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Notfall & Hausarztmedizin 2007; 33(4): 204-210
DOI: 10.1055/s-2007-982781
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© Georg Thieme Verlag Stuttgart · New York

Knieschmerzen in der Hausarztpraxis - Epidemiologie, Differenzialdiagnose und Präsentation in der Praxis

Knee pain in GP practice - epidemiology, differential diagnosis and presentation in medical practiceHagen Sandholzer1
  • 1Abteilung Allgemeinmedizin, Universität Leipzig
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Publikationsverlauf

Publikationsdatum:
29. Mai 2007 (online)

    Lizenzen und Reprints

Knieschmerzen in der Allgemeinpraxis beruhen zu zwei Drittel aller Fälle auf Muskel-Skelett-Erkrankungen. Für den Hausarzt ist die Diagnostik einfacher als für den Orthopäden oder Chirurgen, da er lediglich abwendbar gefährliche Verläufe heraussieben muss und weder diagnostisch (Röntgen, MRT) noch therapeutisch (Operation) Bandläsionen, Meniskusrisse oder Frakturen weiterversorgen kann. Bei der Untersuchung werden immer beide Knie vergleichend untersucht, orientierend auch die anderen Gelenke. Bei steigendem Alter ist die arterielle Verschlusskrankheit eine immer wichtiger werdende Differenzialdiagnose. Bei Einleitung einer symptomatischen Therapie ist die Ulcusanamnese bedeutsam, sowie Allergien oder sonstige Kontraindikationen gegen Nicht-Steroidale Antirheumatika (NSAR). Bei akuten Beschwerden kommt eine „RICE”-Therapie in Betracht: Ruhigstellung, Kaltkompressen und für 24 Stunden Hochlagerung bei aktivierter Arthrose, daneben medikamentöse Entzündungshemmung. In jüngeren Studien und Meta-Analysen hat sich regelmäßiges Gehtraining als effektiv, kostengünstig und umsetzbar in der Hausarztpraxis erwiesen.

Knee pain in GP patients is mostly due to musculoskeletal disorders and acute injuries. A simple algorithmic approach for the management of knee pain works well. After anamnesis and physical examination have excluded serious pathology such as fractures, menisci and ligamental lesions or infections, the GP should consider the age of the patient. In young patients, who often suffer from functional knee pain, a wait-and-see strategy is advisable. The older the patient, the more likely is arthritic pain. Before initiating symptomatic treatment the GP should consider contraindications for anti-inflammatory drugs such as ulcers, heart failure or renal impairment. In such cases a brief treatment with diclofenac is appropriate. Evidence-based non-pharmacological treatment includes regular physical activity (walking) and surgery in severe cases.

Key words

knee pain - GP - differential diagnosis - RICE therapy - training the patient to walk

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Korrespondenz

Prof. Dr. med. Hagen Sandholzer

Selbstständige Abteilung für Allgemeinmedizin, Universität Leipzig

Philipp-Rosenthal-Straße 55

04103 Leipzig

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