Questionnaire/history: 45+ years? Activity-related joint pain, which has developed over months or years? No morning joint-related stiffness or morning stiffness lasting no longer than 30 min? Stiffness? Pain history: - Location? ----- Anteromedial (involvement of medial tibiofemoral compartment)? ----- Anterolateral (involvement of the lateral tibiofemoral compartment)? ----- Anterior (worsened on inclines or stairs, particularly when going down and progressive aching on prolonged sitting that is relieved by standing) (involvement of patellofemoral compartment)? - Onset? - Duration? ------ At rest? ------ Disturbing sleep? - Progression? - Pattern? - Severity of symptoms? Risk factor for osteoarthritis? Trauma? Systemic symptoms? Functional impairment? Psychosocial impact? Tried self-help strategies and treatments? Fall risk? Adjustments to home and/or work needed? Past medical history (eg chronic pain syndrome, obesity)? Family history (eg osteoarthritis or joint problems)? Current medication? Drug allergies? Social support? Examination: Height? Weight? BMI? Antalgic gait? Bony swelling and joint deformity? - Bony swelling of the femoral condyles? - Bony swelling of the lateral tibial plateau? - Varus (bow-legged) deformity? - Valgus (knock-knee) deformity? Joint warmth and/or tenderness (there may be synovitis)? - Tenderness along the joint line? - Tenderness with pressure on the patella? Effusion? - Small? - Moderate? Muscle wasting and weakness? (Note: weakness of the quadriceps is suggested if passive extension of the knee joint is greater than active extension) Restricted and painful range of joint movement? - Restricted flexion? - Restricted extension? Crepitus (a grating sound or sensation produced by friction between bone and cartilage)? Joint instability? Associated features including: - Giving way (due to altered patella tracking, weak quadriceps muscles, severe patellofemoral involvement and altered load-bearing mechanics)? - Locking (inability to straighten the knee) (suggests loose meniscal cartilage in the joint)? Management: Advised: - Paracetamol and/or topical ibuprofen and if ineffective oral ibuprofen +/- codeine - Capsaicin prn - Local heat or cold packs - Appropriate footwear - Local muscle strengthening exercise and aerobic fitness training - To lose weight if overweight or obese - Psychological support options - Adjustments to home and/or work if needed - Sources of information and support: ----- Versus Arthritis ----- Arthritis and Musculoskeletal Alliance (ARMA) ----- NHS Health A to Z: Osteoarthritis ----- Patient UK: Osteoarthritis - Review prn Reference(s): NICE CKS: Osteoarthritis Information for parents/carers: Arthritis and Musculoskeletal Alliance (ARMA) NHS Health A to Z: Osteoarthritis Patient UK: Osteoarthritis British Society for Surgery of the Hand (BSSH): Arthritis at the base of the thumb Versus Arthritis