Differential Diagnosis of Localized Medial Knee Pain
| Condition | Typical Findings | Diagnostic Testing |
|---|---|---|
| Hamstring tendonitis | Localized tenderness or swelling over medial hamstring tendon insertion | Rarely indicated |
| Medial collateral ligament tear | Laxity or regional pain with valgus stress testing; effusion rare | Radiographs or MRI |
| Medial plica syndrome | Tenderness near medial patellar retinaculum that worsens with knee flexion | Radiographs if symptoms are atypical or persistent |
| Meniscal tear | Tenderness over medial joint line; positive McMurray test*; effusion possible >12 hours after injury | MRI or arthroscopy |
| Osteoarthritis | Regional medial knee or joint line tenderness; effusion and decreased range-of-motion possible | Radiographs |
| Osteochondritis dissecans | Decreased range of motion or mild weakness; joint line tenderness or effusion possible; occasional catching or locking | Radiographs; consider arthroscopy, MRI or CT |
| Pes anserine bursitis | Tenderness 2 to 4 cm below medial knee joint line | Rarely indicated |
| Tibial plateau fracture | Localized or diffuse superior tibial tenderness; effusion possible | Radiographs; consider MRI or CT |
| Tibial stress fracture | Localized or diffuse superior tibial pain | Radiographs; consider MRI or bone scan if radiographs are negative |
| Tumor | Insidious pain, swelling, or mass over medial knee; night pain or systemic symptoms may occur | Radiographs; consider MRI or bone scan if radiographs are negative and high clinical suspicion |
* McMurray test: (1) Position patient supine and flex affected knee. (2) Steady the knee with one hand and grasp the ipsilateral heel with the other. (3) Palpate the medial and lateral joint lines. (4) Rotate the ipsilateral foot externally to test the medial meniscus and internally to test the lateral meniscus. (5) A snap felt over the joint line while extending the knee signifies a positive test.