Diagnostic Evaluation Essay

The main goal of diagnostic evaluation is to demonstrate the presence of osteoarthritis unequivocally, or else to rule it out. The major elements of the diagnostic evaluation are the history, physical examination, imaging studies, and in some cases blood test. The diagnosis is largely made by obtaining a detailed history and conducting a complete physical examination. Imaging studies and laboratory testing may occasionally be necessary when the diagnosis remains uncertain.

In history, the usual presenting symptom is pain on movement involving one or only a few joints. Typically occurring when movement is initiated or when the patient begins to walk. The pain is often described as a dull ache. As osteoarthritis progresses, the pain becomes

Knee pain is the leading symptom, usually becoming worse when the affected knee is put in motion and improving when it is at rest. Persistent pain at rest, or at night, can be a sign of advanced osteoarthritis. The physical examination should incorporate all relevant findings, including findings on inspection and palpation, testing of the range of movement, and special functional tests when needed (e.g., ligament stability, meniscus tests, gait analysis).

In imaging studies, X-ray imaging are used both for primary diagnosis and to assess the progression of the disease. Plain films should be obtained in standardized fashion in at least two planes (a-p and lateral). Special functional plain films can be obtained as well to answer specific diagnostic questions. The typical radiological signs of knee osteoarthritis that can be seen on plain films are incorporated in the staging system of Kellgren.

Supplementary radiological studies can include MRI, to demonstrate the hyaline cartilage, as well as bone scanning, to assess metabolic activity in the sub chondral bone. These tests do not appear to yield much additional useful