Persistent Swelling and Heat in the Inner Knee: When to Seek Further Evaluation?

Persistent swelling and warmth on the inner side of the knee?

Hello Doctor: Two months ago (on September 6), I severely sprained my left ankle while playing basketball.
For the following days, I heavily relied on my right leg, which led to discomfort in the inner side of my right knee around the fourth day.
It feels stiff and painful when bending (for example, while sitting), but it doesn't hurt when straightened.
As my left ankle injury improved, the discomfort and swelling in the inner side of my right knee persisted, along with a feeling of heat.
After two weeks, I sought medical attention, and an X-ray showed no bone injury, but cartilage and ligament injuries could not be visualized.
The diagnosis was inflammation of the medial cartilage or ligaments, and I was prescribed glucosamine.
During my follow-up appointment in the fourth week, the doctor continued to prescribe glucosamine.
The knee pain while bending lasted for four weeks before it started to improve, but I still feel stiffness on the inner side, and my movements are not smooth.
Six weeks later, the stiffness sensation has disappeared, but my knee still remains swollen and warm, and I often hear a "pop" sound when moving.
Do you think I need to go to the hospital for further examination? Thank you, Doctor, and I wish you all the best.

R, 20~29 year old female. Ask Date: 2016/11/08

Dr. Shi Guozheng reply Orthopedics

Swelling and warmth in the knee joint indicate that inflammation is still present.
A popping sound may be the result of bones or ligaments sliding over one another.
If these symptoms persist, it is important to consult a physician for evaluation.

Reply Date: 2016/11/08

More Info

Persistent swelling and heat in the knee, especially after an injury, can be concerning and warrants careful evaluation. Based on your description, it seems that you experienced a significant ankle sprain, which led to compensatory overuse of your right knee. This overuse can result in various issues, including inflammation of the soft tissues, such as ligaments and cartilage, which may not always be visible on X-rays.

The symptoms you are experiencing—persistent swelling, heat, and a "catching" sensation in the knee—suggest that there may be underlying issues that require further investigation. While the initial X-rays indicated no bone injury, they do not provide information about soft tissue injuries, such as ligament tears or cartilage damage. Given that you have been experiencing these symptoms for an extended period, it is advisable to seek further evaluation.

Here are some considerations and recommendations based on your situation:
1. MRI Evaluation: Since X-rays do not show soft tissue injuries, an MRI (Magnetic Resonance Imaging) scan may be beneficial. An MRI can provide detailed images of the knee's internal structures, including ligaments, cartilage, and any potential tears or inflammation. This is particularly important if you suspect that the inner cartilage or ligaments may be involved.

2. Physical Examination: A thorough physical examination by an orthopedic specialist is essential. They can assess the range of motion, stability, and any specific areas of tenderness in the knee. This examination can help determine if there is a need for further imaging or intervention.

3. Persistent Symptoms: The fact that you continue to experience swelling and heat, along with a "catching" sensation, indicates that your knee may not be healing properly. This could be due to ongoing inflammation, a possible meniscal tear, or other soft tissue injuries that require treatment.

4. Treatment Options: Depending on the findings from further evaluations, treatment options may include physical therapy, anti-inflammatory medications, or even surgical intervention if there is a significant injury that does not respond to conservative management.

5. Monitoring Symptoms: Keep track of any changes in your symptoms, such as increased pain, changes in swelling, or any new symptoms like locking or instability in the knee. These changes can provide important information to your healthcare provider.

6. Consultation with a Specialist: If you have not already done so, consider consulting with an orthopedic surgeon who specializes in knee injuries. They can provide a more comprehensive evaluation and discuss potential treatment options tailored to your specific situation.

In summary, given the persistence of your symptoms and the impact they have on your daily activities, it is advisable to seek further evaluation. An MRI and a thorough examination by an orthopedic specialist will help clarify the underlying issues and guide appropriate treatment. Early intervention can often lead to better outcomes and a quicker return to normal function.

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