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Knee Pain
What to Expect When You See the Doctor

Knee pain is one of the most common reasons people over the age of 50 have for visiting a physician or orthopaedic surgeon. What exactly should you expect during your visit? Identifying the cause of your knee pain is an important first step toward effective treatment. This article will outline some of the important, but often overlooked, components of a knee examination and will give you some tips about how to be a prepared and informed patient.

Physical Examination versus MRI

In a world where the technology is “king,” we constantly hear of professional athletes who get hurt and get an MRI (magnetic resonance imaging) of their knee. As a result, many people think getting an MRI is necessary for arriving at a diagnosis for the cause of your knee pain. I call this the “Sports Center Phenomenon.” But, is an MRI really necessary? The answer: sometimes.

I don’t want to discount the value of an MRI, but it needs to be used as an adjunct to the physical examination, not a substitute for it. Studies have shown that most people over the age of 40 have some type of abnormality in the knee joint that will show up on an MRI, even when the person has no symptoms or complaints. How, then, can a physician determine if an abnormal finding on MRI is related to your symptoms or just an incidental finding? It all starts with a good physical examination of your knees.

Components of a Thorough Knee Examination

First, you should be asked to put on shorts or a gown so that both of your knees and thighs are exposed for the exam. A good knee exam cannot be accomplished through clothing. It would be like trying to examine a hand through a glove.

The doctor should watch you walk, look at how your legs are aligned, and see if you can squat or hop. To determine what could be wrong with your knee, the doctor should first examine your normal knee so he or she has a basis for comparison. If you are having problems with both knees, he or she should examine the least painful knee first.

Next, the doctor should examine both of your knees to assess the range of motion, amount of swelling, and any specific areas of tenderness around the knee. Depending on your symptoms, the doctor may also perform special knee examination tests designed to evaluate for specific knee problems (i.e. meniscus tears, ligament injuries). To do this type of an examination, you should be lying flat on your back with both of your legs fully supported on an examination table. You should let the doctor know if any of the movements tested cause pain or discomfort. If the pain you are experiencing can be reproduced during the exam, it will help the doctor determine a diagnosis.

Do All Doctors Perform a Thorough Knee Exam?

Several years ago, my practice partner and I had this same question, so we decided to do a research study. We see many patients because they are seeking a second opinion on their knee, so we asked all new patients if they had seen another doctor (primary care physician, emergency physician, orthopaedic surgeon or chiropractor) for their knee problem within the last 6 months. During the timeframe of this study, 428 patients answered “yes” to this question and completed a short (5 question) questionnaire about the physical examination done by the previous doctor. The findings were surprising:

The first step in identifying appropriate treatment options for any knee problem needs to be a good physical examination of the knee. When necessary, MRI and other imaging studies can be helpful in completing the diagnosis.

Why Does This Matter?

Careful observation for signs of knee range of motion or strength loss is critical because these are issues that can be addressed with rehabilitation. You might be surprised by this, but many cases of knee pain can be resolved simply by restoring normal motion and strength. However, if a thorough knee examination is not performed, these subtle, but important differences would not be detected.

Selecting a Physician

When seeking care for a knee problem, most patients look for an orthopaedic surgeon because they specialize in the treatment of joint problems. However, orthopaedic surgeons vary in their degree of specialization. Some surgeons specialize in the treatment of only one joint, while others provide care for a wider variety of orthopaedic problems. By finding a doctor who specializes in treating patients with knee pain and knee injuries only, you will benefit from their unique skills and the experience they have gained treating patients with similar conditions.

Some specialists also team up with physical therapists or athletic trainers who work closely with the doctor to provide rehabilitation while remaining in close communication with the treating physician. This can save you from feeling as if you are “stuck in the middle” between your treating doctor and an external rehabilitation office.

Be Prepared for Your Visit

Things you can do to optimize your time with the doctor:

The bottom line: don’t be afraid to get a second opinion. It is your right and responsibility to be your own advocate regarding your health. When buying a car, you don’t think twice about researching your options and going to several car dealerships before making a purchase, so why not take the same approach when it comes to your health?

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