Persistent Knee Pain After Injury: What to Do Next?

What could be causing this knee pain?

Hello Doctor: My knee was swollen significantly due to a motorcycle accident.
The doctor said that the skin and muscle had separated, and there was a collection of blood and fluid inside.
About a month later, when I visited Chang Gung Hospital, the doctor used a syringe to aspirate the accumulated fluid and injected an anti-inflammatory medication into my knee.
That night, my knee suddenly swelled up significantly and was so painful that I couldn't walk.
Later, a nearby hospital's doctor performed surgery to remove the fluid inside.
However, now it feels better, but I still experience discomfort and soreness around the knee.
It hurts when I kneel down, and if I walk or stand for too long, I feel aching pain near the knee.
I have seen orthopedic specialists multiple times, and they have taken X-rays but couldn't find any issues.
Could you please tell me what this problem might be? Which specialty should I consult for further examinations? Thank you, Doctor.

A Long, 20~29 year old female. Ask Date: 2006/05/26

Dr. Zhou Lizhi reply Orthopedics

There is a bursa located in front of the kneecap, which functions to provide lubrication during movement.
It is often injured, leading to bursitis and the accumulation of fluid.
Although aspiration in the clinic may provide temporary relief, it frequently recurs, which may necessitate surgical removal of the bursa.
After the bursa is excised, patients may experience tightness when bending the knee.
It is recommended that individuals apply heat and perform stretching exercises to alleviate symptoms.

Reply Date: 2006/05/26

More Info

It sounds like you have been through quite a challenging experience with your knee injury, and I understand your concerns about the persistent pain and discomfort you are experiencing. Based on your description, it seems that you have undergone significant trauma to your knee, which has led to complications such as fluid accumulation and possibly some degree of soft tissue damage.

Understanding Your Symptoms
1. Persistent Pain and Discomfort: The ongoing pain and discomfort you feel, especially when kneeling or after prolonged walking or standing, could be attributed to several factors. After a significant injury, the knee joint may develop inflammation, which can lead to pain even after the initial injury has healed. This inflammation can be due to synovitis (inflammation of the synovial membrane), which can occur after trauma or surgery.

2. Fluid Accumulation: The initial accumulation of blood and fluid in the knee joint (hemarthrosis) can lead to changes in the joint's structure and function. Even after the fluid is drained, the knee may remain sensitive and prone to swelling due to residual inflammation or irritation of the tissues.

3. Soft Tissue Damage: The separation of the skin and underlying tissues you mentioned could have resulted in damage to ligaments, tendons, or cartilage. If these structures were affected, they might not have healed completely, leading to ongoing pain and instability in the knee.

Recommended Next Steps
1. Consult a Specialist: Since you have already seen orthopedic doctors without finding a clear issue on X-rays, it may be beneficial to consult a sports medicine specialist or a rheumatologist. They can provide a more comprehensive evaluation of your knee and may suggest advanced imaging techniques, such as MRI, to assess soft tissue structures, including ligaments, cartilage, and the synovial membrane.

2. Physical Therapy: Engaging in a structured physical therapy program can be very beneficial. A physical therapist can help you strengthen the muscles around your knee, improve flexibility, and enhance overall joint stability. They can also provide modalities for pain relief, such as ultrasound therapy or electrical stimulation.

3. Pain Management: If inflammation is a significant contributor to your pain, your doctor may recommend anti-inflammatory medications or corticosteroid injections to help reduce swelling and discomfort. It's essential to discuss these options with your healthcare provider to determine the best approach for your situation.

4. Activity Modification: While you are recovering, it may be helpful to modify your activities to avoid exacerbating your symptoms. This could include avoiding prolonged standing or walking and using supportive devices like knee braces if recommended by your doctor.

5. Monitoring Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any activities that seem to trigger or alleviate the pain. This information can be valuable for your healthcare provider in diagnosing and managing your condition.

Conclusion
In summary, your ongoing knee pain and discomfort after such a significant injury can be multifactorial, involving inflammation, soft tissue damage, and possibly changes in joint mechanics. A thorough evaluation by a specialist, combined with physical therapy and appropriate pain management strategies, can help you on your path to recovery. Remember, healing takes time, and it's essential to be patient with your body as it recovers from trauma. If you have further questions or concerns, don't hesitate to reach out to your healthcare provider for guidance.

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