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As for knee pain, if that is where the symptoms are but there are no signs then clinical reasoning tells you to rule out other possible sources such as the hip. Sherlock would have said "Elementary my dear Watson !"
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I enter this one with trepidation. To start with, though, never in the entire Holmes canon does the great one say:"Elementary my dear Watson!"
For the past several years I have sat as (lawyer) chair of a three-person disability review board (physician/nurse/physio/pharmacist and layman or woman.
"As for knee pain ... rule out ... the hip".
Well now, one would think so. Consider the man in his thirties, married, two young children. Graduate. Well qualified. Athlete. Just starting to make progress in his career. Bright guy. Wife, also bright young graduate, quits job, look after children. Happy family.
Works with the intellect. Starts to feel great discomfort in the thoracic region. Ah! It'll get better. No it does not. Becomes progressively worse over several years. Suspected lung cancer or other lung disease, but difficult to be sure. Many X-Rays and "tests". Many consultants. Heavy thinkers. (Hey! Maybe he is malingering? Whaddaya think? No?). Exploratory surgery. Reports upon reports. Fellows of this College and that. Meetings. Consultations. Chiefs of staff acquire lines of worry. Nothing revealed. What can it be?
Debilitating insomnia. Progressive inability to concentrate. Does his work worse and worse. Understanding employer puts him on less demanding work, then part time. Yip! Gotta real problem with those lungs. People are human after all, and this becomes quite tedious. He has to stop work. Wife goes back to job. Daycare for the children. Marital strains. Prognosis gloomy for survival, quality of life and marriage.
In the midst of all this merriment he goes for a routine dental check. It is not that he has toothache. He does not. No toothache. Just time to go. The dentist by accident knocks a probe against a crown or filling. The crown or filling falls off in his mouth. Right there and then it just falls off. The chap's mouth, and also the room, as he told us, are instantly "filled with the stink of the most awful drains".
Dentist does whatever dentists do in such circumstances. Within a month chap is well on the way to recovery. There was nothing wrong with his knee ...Ooops! ... lungs. There was everything wrong with his tooth, and it apparently had the effect of poisoning his whole body. Seems he'll soon be able to go back to work! Thinking of skiing, maybe next year.
I can now virtually tell as soon I see who are on the panel how they will interpret the evidence, who will be dogmatic, who cautious. If an applicant claims to have pain and take oxycontin or Tylenol 3, one member will insist on seeing the prescription for the laxative, because "everyone knows" (Well, she does) that pain killers are constipating. No laxative, no genuine pain. Well it is not so. Not always. Not for everyone.
Some demand "objective evidence". What's that? Ultrasound, perhaps? Yeah. How much of the result depends on the skill of the technician or radiologist to interpret and the fatness of the patient when the pictures were taken?
Old lady falls. X-Ray of hip. Great! She is Okay. Good. A week later she is still in agony. Ambulance. Admitting physician at Emergency reviews her and X-Ray plates from last week. There we are! See! See! Look there! See the crack! She has had a broken hip for eight days, was sent home with it.
We are not talking a new X-Ray, but last week's.