Recurring Knee Swelling: Causes and Solutions

Knee edema keeps recurring?

Hello Doctor: I previously fell and injured my left foot, but I'm not sure if this is the reason for the persistent swelling and inflammation in my knee.
The first time it swelled, it was so severe that I couldn't walk or bend it at all.
I went to Cathay General Hospital, where the doctor used a syringe to aspirate the fluid from my knee, extracting two full syringes.
The fluid was sent for testing, and when the results came back, the doctor said there were no issues with my immune system; it was just inflammation.
The swelling subsided, but after a month, it suddenly swelled up again, just like the first time, making it impossible for me to walk or bend it.
The doctor at Cathay said it was just inflammation, but it has recurred many times.
I also visited a well-known clinic in Neihu, where I was prescribed medication that helped reduce the swelling, but the doctor mentioned that my lack of exercise was causing the swelling.
I am a nursing student in a five-year program, and my coursework keeps me quite busy, so I rarely have time to exercise.
However, I do ride a bicycle for 10 minutes after work.
I believe the cause of my knee swelling is not related to excessive or insufficient exercise.
This issue with my knee swelling greatly affects me; I am even hesitant to run or engage in activities that strain my knee, and I tend to put more effort into my right leg.
However, the problem with my knee swelling continues to occur.
Could you please tell me what might be wrong with my knee?

Hua Hsuan, 10~19 year old female. Ask Date: 2015/12/24

Dr. Xiao Yongxun reply Internal Medicine

1.
Knee pain is a common site for sports injuries, degenerative arthritis, inflammatory arthritis, and infectious arthritis.
From a clinical anatomical perspective, the joint structures to consider are the medial tibiofemoral, lateral tibiofemoral, and patellofemoral compartments, which share a common synovial joint cavity.
Additionally, the ligaments, tendons, bursae, and the bones and cartilage that make up the joint connect these structures.
The occurrence of pain indicates damage or inflammation in these adjacent tissues.
2.
Common diagnoses include conditions causing medial knee pain, anterior knee pain, lateral knee pain, posterior knee pain, knee joint infections, osteoarthritis, osteochondritis dissecans, and referred pain syndrome, among others.
3.
You have a history of injury to your left knee, followed by recurrent effusion and edema, with joint fluid analysis ruling out autoimmune arthritis.
In adolescent patients, more common conditions include medial meniscal tears, osteochondritis dissecans, patellar subluxation, and Baker's cyst.
Of course, other conditions may also be possible; further examinations are necessary for differential diagnosis.
4.
The above information is for reference only; it is advisable to discuss this with your primary care physician or seek evaluation from an orthopedic specialist at a medical center.

Reply Date: 2015/12/24

More Info

Recurring knee swelling can be a frustrating and debilitating issue, especially when it affects your daily activities and overall quality of life. Based on your description, it seems that you have experienced significant swelling and inflammation in your left knee following a previous injury. The fact that you have had multiple episodes of swelling, requiring aspiration of fluid, suggests an underlying issue that may need further investigation.

Possible Causes of Knee Swelling
1. Post-Traumatic Arthritis: After an injury, such as a fall, the knee joint may develop post-traumatic arthritis. This condition can lead to inflammation and swelling due to the wear and tear of cartilage over time.

2. Meniscus Injury: A tear in the meniscus, which is the cartilage that cushions the knee joint, can cause swelling and pain. This type of injury often results in fluid accumulation in the joint.

3. Ligament Injuries: Injuries to the ligaments, such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL), can also lead to swelling. These injuries can cause instability in the knee, leading to further inflammation.

4. Bursitis: Inflammation of the bursae, small fluid-filled sacs that cushion the knee joint, can result in swelling. This condition is often caused by repetitive motion or prolonged pressure on the knee.

5. Synovitis: Inflammation of the synovial membrane, which lines the joint, can cause excess synovial fluid production, leading to swelling. This can be triggered by various factors, including injury, infection, or autoimmune conditions.

6. Gout or Pseudogout: These conditions are caused by the accumulation of crystals in the joint, leading to sudden and severe swelling and pain.

Recommended Solutions
1. Medical Evaluation: Since you have already undergone aspiration and tests that ruled out infection and autoimmune issues, it may be beneficial to seek further evaluation. An MRI can help visualize soft tissue injuries, such as meniscus tears or ligament damage.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve stability, and reduce the likelihood of swelling. A physical therapist can design a program tailored to your needs, focusing on low-impact exercises that do not exacerbate your symptoms.

3. Activity Modification: While it is important to remain active, certain activities may need to be modified or avoided to prevent further irritation of the knee. Low-impact exercises such as swimming or cycling can be beneficial without putting excessive strain on the knee.

4. Weight Management: If applicable, maintaining a healthy weight can reduce stress on the knee joint, potentially alleviating some of the swelling and discomfort.

5. Ice and Compression: Applying ice to the knee after activities can help reduce swelling. Compression wraps or sleeves may also provide support and minimize swelling.

6. Medication: If you are allergic to NSAIDs, discuss alternative pain relief options with your healthcare provider. Acetaminophen or topical analgesics may be recommended.

7. Follow-Up Care: Regular follow-ups with your healthcare provider are essential to monitor your condition and adjust your treatment plan as necessary. If swelling persists or worsens, further diagnostic tests may be warranted.

Conclusion
Your knee swelling could be attributed to a variety of factors stemming from your previous injury. It is crucial to address this issue comprehensively, considering both medical evaluation and lifestyle modifications. Engaging in physical therapy and maintaining an active lifestyle, while being mindful of your knee's limitations, can significantly improve your symptoms and overall knee health. If you continue to experience swelling and pain, do not hesitate to seek further medical advice to explore additional treatment options.

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