The guidelines formulated by the New York State Workers Compensation Board aim to aid physicians, and healthcare practitioners in delivering suitable treatment for Knee Injury.
These guidelines are designed to support healthcare professionals in determining the proper care for patients with Knee Injury. It is important to note that these guidelines do not replace clinical judgment or professional expertise. The final decision regarding care should be a collaborative effort between the patient and their healthcare provider.
History Taking and Physical Examination
History Taking and Physical Examination are crucial steps that form the basis for and determine subsequent phases of diagnostic and therapeutic procedures. In instances where the findings from clinical assessments and other diagnostic methods diverge, priority should be given to the objective clinical findings. The medical records should adequately record the following:
History of Present Injury
- Mechanism of Injury: This involves details about when symptoms started and progressed, as well as symptoms that may result from postural or functional adjustments to the knee injury.
- Relationship to Work: This includes a statement indicating the likelihood that the illness or injury is related to work.
- Previous Occupational and Non-Occupational Injuries: Any prior injuries to the same area, both work-related and non-work-related, along with specific prior treatments and the use of any bracing devices.
- History of Locking, Clicking, Giving Way, Crepitation, Popping, Swelling: Comprehensive description of onset and volume of swelling, and the presence or absence of pain while ascending or descending stairs.
- Ability to Perform Job Duties and Activities of Daily Living.
Exacerbating and Alleviating Factors for Symptoms:
- These factors are not limited to the knee and should be thoroughly explored.
Past History
Past Medical History: This encompasses, but is not restricted to, conditions such as neoplasm (or recurrence), gout/pseudogout, infections, significant trauma to the knee, femur, and/or leg, arthritis, and diabetes.
Review of Systems: A thorough examination of various systems, including constitutional symptoms; eyes; ear, nose, mouth, and throat; cardiovascular; respiratory; gastrointestinal; genitourinary; musculoskeletal; integumentary/breast; neurological; psychiatric; endocrine; hematologic/lymphatic; allergic/immunologic. The extent and focus of the review can be tailored on a case-by-case basis, depending on the underlying condition and clinical judgment.
Smoking History;
Vocational, Military Service, and Recreational Pursuits;
Prior Imaging Studies; and
Past Surgical History.
Physical Examination
Examination of a Joint: This should involve the joint both above and below the affected area. Physical examinations should encompass accepted tests and examination techniques relevant to the joint or area under examination, including:
Visual Inspection;
Palpation;
Range of Motion/Quality of Motion;
Strength, with attention given to evaluating for atrophy and muscle fasciculations;
Joint Stability;
Examination for a Displaced or Abnormally Displaceable Patella;
Applicable to Injury, Integrity of Distal Circulation, Sensory, and Motor Function; and
If Applicable, Full Neurological Exam, Including Muscle Atrophy and Gait Abnormality.
Red Flags
Certain findings, referred to as “red flags,” give rise to suspicion of potentially severe medical conditions. The assessment, comprising both history and physical examination, should encompass an evaluation for these red flags. In the context of the knee, these findings or indicators may encompass: fracture, dislocations, and ligamentous tears; infection or inflammation; neurological or vascular compromise, including compartment syndrome; and a history of trauma, which may include, but is not necessarily limited to, serious motor vehicle crashes, crush injuries, or falls from heights. Further assessment, consultation, or urgent/emergency intervention may be warranted.
