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Knee Injury (cont.)

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, 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 may be obtained. An MRI might be considered to evaluate the ligaments and cartilage within the knee joint.

What Types of Doctors Treat Knee Injuries?

Often, knee injuries are cared for by primary-care providers who have the knowledge and skills to diagnose and treat many of the common knee injuries that occur. Orthopedic surgeons are involved in knee injury care to determine whether surgery might be required. They are also the specialists to perform the surgery. Physical therapists have an important role in the treatment of knee injuries regardless of whether surgery is required.

Medically Reviewed by a Doctor on 5/17/2016

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