Persistent Knee Swelling and Pain After Injury: What to Do Next?

Knee swelling and pain with bending?

Hello Doctor, three weeks ago I was in a car accident where my left knee hit the ground, causing my pants to tear.
I was taken to the emergency room where they performed an X-ray, and the doctor said there was no significant bone injury.
They treated the external wound, prescribed anti-inflammatory pain medication, and administered a tetanus shot.
I was advised to avoid walking as much as possible and to apply ice.

After returning home, I started icing the knee, but I only took the anti-inflammatory pain medication a few times because I felt it wasn't too painful at the time.
However, about a week later, my knee was still swollen, and when I bent it, I felt something stuck in the lower part of my knee, which was uncomfortable and painful.
I went back to see a doctor, who prescribed more anti-inflammatory pain medication and advised me to ice the painful area while applying heat to the non-painful areas.

Another week passed, and I didn't notice significant improvement, so I consulted a different doctor due to time constraints.
This doctor advised me to avoid bending my knee and also prescribed anti-inflammatory medication.
It has now been three weeks since the accident, and I am unsure why my knee is still swollen.
When I bend or move it, I feel something catching in the lower part of my knee, which is painful and causes me to limp when walking.
I am afraid to bend it and would like to know what I should do.
Should I continue icing the painful areas and apply heat to the swollen areas? Do I need to finish the anti-inflammatory medication? Should I continue seeing an orthopedic specialist? Is this normal after three weeks? I apologize for my concerns, and thank you, Doctor.

Chen, 20~29 year old female. Ask Date: 2018/08/10

Dr. Shi Guozheng reply Orthopedics

Swelling after a knee joint injury typically takes about six weeks to subside, although it may take longer for some individuals.
The swelling and pain can limit the joint's ability to bend fully.
During this time, analgesics and anti-inflammatory medications can be taken to alleviate symptoms.
Alternating between heat and ice therapy can also be beneficial; if the swelling is significant, ice should be applied, while heat can be used on tight muscles.
Additionally, it is important to practice joint flexion exercises and perform up-and-down movements with the ankle to help stretch the calf muscles, which can promote faster recovery.
If there is no improvement after three months, it is advisable to consult a physician for further evaluation.

Reply Date: 2018/08/10

More Info

It sounds like you are experiencing persistent knee swelling and pain following a car accident, which can be quite concerning. Given the details you've provided, it’s important to approach your situation with a comprehensive understanding of knee injuries and the healing process.

Firstly, it’s not uncommon for swelling and discomfort to persist for several weeks after a knee injury, even if initial X-rays did not show any fractures. Soft tissue injuries, such as sprains, strains, or contusions, can lead to significant swelling and pain. The presence of a "lump" or a sensation of something being "stuck" in the knee could indicate swelling in the joint or possibly a meniscal tear, which is a common injury that can occur with knee trauma.

Here are some steps you can take to manage your symptoms and facilitate recovery:
1. Rest and Activity Modification: It’s crucial to avoid activities that exacerbate your pain. While complete immobilization is not usually recommended, you should limit weight-bearing activities and avoid bending the knee if it causes discomfort. Using crutches can help you avoid putting weight on the injured knee.

2. Ice and Heat Therapy: Ice therapy is beneficial in the acute phase of an injury to reduce swelling and numb pain. You should continue to ice the knee for 15-20 minutes every couple of hours, especially after any activity that causes discomfort. After the initial swelling has decreased (usually after a few days), you can incorporate heat therapy to help relax and loosen tissues and stimulate blood flow to the area. However, if swelling persists, continue with ice.

3. Medication: If you have been prescribed anti-inflammatory medications, it’s advisable to complete the course as directed by your physician. These medications can help reduce inflammation and alleviate pain. If you experience side effects or if the medication does not seem to help, consult your doctor for alternatives.

4. Follow-Up with Your Doctor: Since you have seen different doctors, it may be beneficial to follow up with an orthopedic specialist who can perform a thorough examination, possibly including imaging studies like an MRI, to assess for any soft tissue injuries that may not have been visible on the initial X-rays. Persistent swelling and pain warrant further investigation to rule out conditions such as a meniscal tear, ligament injury, or even a joint effusion (fluid accumulation in the knee).

5. Physical Therapy: Once the acute phase of your injury has passed and if your doctor agrees, physical therapy can be very beneficial. A physical therapist can guide you through exercises to improve range of motion, strengthen the muscles around the knee, and promote healing. They can also provide modalities such as ultrasound or electrical stimulation to help reduce pain and swelling.

6. Monitoring Symptoms: Keep track of your symptoms. If you notice increased swelling, redness, warmth, or if you develop a fever, these could be signs of infection or other complications that require immediate medical attention.

7. Patience and Recovery: Healing from a knee injury can take time, and it’s important to be patient with your body. Everyone heals at their own pace, and while three weeks may feel like a long time, it’s not unusual for swelling and discomfort to persist for several weeks, especially if there is soft tissue damage.

In summary, continue to manage your symptoms with rest, ice, and medication as needed, and follow up with a healthcare provider for further evaluation. If your symptoms do not improve or worsen, seeking a specialist's opinion is crucial to ensure you receive the appropriate care for your knee injury.

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