Approach to knee pain Quiz: Ace Your Exams
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A 66-year-old woman presents to her primary care provider’s office for evaluation of left knee pain for the past six months. The patient denies injury or trauma, and she does not feel unstable while walking. However, she does have difficulty with ambulation secondary to pain. Past medical history includes obesity, hypertension, gout, and hyperlipidemia. Vital signs are within normal limits. Physical examination demonstrates diffuse tenderness to palpation over the left knee as well as pain and crepitus with flexion and extension at the knee. There is no warmth or erythema over the joint. Patellar tap testing is negative for joint effusion. There is no laxity with stress testing. Radiograph of the left knee (shown below) reveals osteophytes, narrowing of the joint space, and increased subchondral bone density. Which of the following is the most likely diagnosis?

Image source: Wikimedia Commons

Image source: Wikimedia Commons
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