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Pinpointing the reason for knee pain can be challenging because of the wide range of possible causes. Often, a comprehensive medical history and thorough physical exam play a larger role in knee pain diagnosis than does any single test.

In addition to asking about your pain — its location, what it feels like, when it started, what makes it seem better or worse — your doctor may inquire about your exercise program, sports you play or used to play, and any previous injuries to your knee joint. During the physical exam, your doctor is likely to inspect your knee for swelling, pain, tenderness, warmth and visible bruising; check your range of motion; and perform a number of maneuvers to evaluate the integrity of the structures in your knee.

One of these maneuvers, the Lachman test, helps detect injuries to the ACL. In the Lachman test, your knee is bent at a 30-degree angle and your doctor gently moves your lower leg forward at the knee. If your lower leg moves freely without reaching a firm endpoint, you’re likely to have a torn ACL. Other maneuvers assess the PCL, tendons and menisci.

These tests may not be accurate in some instances — when movement in your knee is restricted by swelling or by contracted muscles in the back of your leg, for example. In that case, your doctor may order a magnetic resonance imaging (MRI) test or another imaging test to aid in the diagnosis.

Unlike an X-ray, which isn’t useful for viewing ligaments, tendons and muscles, an MRI can help identify injuries and damage to soft tissue. MRI uses a powerful magnet to create 3-D images of the inside of your knee. Generally, no special preparation is needed for this test; however, if you’re bothered by confined spaces, be sure to let your doctor know. He or she may be able to send you to a facility with an open MRI machine, which allows you to see outside of the machine, or you may be prescribed a mild sedative for the test.

1.Computerized tomography (CT) scan. This specialized X-ray, which creates cross-sectional images of the inside of your body, may help diagnose bone problems and detect loose bodies.

2.X-ray. Your doctor may first recommend having an X-ray, which can help detect bone fractures and degenerative joint disease.

If your doctor suspects an infection, gout or pseudogout, you’re likely to have blood tests and sometimes arthrocentesis, a procedure in which a small amount of fluid is removed from your injured joint with a needle and sent to a laboratory for analysis.

Radiological examination:

1.X-Ray of knee may show a fracture, osteoarthritis changes and punched out lesion of gout and pseudogout

2. MRI may be indicated to diagnose torn menisci or other conditions

3.Bone survey at times may be indicated

Urine tests

1.Urinalysis for blood, sugar and protein

2.24 hour urinary uric acid, if suspect gout

3.Blood tests

4.Full blood count, ESR and CRP

5.Renal function tests and Electrolytes

6.ASO titre, if suspect rheumatic fever

7.Arthritis screen depending on suspicion including Rheumatoid factor, ANA and ENA antibodies, HLA-B27

8.Uric acid (marker of gout)

9.Coagulation profile

10.Blood cultures, if fever

11.Lyme disease serology

12.Iron studies, if suspect hemochromatosis

Physical examination

1.Full physical examination looking for signs of systemic disease that can predispose or present with joint pain – e.g. rash and pitted nails of psoriasis; Raynaud’s phenomenon of rheumatoid arthritis; doughnut-shaped rash of Lyme disease; butterfly rash of systemic lupus erythematosus; abdominal tenderness of ulcerative colitis and Crohn’s disease; heart murmur of rheumatic fever or subacute bacterial endocarditis.

2.A systematic examination of the affected knee looking for signs of inflammation, deformity, swelling, disordered stability and reduced range of motion – e.g. tenderness and warmth indicates inflammation; redness of the skin over the joint indicates gout, pseudogout, rheumatic fever or septic arthritis.

3.Inspect the knee with the person walking, standing and lying.

Call Your Doctor If:

1.You still have pain after 3 days of home treatment

2.You have pain, swelling, numbness, tingling, or bluish discoloration in the calf below the sore knee

3.You have a fever, redness or warmth around the knee, or significant swelling

4.Your knee is deformed or misshapen

5.Your knee buckles, clicks, or locks

6.You have severe pain, even when not bearing weight

7.You cannot bear weight on your knee