weight-bearing AP/ lateral views 
If symptoms persist more than 6/52 despite treatment
Failed conservative treatment
Considering injection (if not available at GP surgery)
Consider referral for joint replacement surgery if patient restricted and willing
Patient specific factors such as age, gender, smoking, obesity and co-morbidity should not be barriers to referral
Local knee pain
Pain local to knee
No trauma
Mild swelling (if any)
Education & advice
Exercise
Simple analgesics
NSAIDS
Walking aid as required
Physio referral for younger OA patients, activity mildly affected, minor x-ray findings, no true locking or giving way
X-ray: weight-bearing AP/ lateral views 
Poor response to analgesics
Symptoms affecting ADLs/ occupation
Significant X-ray findings
True locking/ Giving way
High impact/ Sporting injury/ Trauma
Acute pain
Swelling
Effusion within 2 hours is Haemarthrosis and needs prompt assessment in A&E or fracture clinic
Instability
Locking
Mechanical symptoms: True locking/ giving way
Advice
First aid (PRICE)
NSAIDS
Analgesics
Physiotherapy
X-ray: weight-bearing AP/ lateral views 
MRI
No response to conservative treatment – refer to MSK service
Confirmed meniscal injury; ACL injury; Chondral injury – refer to Orthopaedics
Low impact trauma
Low impact injury
Twisting injury
Soft tissue injury
Pain and swelling
No true locking or instability
Advice & Education
First aid (PRICE)
Simple analgesics
NSAIDS
X-ray: weight-bearing AP/ lateral views 
No response to conservative treatment – refer to MSK service
Confirmed meniscal injury; ACL injury; Chondral injury – refer to Orthopaedics
Patella Dislocation
Report of dislocation
Anterior knee pain/ swelling
Pain with knee flexion
Reduced ROM
Acute: Refer to physio
Chronic: Education/ advice; Exercise; physio
X-ray: weight-bearing AP/ lateral views 
Acute: Refer physiotherapy
Chronic: Recurrent patella dislocations, Physiotherapy unhelpful, patient considering surgery – ref to orthopaedics
Tendinopathy/ Muscle strain
Local pain in muscle or tendon
Worse with stretch
Worse with contraction
Advice & Education
Exercise
NSAIDS/ Analgesics
Refer to Physio after 6/52 if not improving
Refer to physio before 6/52 if affecting ADLs
No investigations indicated in initial stages
Failed conservative treatment
ADLs severely restricted
Patient would consider invasive treatment
Popliteal cyst (Bakers cyst)
Posterior knee swelling
Soft and non-tender
Posterior knee stiffness
Manage in Primary Care
Advice & Education
X-ray: weight-bearing AP/ lateral views 
If symptoms not improving after 12/52
Not managing with treatment