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
