Posterior knee pain

[The Full Nelson]

I have a patient who presented with:

*insidious, sudden onset knee pain.
*explains area behind knee jt, medial joint line, and radiating to ankle (has limited ankle inv/eversion compared to other foot).
*complaining of altered sensation in area of dorsum of foot
*lumbar, SIJ, pelvic, hip - clear
*is unable to achieve terminal knee ext, or >75deg knee flexion.
*pt is not sporty or active (desk job) - 30years old
*nil past history
*nil clicking, locking, grinding

Has felt knee "nearly give way" since pain began.

McMurray's negative (but difficult due to lack of range)
MCL/LCL/ACL/PCL negative
Swelling in posterior compartment (popliteal fossa)
Tender, thickened over popliteus
Very tight hamstrings, gastroc

Any thoughts??

?posterior horn meniscus injury - any other tests i should perform to confirm?
?Baker's cyst
?posterior capsule
?bursitis

help!

Should i be worried about anything sinister? Am i missing something obvious?

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[Physio Dace]

Any other joints affected? History of gout or other inflammatory joint disorders (psoriatic arthritis)? Check neurodynamic tests?

[The Full Nelson]

Yes, he does have a history of gout. In that case, I will probably refer him to his GP for treatment, or referral to a specialist.

Thanks

[ginger]

sciatica, just another presentation of a common referred event.( Nb. tight hamstrings and calves.) Mobilise L5S1 for five minutes or so , until protective hypertonicity there resolves, then recheck the knee for a change to disturbed sensations there. Should be fairly straight forward if you have good hands and some reasonable thumb strength.