Medications:
Its important to understand
the medications that a patient is taking in terms of understanding their overall
knee pathology. Some of the anti-inflammatory medications or steroids could
be important in understanding the treatment of knee dysfunction. For example,
this may be true for anybody who has taken corticosteroids in the past. It
has been known that sometimes some areas of bone can actually die (avascular
necrosis) which could contribute to knee pain.
Allergies:
It is important to know
the allergies of the patient so that we know if any of the drugs prescribed
may not be tolerated by the patient.
Duration of symptoms:
It's important to understand
if a patient's symptomatology is due to an acute or a chronic injury. Acute
injuries with symptomatology usually need a different treatment algorithm
than those which are chronic injuries. In many instances, chronic injuries
need a different diagnostic workup than acute injuries.
Occupation or Sport:
Its important to know
a patient's occupation and the sport (or other event like a motor vehicle
accident, etc.) in which they were injured. This is to determine if they are
at risk for further problems due to their injury or symptomatology or whether
their occupation or sport contributed to their problem. For example, it well
known that SLAP lesions of the shoulder are commonly due to injuries in volleyball
and that meniscal tears are common in wrestlers.
Previous Injuries:
A past history is necessary
to determine if a patient's injury is an acute injury, an acute on chronic
injury, or a chronic injury with a current exacerbation of symptoms. It is
important for the patient and clinician to understand why they are currently
having symptoms as this could affect their treatment recommendations.
Previous Surgical Dates:
It is important to know
the dates of previous surgeries, as well as the type of surgeries performed,
in order to determine whether the previous surgeries have failed, are still
in the early healing phases, or have contributed to any of the current symptomatology.
Functional
Limitations :
Functional limitations due to a knee injury must be determined to aid in the
potential etiology of the knee pathology. For example does the patient have
instability, pain with stairs, locking of the knee, inability to squat, etc.
Ultimately, our role as physicians is to return a patient back to normal functional activity. The type of functional activity which a patient expects is going to vary significantly based upon their age, sport, recreation level, working environment, and their expectations. High level athletes certainly have different expectations than a retired executive that wishes to be able to walk eighteen holes of golf. For this reason, it is important during the initial and subsequent encounters to determine what a patient's functional limitations are, and then their desired activity level. While in many instances we are able to return people back to their desired levels of activity, there are just some instances, such as in arthritis or for scar tissue formation around the knee, that this is not possible. Then, it is our role as physicians to work with the patients so they understand this and help them adapt to different functional levels.
Our other role in assessing the patient's function is during a decision on when to return back to sports or work after an injury or surgery. In the majority of cases, the patient and physician work together and are able to decide when this is appropriate. In some instances, specific testing may be necessary. During athletic contests, this may include functional testing of an athlete on the sideline to determine if they can return safely back to play. Postoperatively, it may include specific muscle testing to make sure that there is appropriate lower extremity strength, balance, and coordination after ligament reconstructions of the knee. In other instances, it may involve the use of a functional capacity evaluation, which is a very specific test utilized to determine how hard a patient is trying to do their best and at what levels a patient can safely function during simulated work environments, to assist the patient in determining what functional limitations may need to be for them to return to work after an injury or after surgery.
