What is the appropriate management and investigation for a patient presenting wi

Immediate management and investigation of the patient with severe right knee pain, inability to weight bear requiring a wheelchair, locked knee, and a history of prior knee pain should involve urgent clinical assessment. The locked knee suggests mechanical obstruction, likely due to meniscal injury or loose bodies, common in active individuals engaged in sports like tennis.

History and examination: Take a detailed history including any recent trauma, mechanism of injury, pain characteristics, presence of swelling or effusion, prior knee problems, and any systemic symptoms.

Clinical findings of a locked knee and inability to walk, especially with severe pain, are red flags requiring urgent referral. On examination, assess the knee for swelling, joint line tenderness, range of motion, ligamentous stability, neurovascular status, and signs of meniscal injury (e.g. positive McMurray’s test), though acute pain may limit these.

Urgent imaging: Initial appropriate investigation is knee X-ray (weight bearing if possible) to exclude fracture, dislocation, or advanced osteoarthritis. However, plain X-rays have limited sensitivity for soft tissue injuries.

Magnetic Resonance Imaging (MRI) is considered the reference standard to evaluate meniscal tears, ligamentous injuries, cartilage damage, loose bodies, and bone contusions and should be arranged urgently where available NICE CKS. MRI may be accessible directly in some primary care settings depending on local pathways.

Red flag conditions such as septic arthritis or fracture require immediate hospital admission. There is no indication for waiting for investigations prior to referral in this scenario due to the severity of symptoms and mechanical blockage NICE CKS.

Acute management: Immobilization, analgesia, and non-weight-bearing status pending specialist assessment are recommended.

Referral: Urgent or same-day specialist referral to orthopaedics or an acute knee clinic is indicated to assess the need for possible arthroscopy or other surgical interventions NICE CKS.

Chronic management considerations: The history of prior knee pain episodes and active participation in tennis suggest possible pre-existing degenerative changes or prior meniscal pathology, which may contribute to current findings.

After surgical or specialist assessment, rehabilitation including physiotherapy focusing on strength, range of motion, and functional recovery will be required.

General advice: Patients with locked knees and severe symptoms should not delay seeking care; early diagnosis and management improve outcomes.

Summary: A person presenting with severe knee pain, inability to weight bear requiring a wheelchair, locking, and prior knee pain needs immediate clinical evaluation, urgent imaging starting with X-ray then MRI, analgesia, immobilization, and referral for orthopedic assessment without delay to exclude significant soft tissue or bony injury and to plan management NICE CKS.