Post-Accident Knee Swelling: Causes and Treatment Options

Q: Post-Accident Knee Swelling: Causes and Treatment Options

Dear User： The course of your condition resembles Prepatellar Bursitis, but it is important to first determine the possibility of infection. <br>Bursae can become inflamed or infected due to overuse or injury. <br>Injuries may result from direct impact or chronic irritation, such

Knee contusion after a car accident with swelling and pain during the healing process?

I had a car accident on February 2nd, during which I sustained abrasions on my knee.
After an X-ray at the orthopedic clinic, the doctor confirmed that there were no fractures or breaks in the bone, so I was prescribed a topical ointment and anti-inflammatory pain medication.
After returning home, I changed the dressing myself, applying iodine and the ointment prescribed by the doctor, until the wound scabbed over.
I was able to walk normally without any pain.
However, around February 21st, the area around the wound became swollen, and the swelling continued to increase until it reached the size of a ping pong ball.
When standing upright and looking at my leg from the side, it appeared as if I had two kneecaps.
Initially, I thought that perhaps the internal healing was incomplete, even though the external wound had healed, which caused the swelling.
Pressing around the area was painful, and by today, even walking caused pain, particularly with any bending motion.
I consulted a rehabilitation specialist (as I was unsure which department to visit), and the doctor suggested that it might be cellulitis, prescribing some antibiotics and anti-inflammatory medication, and recommended that I see a dermatologist or a plastic surgeon.
To confirm, I made an appointment with a dermatologist.
During the consultation, I expressed my concerns about the possibility of an abscess or cellulitis.
After examining me, the dermatologist stated that it did not appear to be cellulitis.
They removed the scab and found no pus, and the wound healing seemed normal.
I asked why the swelling was so pronounced, and the doctor said they did not know and advised me to see an orthopedic specialist for further evaluation.
I then visited an orthopedic doctor, explained my situation, and underwent another X-ray.
The doctor found a 0.3 cm foreign body in the swollen area, which was causing the swelling.
I asked the doctor what to do, and they advised against removing it because it was too small.
They explained that making an incision and searching for it could damage the surrounding healthy tissue.
However, I am puzzled as to why the swelling only occurred after the wound was nearly healed, between February 2nd and February 21st, when there was no swelling at all.
The doctor reiterated that the current swelling is likely due to the presence of the foreign body.
I would like to know if it is really okay not to remove it.
Also, why was there no issue during the recovery period, and why did the swelling occur just as the wound was almost healed? Is it truly only related to the foreign body? I just consulted another orthopedic doctor and expressed my concerns, especially since this morning, the swollen area was even more painful than yesterday, to the point of limiting my mobility.
The doctor suggested that the foreign body might be causing internal injury and infection due to friction and recommended an ultrasound examination.
If it is confirmed that the foreign body is the cause, surgery may be necessary.
I would like to ask if there are any other possible causes besides the foreign body.

Mr. Lin, 30~39 year old female. Ask Date: 2013/02/26

Dr. Chen Xingyuan reply Orthopedics

Dear User: The course of your condition resembles Prepatellar Bursitis, but it is important to first determine the possibility of infection.
Bursae can become inflamed or infected due to overuse or injury.
Injuries may result from direct impact or chronic irritation, such as excessive kneeling, which can occur in activities like wrestling or jobs that require kneeling.
Clinically, it is common to see swelling in the front of the kneecap 2 to 4 weeks after the injury, and aspiration with a syringe can yield fluid that is pale yellow, light red, or dark red in color.
If there is inflammation without bacterial infection, reducing activity or temporary immobilization can lead to improvement.
For initial bacterial infections, oral antibiotics may suffice, while more severe infections may require injectable antibiotics from the outset.
Swollen bursae may need repeated aspiration to relieve pressure, and if antibiotic treatment and aspiration are ineffective, surgical intervention for drainage or bursectomy may be necessary.
Wishing you health and safety! Sincerely, Dr.
Chen

Reply Date: 2013/02/26

More Info

Understanding post-accident knee swelling can be quite complex, especially when the initial injury seems to have healed but swelling and pain develop later. In your case, the timeline and symptoms suggest a few potential causes for the swelling and discomfort you're experiencing.

Causes of Knee Swelling After Injury
1. Infection: Although the dermatology assessment ruled out cellulitis (a type of skin infection), it’s still possible to have an underlying infection in the joint or surrounding tissues. This could be due to bacteria entering through the original injury site, even if it appeared to heal well.

2. Foreign Body Reaction: The presence of a foreign object, as identified by the orthopedic doctor, can lead to inflammation. The body may react to this foreign material, causing localized swelling and pain. This reaction can occur even after the initial healing phase, as the body may start to recognize the foreign body as a threat.

3. Synovitis: This is inflammation of the synovial membrane, which can occur after an injury. It can lead to excess synovial fluid production, causing swelling in the knee joint.

4. Hemarthrosis: If there was any bleeding into the joint space during the injury, it might not have been immediately apparent. Over time, this blood can cause swelling and pain as it gets reabsorbed or if it leads to irritation.

5. Tendinitis or Bursitis: The trauma from the accident could have caused inflammation in the tendons or bursae around the knee, leading to pain and swelling.

Treatment Options
1. Rest and Ice: Continuing to rest the knee and applying ice can help reduce swelling and pain. Avoid activities that exacerbate the symptoms.

2. Anti-inflammatory Medications: Since you mentioned allergies to NSAIDs, discuss alternative pain relief options with your doctor, such as acetaminophen or topical treatments.

3. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the knee, improve range of motion, and reduce swelling.

4. Monitoring the Foreign Body: If the foreign body is small and not causing significant issues, some doctors may recommend monitoring it rather than immediate removal. However, if it is causing ongoing pain or swelling, surgical intervention may be necessary.

5. Ultrasound or MRI: Further imaging studies can help assess the situation more clearly. An ultrasound can provide real-time information about the soft tissues and any fluid accumulation, while an MRI can give a detailed view of the knee structures.

When to Seek Further Medical Attention
If the swelling and pain worsen, or if you develop additional symptoms such as fever, increased redness, or warmth around the knee, it is crucial to seek immediate medical attention. These could be signs of an infection or other complications that require prompt treatment.

Conclusion
In summary, while the presence of a foreign body is a likely cause of your knee swelling, other factors such as infection, synovitis, or tendinitis could also contribute. It’s essential to follow up with your orthopedic specialist, especially if your symptoms persist or worsen. They may recommend further imaging or a referral to a specialist if necessary. Always prioritize open communication with your healthcare providers to ensure you receive the most appropriate care for your situation.

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