Table 2.

Differential Diagnosis of Localized Medial Knee Pain

ConditionTypical FindingsDiagnostic Testing
Hamstring tendonitisLocalized tenderness or swelling over medial hamstring tendon insertionRarely indicated
Medial collateral ligament tearLaxity or regional pain with valgus stress testing; effusion rareRadiographs or MRI
Medial plica syndromeTenderness near medial patellar retinaculum that worsens with knee flexionRadiographs if symptoms are atypical or persistent
Meniscal tearTenderness over medial joint line; positive McMurray test*; effusion possible >12 hours after injuryMRI or arthroscopy
OsteoarthritisRegional medial knee or joint line tenderness; effusion and decreased range-of-motion possibleRadiographs
Osteochondritis dissecansDecreased range of motion or mild weakness; joint line tenderness or effusion possible; occasional catching or lockingRadiographs; consider arthroscopy, MRI or CT
Pes anserine bursitisTenderness 2 to 4 cm below medial knee joint lineRarely indicated
Tibial plateau fractureLocalized or diffuse superior tibial tenderness; effusion possibleRadiographs; consider MRI or CT
Tibial stress fractureLocalized or diffuse superior tibial painRadiographs; consider MRI or bone scan if radiographs are negative
TumorInsidious pain, swelling, or mass over medial knee; night pain or systemic symptoms may occurRadiographs; 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.