Knee Injuries: When to Seek Further Evaluation and Treatment

Knee contusion issues?

Hello Doctor,
I would like to consult you regarding my left knee.
On December 31, while working abroad, I was bumped into and fell on the ground, resulting in an injury.
The bruise has not yet faded.
I have visited an orthopedic specialist who confirmed that there are no issues with the bones.
The doctor mentioned that since the injury was not caused by a significant external force but rather a simple fall, the likelihood of a meniscus or cruciate ligament injury is quite low, and therefore, further examinations were not conducted.
It has been nearly three weeks since the incident.
I have performed some tests in bed and can stand straight and bend my knee beyond 90 degrees without issues.
However, when walking normally, I experience a sharp pain in the inner thigh after taking about 3 to 4 steps, which feels similar to cramping.
Additionally, if I stand for a long time, the bruised area also experiences a stabbing pain.
In the morning, upon waking, I feel a stabbing pain in the deeper bruised area on the inner and lower part of the patella, but it subsides shortly after.
Given this situation, do you think I need to return to the hospital to monitor the condition of the meniscus for any potential tears? Or could it simply be tendonitis or a ligament injury? What would be the appropriate course of treatment?
Thank you for your response, and I look forward to hearing from you.

Niming, 20~29 year old female. Ask Date: 2016/01/25

Dr. Chen Yongxue reply Orthopedics

Hello, as your orthopedic surgeon mentioned, the likelihood of injuring the meniscus or cruciate ligaments from a fall is indeed very low.
Based on your description, your symptoms are very similar to a medial collateral ligament strain.
In the vast majority of cases, this will heal on its own.
However, since the knee is used frequently, it may not get adequate rest.
I recommend wearing a knee brace, resting more, and applying heat, which should be helpful.
Thank you.

Reply Date: 2016/01/25

More Info

When it comes to knee injuries, understanding when to seek further evaluation and treatment is crucial for proper recovery. Based on your description, it appears that you experienced a fall that resulted in bruising and pain in your left knee. While initial evaluations have indicated that there are no significant bone injuries, the persistent symptoms you are experiencing warrant further attention.

Understanding Your Symptoms
1. Bruising and Pain: The presence of bruising suggests that there was some degree of soft tissue injury, which could involve muscles, tendons, ligaments, or the joint capsule itself. The pain you describe, particularly the sharp sensation when standing for long periods or walking, could indicate irritation or inflammation in the surrounding structures.

2. Range of Motion: The fact that you can achieve full extension and flexion beyond 90 degrees is a positive sign, as it suggests that major structural injuries, such as complete tears of the ligaments or significant meniscal tears, are less likely. However, the pain during specific movements indicates that there may still be underlying issues that need to be addressed.

3. Location of Pain: The pain you experience on the inner side of the knee, particularly around the patella (kneecap), could be related to several conditions, including patellar tendinopathy, medial collateral ligament (MCL) strain, or even early signs of osteoarthritis if there is any underlying degeneration.

When to Seek Further Evaluation
Given that you have been experiencing these symptoms for nearly three weeks without significant improvement, it would be prudent to seek further evaluation. Here are some specific indicators that suggest you should return to a healthcare provider:
- Persistent Pain: If the pain continues to worsen or does not improve with rest and conservative measures, it is essential to have a thorough evaluation.

- Swelling: If you notice increased swelling or warmth around the knee, this could indicate inflammation or a more serious injury.

- Instability: If you feel that your knee is unstable or gives way during activities, this could suggest ligamentous injury.

- Difficulty with Daily Activities: If your symptoms are interfering with your ability to perform daily tasks or engage in physical activities, further assessment is warranted.

Potential Diagnostic Approaches
1. Physical Examination: A detailed physical examination by an orthopedic specialist can help assess the stability of the knee, the integrity of the ligaments, and the presence of any meniscal tears.

2. Imaging Studies: While initial X-rays may not have shown any fractures, an MRI could provide a clearer picture of the soft tissues, including the menisci and ligaments. This is particularly useful if there is suspicion of a meniscal tear or ligament injury.

3. Functional Testing: Sometimes, functional tests can help determine the extent of the injury and guide treatment decisions.

Treatment Options
If further evaluation confirms a soft tissue injury, treatment may include:
- Rest and Ice: Continuing to rest the knee and applying ice can help reduce inflammation and pain.

- Physical Therapy: A structured rehabilitation program focusing on strengthening the muscles around the knee and improving flexibility can be beneficial.

- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation, but since you mentioned allergies to NSAIDs, alternatives such as acetaminophen or topical analgesics may be considered.

- Activity Modification: Avoiding activities that exacerbate your symptoms, such as prolonged standing or walking, can help facilitate recovery.

Conclusion
In summary, while your initial assessment did not reveal significant injuries, the ongoing symptoms you are experiencing suggest that further evaluation is necessary. It is essential to consult with a healthcare provider who can perform a comprehensive assessment and determine the best course of action for your recovery. Early intervention can help prevent long-term complications and ensure a return to your normal activities.

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