Healing a Swollen Knee
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I fell on the sidewalk about a month ago and skinned and bruised my knee. I went home, iced my knee, and put Bactine and Neosporin on it. I had a lot of pain in my knee. I noticed there is swelling around my kneecap. It looks like fluid inside. What should I do?
— Angela, New Jersey
Following trauma to any part of our bodies, it is very natural to bleed. When the bleeding occurs into the skin, we develop what is referred to as a hematoma, a collection of blood in the soft tissue. Hematomas will usually heal over time; all that is necessary to help with the healing is application of ice at first, followed by heat. Bleeding can occur into other parts of our body as well.
Around the knee there are a number of fluid-filled sacs known as bursa. These normal structures are filled with small amounts of fluid that help lubricate and prevent friction as we move around our joints. Bleeding can occur into these sacs and cause swelling around the knee. Another place where blood can accumulate is in the joint itself. This usually occurs with more severe injuries and may be the result of simply banging the joint, such as what happened with your knee, or may be a sign of more significant damage such as a torn cartilage, ligaments, or even a fractured bone. If there is no significant pain and loss of function, fluid in the bursa and joint are often treated in the same way as a soft tissue hematoma — rest, ice, heat, and an over-the-counter medication for minor pain. If the fluid remains after a month, local treatment, such as you did at home, may not be sufficient to eliminate the problem. One of the concerns we have is that blood that stays in a closed space has the potential to become infected, and if the joint becomes infected, it often requires prolonged treatment with antibiotics and may require surgery.
I would strongly recommend you visit your physician so that a determination can be made as to whether the fluid is in the bursa — which is less serious — or in the joint, which would be of greater concern. Once the diagnosis is made, appropriate treatment can be initiated. Warning signs of fluid in your joint would include a decrease in the knee's range of motion, as well as fever or increased pain.
Q: Sometimes my knee is swollen and painful. What could be the cause of my sore knee?
A:There are lots of reasons you may have sore, achy, and stiff knees. If your knee is swollen and painful, or if it ever gets locked and immobile, you need to see a doctor who can make a diagnosis.
The doctor will look at where your knee hurts — whether the pain is in the back, behind the knee or in the front by your knee cap where you might experience clicking — and when it hurts — whether it’s only at night or constant, whether it hurts only when you exercise or move it in some way, or just when the doctor moves it. Constant pain, particularly pain with passive movement of your joint, suggests trouble with the joint itself whereas if the pain only occurs when you actively move your knee it could be problems with your tendons or ligaments or bursa.
Athletic activities commonly cause ligament injuries. Athletes are known to tear their anterior cruciate ligament (the ACL). Women are at particularly increased risk for this injury and the reason for this susceptibility is not entirely understood. Cartilage (meniscal) injuries or tears also are common in both young and older people and are a common cause of knee pain.
When the large tendon over the front of the knee, the patellar tendon, is inflamed it’s called patellar tendonitis. A sign that you have tendinitis is if the pain in the front of your knee gets worse when you climb stairs and after running up and down inclines.
When you have swelling in the back of the joint, it could be a baker’s cyst or a meniscus tear. If you have a meniscus tear, you usually feel the pain on the inside or the outside of your knee joint.
Related conditions can cause many aches and pains felt in the knees. As people get older, they are at increased risk for developing various conditions, such as certain types of arthritis, and arthritis can cause knee pain. Types of arthritis include rheumatoid arthritis (RA), osteoarthritis, and gouty arthropathy. People who are older and heavier and who complain of tenderness to the touch and whose knees look big and boney may have osteoarthritis. People with osteoarthritis tend to have minimal stiffness in the morning — it will last less than 30 minutes — and more so as the day progresses and at night. Folks who have inflammatory arthritis or lupus will have discomfort including stiffness that can last for hours. With rheumatoid arthritis, your knee will usually feel warm to the touch while with osteoarthritis it doesn’t. With osteoarthritis, you may feel a boney enlargement as if there’s bone there and it may be tender but you won’t typically see redness or feel heat. RA can lead to disability.
Swelling around the knee cap suggests fluid on the knee. The question is whether the fluid is inside the joint or not. When you find swelling around the knee cap, it’s usually outside the joint and that happens when you have a condition known as pre-patellar bursitis. The patellar is the large tendon over the front of the knee and there is a bursa associated with it that prevents friction when the tendon moves during extension of the lower leg.
Other disorders that can cause knee pain are bone tumors, which are not very common, and Osgood-Schlatter disease, which is seen in adolescents and is caused by the irritation of the growth plate that is just to the front of the knee joint.
Q: What could cause knee pain and a swollen leg, swollen ankles, a swollen calf, or swollen joints?
A:If you see swelling around your knee, besides arthritis and bursitis, it could be a baker’s cyst inside the knee joint that has ruptured. That can give you a lot of pain and swelling in your knee. The pain can go all the way down to your calf or ankle and there can be swelling down to the ankle as well. A blood clot in the veins of the lower extremity also can cause pain — usually in the back of the leg, and swelling. This condition requires prompt medical attention.
If you have bleeding into your knee from an injury, it can cause swelling. People who are on blood thinners may experience bleeding from a slight bang or bruise to the knee.
Some causes of knee pain will go away on their own with rest and self-care. If you are overweight it can put extra strain on your knee and put you at greater risk for knee problems. It is important if you have persistent pain to see a doctor who can make the proper diagnosis and treat your swollen knee pain.
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