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Knee History and Symptoms

Background
1

What is your age?
2

What is your gender?

3

How long ago did your symptoms begin?

4

Are you a runner or hiker?

Yes No
5

Do you use any device (cane, crutches, etc...) to assist you?

Yes No
6

Do you have a new (acute) injury to your knee?

Yes No
7

Do you take any medication for knee pain?

Yes No

Does your knee hurt...?
8
 ... in the front (location 1 in the photo)
9
 ... on the outside (location 2 in the photo)
10
 ... on the inside (location 3 in the photo)
11
 ... in the back (location 4 in the photo)
12
 ... all over
13

... when going upstairs?

Yes No
14

... when going downstairs?

Yes No
15

... at night?

Yes No
16

... when you stand after sitting for a long time?

Yes No
17
 ... when you kneel down? Yes No
18
 ... with burning pain around your knee? Yes No

Other Symptoms
19

Does your knee give out or buckle?

Yes No
20

Does your knee catch, lock, or snap?

Yes No
21

Do you have any back pain?

Yes No
22
 Do you have pain in the muscle behind your thigh? Yes No
23
 Do you have pain that starts in your back and goes to your leg? Yes No
24

Does your knee feel weak?

Yes No
25

Does your knee swell when you use it?

Yes No
26

Can you walk (put weight down) on the affected leg?

Yes No
27

Have you had any recent fevers, chills or sweating at night?

Yes No
28

Can you fully straighten (extend) your knee?

Yes No
29

Can you fully bend (flex) your knee?

Yes No
 30 

Do you have swelling directly behind your knee?

Yes No
 

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