Chronic knee pain

Signs/symptoms

Longstanding ache in knee with no acute trauma/injury
May have evidence of OA/degenerative change on x-ray (though x-ray not required to diagnose OA of the knee)
May have restriction in AROM of the knee
May have reduced quadriceps strength due to pain inhibition
Absence of red flags for knee pain
Possible antalgic gait due to pain on weight bearing

Chronic Knee Pain is effectively managed within primary care with analgesia, advice and signposting to appropriate information and exercises
Encourage use of NHS Inform and Versus Arthritis for information on OA of the knee (downloadable leaflet available on Versus Arthritis) and use of strengthening to support of the muscles around the knee to support the joint
Weight management/advice if applicable
Prescribe/advise analgesia where required and appropriate to pt
Consider Corticosteroid Injection for symptom relief where required and if no contraindications present (please note CSI should not be given for 6 months prior to Knee Joint replacement if on waiting list for Orthopaedic surgery)
X-ray to confirm OA if it will alter current management plan (to inform further referrals)
Smoking Cessation
Exercise Referral Scheme for general strengthening and fitness
Signpost to DG Doing More for activity and maintenance of strength and function

Walking aid provision may be required if acute on chronic flare and weight bearing affected – refer to MSK physiotherapy as Urgent if for walking aids only.If pt is housebound please refer to appropriate Home team.
Where reduction in function and management in PCT has not been effective – refer MSK Services
Ensure pt understands they may see EITHER a physiotherapist or a member of the orthopaedic team and that will be further managed from point of contact in Secondary care with no need for Dual referral to Orthopaedics and Physiotherapy