Persistent Knee Swelling and Pain After Major Bruising: When to Seek Help?

Extensive bruising of the knee?

Last April, I was involved in a car accident, which resulted in extensive bruising on my knee that extended to part of my thigh.
The doctor mentioned that there was internal bruising and blood clots and asked if I wanted surgery.
However, the bruising gradually subsided over the course of a month, so I opted against surgery.
I also had my ligaments checked, and there were no injuries.
After the bruising resolved, I did not return for a follow-up.
However, since then, I have been experiencing a persistent feeling of swelling in my knee, which is painful when pressed.
It feels constantly swollen, and I also experience tightness and pain when soaking in hot water or during the winter.
Now, a year later, the symptoms persist, and I occasionally notice that the skin over the previous bruised area is darker.
I would like to ask if I need to visit a hospital for this issue.
If so, which department should I consult?

Jiajia, 20~29 year old female. Ask Date: 2017/07/03

Dr. Xu Kaixi reply Surgery

The symptoms of the knee are due to bruising and inflammatory responses caused by trauma, leading to fibrosis and neuropathic pain.
If the symptoms are significant and have not improved, it is advisable to visit a hospital for examination and treatment.

Reply Date: 2017/07/03

More Info

It sounds like you've been dealing with a persistent issue following your knee injury from the car accident last April. Given the details you've provided, it is important to address your concerns regarding the ongoing swelling, pain, and discoloration in your knee.

First and foremost, it is not uncommon for individuals to experience lingering symptoms after a significant injury, especially one that involved major bruising and potential blood clots. The fact that you initially had a large area of bruising and swelling suggests that there was significant trauma to the soft tissues around your knee. While the bruising may have resolved, the residual swelling and discomfort can be attributed to several factors, including inflammation, scar tissue formation, or even synovitis (inflammation of the synovial membrane).

1. When to Seek Help: Given that you have been experiencing these symptoms for over a year, it is advisable to seek medical attention. Persistent swelling, pain, and changes in skin color (such as the deeper pigmentation you mentioned) can indicate underlying issues that may require further evaluation. It is particularly important to consult a healthcare provider if the swelling worsens, if you experience increased pain, or if you notice any new symptoms such as fever or instability in the knee.

2. Which Specialist to See: For your situation, you should consider seeing an orthopedic specialist, particularly one who focuses on knee injuries. An orthopedic surgeon can evaluate your knee through a physical examination and may recommend imaging studies such as an MRI or ultrasound to assess the soft tissues, ligaments, and any potential joint effusion (fluid accumulation in the knee joint).

3. Potential Causes of Symptoms: The ongoing swelling and pain could be due to several reasons:
- Residual Hematoma: Sometimes, a hematoma (a localized collection of blood outside of blood vessels) can persist and cause discomfort.

- Synovitis: Inflammation of the synovial membrane can lead to swelling and pain, particularly if there is irritation from previous trauma.

- Scar Tissue: After an injury, scar tissue can form, which may restrict movement and cause discomfort.

- Post-Traumatic Arthritis: In some cases, trauma to the knee can lead to early onset of arthritis, which can cause chronic pain and swelling.

4. Management Strategies: While waiting for your appointment, you can manage your symptoms with several strategies:
- Rest and Ice: Avoid activities that exacerbate your pain. Applying ice to the knee can help reduce swelling.

- Compression: Using a knee brace or compression wrap may provide support and help manage swelling.

- Elevation: Keeping your knee elevated can also help reduce swelling.

- Gentle Range of Motion Exercises: If you are able, gentle stretching and strengthening exercises may help maintain mobility and reduce stiffness.

5. Follow-Up Care: If you do see a specialist, they may recommend physical therapy to help strengthen the muscles around your knee and improve flexibility. They may also discuss options for pain management, including medications or injections if necessary.

In summary, given your ongoing symptoms, it is wise to seek evaluation from an orthopedic specialist. They will be able to provide a thorough assessment and recommend appropriate treatment options based on your specific condition. Don't hesitate to advocate for your health and seek the care you need to address these persistent issues.

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