What Are Knee Injury Treatments?دکتر نیما محسنی
What Are Risk Factors for Knee Injuries?
Accidents happen, and injuries occur on the football field, on the basketball court, on the soccer pitch, and in daily life. Often knee injuries cannot be prevented. Maintaining a healthy weight, keeping fit, staying strong, and stretching may be helpful in minimizing the risk of many injuries, including those that involve the knee.
Imbalances of muscles that surround and support the knee can lead to knee injuries. If either the quadriceps or hamstring muscle groups become weak, the stability of the knee and ability to withstand an injury is decreased.
Similarly, an imbalance between muscles within the quadriceps muscles of the thigh may cause the kneecap (patella) to track improperly, causing patellofemoral syndrome or increasing the risk of patellar dislocation.
Pregnant women are at higher risk for knee injury and pain because of increased weight, the body’s shifted center of gravity, and hormonal changes that can weaken ligaments and make them more lax.
The knee joint absorbs a significant amount of the force that is generated with each step with walking or running. People who are significantly overweight may develop knee pain because of the excess weight that needs to be supported.
What Are Knee Injury Symptoms and Signs?
Acute knee injuries can cause pain and swelling with difficulty bending the knee and weight-bearing. Acute knee injuries often may be considered as falling into two groups: those where there is almost immediate swelling in the joint associated with the inability to bend the knee and bear weight, and those in which there is discomfort and perhaps localized pain to one side of the knee, but with minimal swelling and minimal effects on walking.
If the swelling occurs immediately, it may suggest a ligament tear or fracture. If the swelling arises over a period of many hours, meniscal or cartilage injuries may be the cause. However, injuries to the knee may involve more than one structure and the symptoms may not present classically.
Longer-term symptoms that point to knee problems will include pain and swelling in addition to other complaints. Inflammation in the joint may be caused by even minor activity. Swelling may be intermittent, brought on by activity, and may gradually resolve as the inflammation decreases.
Pain, too, may come and go. It may not occur right away with activity but might be delayed as the inflammation develops. Pain can also be felt with specific activities. Pain while climbing stairs is a symptom of meniscus injury, where the cartilage is being pinched in the joint as the joint space narrows with knee bending. Pain with walking down stairs suggests patellar pain, where the kneecap is being forced onto the femur.
Giving way, or a feeling of instability of the knee, or popping or grinding in the knee is associated with cartilage or meniscus tears. Locking is the term used when the knee joint refuses to completely straighten, and this is almost always due to torn cartilage. In this situation, the torn piece of cartilage folds upon itself and doesn’t allow the knee to extend.
When Should You Call the Doctor for a Knee Injury?
Emergent medical care should be sought if, due to injury,
- there is almost immediate swelling in the knee,
- if the bones appear deformed,
- if there is inability to bear weight,
- if the pain is intolerable,
- if there is loss of sensation below the injury site,
- if the foot and ankle turn cold and no pulses can be felt.
Medical care should be considered if a knee injury does not resolve with routine home care, including rest, ice, compression, and elevation (RICE). Other symptoms that may suggest the need for medical care include recurrent pain and swelling.
A swollen joint is never normal, and if it is red and warm or if there is an associated fever, more urgent medical attention should be accessed because of the worry of infection being present. This is particularly a warning sign in infants and children, people who have had knee joint replacements, intravenous drug abusers, and those who have compromised immune systems.
How Do Doctors Diagnose Knee Injuries?
The initial evaluation by the health care professional will begin with a medical history. Whether the evaluation is occurring immediately after the injury or weeks later, the physician may ask about the mechanism of injury to help isolate what structures in the knee might be damaged. Is the injury due to a direct blow that might suggest a fracture or contusion (bruise)? Was it a twisting injury that causes a cartilage or meniscus tear? Was there an injury associated with a planted foot to place stress and potentially tear a ligament?
Further questions will address other symptoms. Was swelling present, and if so, did it occur right away or was it delayed by hours? Did the injury prevent weight-bearing or walking? Does going up or down steps cause pain? Is there associated hip or ankle pain? Is this an isolated injury, and have there been other occurrences?
Past medical history and information on medications and allergies will be helpful information to learn about the patient.
Physical examination of the knee begins with inspection, in which the physician will look at the bones and make certain they are where they belong. With fractures of the kneecap or patellar tendon injuries, the kneecap can slide high out of position. Also, patellar dislocations, where the kneecap slides to the outside or lateral part of the knee, are easily evident on inspection. Looking at how the knee is held is also important. If the knee is held slightly flexed, it can be a clue that there is fluid in the joint space, since joint space is maximal at 15 degrees of flexion.
Palpation (feeling) is the next part of the exam, and knowing the anatomy, the physician can feel where any pain might exist and correlate that to the underlying structures like ligaments or muscle-insertion points. Palpation over the joint line, the space between the bones in the front part of the knee, can uncover fluid or tenderness associated with a meniscus injury. This is also the part of the exam when the ligaments are stressed to make certain that they are intact. Sometimes, the physician will also exert stress on the uninjured knee to see how loose or tight the normal ligaments are as a comparison. Finally, the blood supply and nerve supply to the leg and foot will be assessed.
Sometimes X-rays of the knee are required to make certain there are no broken bones, but often with stress or overuse injuries where no direct blow has occurred, plain X-rays may not be initially needed and imaging of the knee may wait until a later date. Standing X-rays of the knees are used to assess the joint space and compare the injured knee to the uninjured one. An MRI might be considered to evaluate the ligaments and cartilage within the knee joint.