Last week I woke up one morning with significant knee pain on the L side. I hadn't exercise or done any new activity the prior day. I simply woke up with knee pain. The pain was primarily located medially and was increased with any twisting or flexing of the knee beyond 90 degrees. It's one of those occasions where it is good to be a PT, because you can treat yourself and do so quickly!
The typical presentation may lead some to think meniscus tear. While I believe I have meniscus tears in both knees, I think they are asymptomatic and I have had them for years. The fact that there was no mechanism of injury should lower meniscus as your diagnosis as well. Typically if I were to have an evaluation like this, I would check the spine and neural tension immediately even if I suspect local involvement. However, for myself I went straight to the knee due to rapid improvement. The significant findings were lack of knee flexion mobility, maybe a slight loss of end-range knee extension, but the most significant findings was decreased tibial IR on the symptomatic side. You can assess this with the patient seated by having them actively (or you perform passively) tibial IR (watch out for ankle inversion!). Often you will notice a loss of mobility on the involved side.
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