Knee Assessment

Atraumatic Knee Pain Differential Diagnosis | ITBS, PFPS, Jumper's Knee

Buying options
Knee pain differential diagnosis

Atraumatic Knee Pain Differential Diagnosis | ITBS, PFPS, Jumper’s Knee

When a patient presents with atraumatic knee pain you will probably look into the direction of osteoarthritis, degenerative meniscus lesions, patellofemoral pain syndrome (PFPS), iliotibial band syndrome (ITBS), or patellar tendinopathy. We can split that list already based on age ranges where they are most prevalent. Osteoarthritis and degenerative meniscus lesions will be more prevalent in older patients, whereas the latter 3 are commonly seen in more active healthy young individuals


Physiotutors Free Assessment E-book

Click here for a diagnostic cluster for knee osteoarthritis. In this post we want to focus on the latter 3: PFPS, ITBS, and patellar tendinopathy or jumper’s knee as they can be tricky to diagnose for some.

First of all, they’re a diagnosis of exclusion so ruling out any other injury whether that’s ligamentous or muscular is warranted prior. Furthermore, while you will find special tests for these clinical pictures on our website the tests perform weakly and may not add much to forming a diagnosis.

What you should rather look at is the clinical presentation of these three pathologies let’s move to the following table:

Differential diagnosis table

As you can see the 3 pathologies are subdivided into their primary pain location, the quality of the pain presentation, sport-specific risk – as they are rarely seen in the sedentary population -, the typical age of onset, and the pattern of onset. Already looking at the pain location and presentation you can rule out one third of the pathologies, as ITBS will have a sharp localized lateral knee pain

Patients with PFPS or patellar tendinopathy will have more anterior pain which may be diffuse in nature. So if the symptoms do not present laterally to the knee in a localized spot usually the femoral condyle rule out ITBS. On the flip side if the symptom is localized, sharp, and lateral it’s very likely not PFPS or patellar tendinopathy.

Let’s move on to the typical age of onset. As you can see ITBS and patellar tendinopathy are rather seen in adults, whereas PFPS is also prevalent in the adolescent population. Rathleff and colleagues conduct a ton of PFPS research in the adolescent population. Furthermore, if we had to describe the typical patient with PFPS it would be a teenage female runner

Lastly, the pattern of onset can give you clues in differentiating between the 3. While all of the 3 are overuse injuries and commonly result from a rapid increase in training load, the onset of symptoms and ITBS is usually sudden, whereas PFPS has an insidious onset developing over several weeks and increasing in severity So next time you have a patient with atraumatic knee pain remember these characteristics

If you want to learn more about PFPS or ITBS you can enroll in our online course The link is in the video description.



Like what you're learning?

Follow a course

  • Learn from wherever, whenever, and at your own pace
  • Interactive online courses from an award-winning team
  • CEU/CPD accreditation in the Netherlands, Belgium & UK


Assessment app banner
Assessment E-book

What customers have to say about the Assessment E-Book

  • Kangmin Lee Avatar
    Kangmin Lee

    The Assessment E-Book This is amazing book for health professions & students

    Janine Doe Avatar
    Janine Doe

    The Assessment E-Book The book is fantastic. A great acquisition for all professionals because it presents all information in a concise, clear and grouped way.

    As I said earlier I would like to be able to access the material on all my devices.

  • Vince1992 Avatar

    The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!

    Simon Pagitz Avatar
    Simon Pagitz

    The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
    Great work, guys

  • Angel10 Avatar

    The Assessment E-Book (Spanish Version) Excelente Libro electrónico, me gusta que esta basado en la evidencia clínica y me apoya mucho para mi practica clínica. Es el mejor libro que he visto de evaluación, y me gusta mucho que esta en constante actualización, estaría bien meter más evaluaciones funcionales, que ya comienzan a subir en los videos con la nueva integrante mujer al equipo. Gracias kai y Andreas.

    혁 이 Avatar
    혁 이

    The Assessment E-Book I can’t believe this extremely inconvenience interface of this book. I’m used to reading my physio books with kindle, ipad just swiping the page back and forth, but this book , you need to tap the arrow on the left corner of the book to turn the page..even space bar and enter key don’t work to turn the’s feel like read a book in the computer in 1990s..

  • Jordi Burrut Avatar
    Jordi Burrut

    The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!

    Roel Rademaker Avatar
    Roel Rademaker

    The Assessment E-Book Very helpful during my study and making clinical decisions. You have made the test descriptions perfect for every region! Compliments! Loving the extra information (screening/guidelines) that comes with the cervical spine and the lumbar spine. Looking forward to see those as well for the other regions.

  • Manel Avatar

    The Assessment E-Book (Spanish Version) Un libro genial!!! Pero le doy 4 estrellas en vez de 5 ya que no me gusta el poder abrirlo solo en dos dispositivos. Tengo 2 ordenadores (uno en el trabajo), un móvil y una tablet, pudiendo abrirlo solo en dos de ellos. Por lo demás, un libro muy recomendable.

    Josh Avatar

    The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.

  • Julia Hauser

    The Assessment E-Book These are probably the best 80€ that I have ever invested in a book. Absolutly greatful for your work. It has been such a great effort, that you have put into this book and together with your videos, it really helped me to pass some exams and to later decide which assessment to use for my patients. I can only recommend this book to every single physiotherapist or physio student!!!
    thumps up, guys

    Polo_soa Avatar

    The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
    Congrats guys you’ve done an incredible job.
    I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
    In one word: amazing. Keep going guys ! Best wishes from france.

  • VCocho Avatar

    The Assessment E-Book Congrats ! It’s an amazing work ! A great book you have to work with: on a computer & on my iPad, at home and at work ! Links with articles and videos are fabulous !
    Thank you very much & long life to Physiotutors !

    dominicledinger Avatar

    The Assessment E-Book A must-have for every pt in this field! Excellent content that is absolutely worth the price. As you can use the ebook on two different devices, you can have it on your (work) computer and your phone.

  • Simon Busk Avatar
    Simon Busk

    The Assessment E-Book Got me through my assessment exams with a breeze would not have been as easy and enjoyable without the assessment handbook. It provides relevant data, and insights into statistical values and the lay of the land on the research side of things. A great book and a must for any physiotherapist, student, or practitioner...

    Marios Pan Avatar
    Marios Pan

    The Assessment E-Book Very good book to easily find relevant tests and their clinical value. I would recommend it for everyone in the Musculoskeletal or Sports Medicine field.

  • Facundo Avatar

    The Assessment E-Book -