What causes knee pain and swelling. How to identify different types of knee injuries. When should you see a doctor for knee problems. What are the treatment options for knee pain and swelling. How can you prevent knee injuries and manage chronic knee conditions.

Common Causes of Knee Pain and Swelling

Knee pain and swelling can arise from various causes, ranging from acute injuries to chronic conditions. Understanding these causes is crucial for proper diagnosis and treatment.

Injuries and Trauma

Knee injuries often occur during athletic activities or accidents. Some common traumatic causes include:

• Ligament tears (e.g., ACL, MCL)
• Meniscus tears
• Fractures
• Dislocations

Inflammatory Conditions

Inflammation can lead to knee pain and swelling. Conditions that may cause this include:

• Rheumatoid arthritis
• Gout
• Bursitis
• Tendinitis

Degenerative Conditions

As we age, wear and tear on the knee joint can result in pain and swelling. The most common degenerative condition affecting the knee is osteoarthritis.

Diagnosing Knee Pain and Swelling

Proper diagnosis is essential for effective treatment of knee problems. Healthcare providers use various methods to determine the cause of knee pain and swelling.

Physical Examination

During a physical exam, your doctor will assess:

• Range of motion
• Stability of the joint
• Presence of swelling or effusion
• Tenderness or pain points

Imaging Studies

Imaging tests can provide detailed information about the structures within and around the knee. Common imaging studies include:

• X-rays
• MRI scans
• CT scans
• Ultrasound

Laboratory Tests

In some cases, blood tests or joint fluid analysis may be necessary to diagnose certain conditions, such as gout or rheumatoid arthritis.

Treatment Options for Knee Pain and Swelling

Treatment for knee pain and swelling depends on the underlying cause and severity of the condition. Options range from conservative measures to surgical interventions.

Conservative Treatments

Many knee problems can be managed with non-invasive approaches, including:

• Rest and activity modification
• Ice or heat therapy
• Compression and elevation
• Physical therapy exercises
• Over-the-counter pain medications

Medications

Prescription medications may be necessary for more severe cases. These might include:

• Stronger pain relievers
• Anti-inflammatory drugs
• Disease-modifying antirheumatic drugs (DMARDs) for conditions like rheumatoid arthritis

Injections

Injections into the knee joint can provide relief for certain conditions:

• Corticosteroid injections for inflammation
• Hyaluronic acid injections for osteoarthritis
• Platelet-rich plasma (PRP) injections for various knee injuries

Surgical Interventions

When conservative treatments fail, surgery may be recommended. Surgical options include:

• Arthroscopy for meniscus tears or cartilage damage
• Ligament reconstruction for ACL or other ligament tears
• Partial or total knee replacement for severe osteoarthritis

Preventing Knee Injuries and Managing Chronic Conditions

Taking proactive steps can help prevent knee injuries and manage chronic knee conditions effectively.

Injury Prevention

To reduce the risk of knee injuries:

• Maintain a healthy weight to reduce stress on the knees
• Strengthen the muscles supporting the knee joint
• Use proper technique during sports and exercise
• Wear appropriate footwear and protective gear

Managing Chronic Conditions

For those with chronic knee conditions:

• Follow your healthcare provider’s treatment plan
• Engage in low-impact exercises to maintain joint health
• Use assistive devices when necessary
• Consider lifestyle modifications to reduce stress on the knees

When to Seek Medical Attention for Knee Problems

While some knee issues may resolve on their own, certain symptoms warrant prompt medical attention. Seek medical care if you experience:

• Severe pain or swelling
• Inability to bear weight on the affected leg
• Visible deformity of the knee
• Fever accompanying knee pain
• Signs of infection, such as redness and warmth around the knee

Understanding Different Types of Knee Pain

The location and nature of knee pain can provide clues about its underlying cause. Different types of knee pain include:

Anterior Knee Pain

Pain in the front of the knee is often associated with:

• Patellofemoral pain syndrome
• Patellar tendinitis
• Quadriceps tendinitis

Posterior Knee Pain

Pain behind the knee may be caused by:

• Baker’s cyst
• Hamstring tendinitis
• Posterior cruciate ligament injuries

Medial and Lateral Knee Pain

Pain on the sides of the knee could indicate:

• Meniscus tears
• Collateral ligament injuries
• Iliotibial band syndrome (lateral knee pain)

Specialized Treatments for Specific Knee Conditions

Certain knee conditions require specialized treatments tailored to their unique characteristics.

Osteoarthritis Management

For individuals with knee osteoarthritis:

• Weight management programs
• Bracing or orthotic devices
• Viscosupplementation injections
• Joint preservation surgeries in early stages

Rheumatoid Arthritis Care

Patients with rheumatoid arthritis affecting the knees may benefit from:

• Disease-modifying antirheumatic drugs (DMARDs)
• Biologic therapies
• Regular monitoring and adjustments to treatment plans

Sports Injury Rehabilitation

Athletes recovering from knee injuries often undergo:

• Sport-specific rehabilitation programs
• Functional training to improve performance and prevent re-injury
• Gradual return-to-play protocols

Understanding the complexities of knee pain and swelling is crucial for effective management and treatment. By recognizing the various causes, diagnostic methods, and treatment options available, individuals can work closely with healthcare providers to address their knee issues and maintain optimal joint health. Whether dealing with an acute injury or a chronic condition, a comprehensive approach that combines medical interventions with lifestyle modifications can lead to improved outcomes and enhanced quality of life. Remember, early intervention and proper care are key to preserving knee function and preventing long-term complications.

Healing A Swollen Knee and Leg

I would strongly recommend you visit your physician so that a determination can be made as to whether the fluid is in the bursa — which is less serious — or in the joint, which would be of greater concern. Once the diagnosis is made, appropriate treatment can be initiated. Warning signs of fluid in your joint would include a decrease in the knee’s range of motion, as well as fever or increased pain.

Q2. Sometimes my knee is swollen and painful. What could be the cause of my sore knee?

There are lots of reasons you may have sore, achy, and stiff knees. If your knee is swollen and painful, or if it ever gets locked and immobile, you need to see a doctor who can make a diagnosis.

The doctor will look at where your knee hurts — whether the pain is in the back, behind the knee or in the front by your knee cap where you might experience clicking — and when it hurts — whether it’s only at night or constant, whether it hurts only when you exercise or move it in some way, or just when the doctor moves it. Constant pain, particularly pain with passive movement of your joint, suggests trouble with the joint itself whereas if the pain only occurs when you actively move your knee it could be problems with your tendons or ligaments or bursa.

Athletic activities commonly cause ligament injuries. Athletes are known to tear their anterior cruciate ligament (the ACL). Women are at particularly increased risk for this injury and the reason for this susceptibility is not entirely understood. Cartilage (meniscal) injuries or tears also are common in both young and older people and are a common cause of knee pain.

When the large tendon over the front of the knee, the patellar tendon, is inflamed it’s called patellar tendonitis. A sign that you have tendinitis is if the pain in the front of your knee gets worse when you climb stairs and after running up and down inclines.

When you have swelling in the back of the joint, it could be a baker’s cyst or a meniscus tear. If you have a meniscus tear, you usually feel the pain on the inside or the outside of your knee joint.

Related conditions can cause many aches and pains felt in the knees. As people get older, they are at increased risk for developing various conditions, such as certain types of arthritis, and arthritis can cause knee pain. Types of arthritis include rheumatoid arthritis (RA), osteoarthritis, and gouty arthropathy. People who are older and heavier and who complain of tenderness to the touch and whose knees look big and boney may have osteoarthritis. People with osteoarthritis tend to have minimal stiffness in the morning — it will last less than 30 minutes — and more so as the day progresses and at night. Folks who have inflammatory arthritis or lupus will have discomfort including stiffness that can last for hours. With rheumatoid arthritis, your knee will usually feel warm to the touch while with osteoarthritis it doesn’t. With osteoarthritis, you may feel a boney enlargement as if there’s bone there and it may be tender but you won’t typically see redness or feel heat. RA can lead to disability.

Swelling around the knee cap suggests fluid on the knee. The question is whether the fluid is inside the joint or not. When you find swelling around the knee cap, it’s usually outside the joint and that happens when you have a condition known as pre-patellar bursitis. The patellar is the large tendon over the front of the knee and there is a bursa associated with it that prevents friction when the tendon moves during extension of the lower leg.

Other disorders that can cause knee pain are bone tumors, which are not very common, and Osgood-Schlatter disease, which is seen in adolescents and is caused by the irritation of the growth plate that is just to the front of the knee joint.

Q3. What could cause knee pain and a swollen leg, swollen ankles, a swollen calf, or swollen joints?

If you see swelling around your knee, besides arthritis and bursitis, it could be a baker’s cyst inside the knee joint that has ruptured. That can give you a lot of pain and swelling in your knee. The pain can go all the way down to your calf or ankle and there can be swelling down to the ankle as well. A blood clot in the veins of the lower extremity also can cause pain — usually in the back of the leg, and swelling. This condition requires prompt medical attention.

If you have bleeding into your knee from an injury, it can cause swelling. People who are on blood thinners may experience bleeding from a slight bang or bruise to the knee.

Some causes of knee pain will go away on their own with rest and self-care. If you are overweight it can put extra strain on your knee and put you at greater risk for knee problems. It is important if you have persistent pain to see a doctor who can make the proper diagnosis and treat your swollen knee pain.

Q4. My brother-in-law has a swollen knee, and it looks like there is fluid inside. Is there anything we can do to treat this at home, and does rubbing it make it worse?

A lot more information is needed in order to give you some suggestions:

• How old is the patient?
• Is there pain, heat, or fever in the knee?
• Is there any redness, rash, or pimples on and around the knee?
• How long has the swelling been there?
• Was there any trauma? Did he hurt his knee and how?
• Are there any other swollen and/or painful joints, and which ones?
• What does your brother-in-law do by way of occupation?
• How is his general health?
• Does he have diabetes?
• Has he ever been diagnosed with tuberculosis, or been in close contact with a tuberculosis patient?

Removal and examination of the joint fluid can help greatly in the diagnosis.

The worst possible scenario would be infectious arthritis, due to bacteria that invade the joint and cause the formation of pus and, if left untreated, severe damage to the joint structures. At times even septicemia can result, where the infectious bacteria circulate in the bloodstream and may infect the heart valves, which could even cause death. Infectious arthritis usually causes severe pain, redness, and inability to move the joint because of severe pain.

There is one specific type of joint infection, however, that may not cause the acute, severe symptoms that I described above. Tuberculosis of a joint causes milder symptoms but can also be destructive and may be accompanied by tuberculosis of other systems of the body, especially the lungs. All joint infections tend to be more frequent and more severe in persons with diabetes, especially if it is poorly controlled — meaning blood sugar levels are too high most of the time.

Trauma can also produce joint swelling. If acute trauma is the cause, there may be blood in the joint, and that should be removed by a doctor through a needle and syringe. If blood is allowed to remain in the joint, a chronic arthritis-like osteoarthritis (OA) may result.

Hematoma

A hematoma is a collection of blood trapped outside of a blood vessel. It is what we think of as a bruise or a contusion. It is usually seen under the skin as a black and blue spot on your arm or leg, or a bump on your head after an injury. It can be almost anywhere on or in your body. It can also occur in an internal organ where it can be more serious.

A hematoma is caused by an injury with damage to small blood vessels. This causes blood to leak into the tissues. Blood forms a pocket under the skin that swells and looks like a purplish patch. Hematomas sometimes form under the skin from bleeding during childbirth and can be particularly serious. Another serious form of hematoma forms after a fall on the head, called a subdural hematoma.

Gradually the blood in the hematoma is absorbed back into the body. The swelling and pain of the hematoma will go away. This takes from 1 to 4 weeks, depending on the size of the hematoma. The skin over the hematoma may turn bluish then brown and yellow as the blood is dissolved and absorbed. Usually, this only takes a couple of weeks but can last months.

Home care

• Limit motion of the joints near the hematoma. If the hematoma is large and painful, avoid sports and other vigorous physical activity until the swelling and pain goes away.

• Apply an ice pack (ice cubes in a plastic bag, or a frozen bag of peas, wrapped in a thin towel) over the injured area for 20 minutes every 1 to 2 hours the first day. Continue with ice packs 3 to 4 times a day for the next 2 days. Continue the use of ice packs for relief of pain and swelling as needed.

• If you need anything for pain, you can take acetaminophen, unless you were given a different pain medicine to use. Talk with your healthcare provider before using this medicine if you have chronic liver or kidney disease. Also talk with your healthcare provider if you have had a stomach ulcer or digestive tract bleeding, or are taking blood-thinner medicines.

Follow-up care

Follow up with your healthcare provider, or as advised. If X-rays or a CT scan were done, you will be notified if there is a change in the reading, especially if it affects treatment.

When to seek medical advice

Call your healthcare provider right away if any of the following occur:

• Redness around the hematoma

• Increase in pain or warmth in the hematoma

• Increase in size of the hematoma

• Fever of 100.4ºF (38ºC) or higher, or as directed by your healthcare provider

• If the hematoma is on the arm or leg, watch for:

Bruising (Hematoma) – Managing Side Effects

What Is Bruising?

Bleeding into the skin from damaged blood vessels causes bruising.
This is also called a bruise. Bruises cause a “black and blue mark” when they first
occur. After a few days to weeks, depending on how severe the bruising is, the damaged
area will turn more yellowish in color. This is as the body reabsorbs the blood
under the skin.

Everyone gets bruises. However, if you have low platelet or other bleeding problems, you may develop blood disorder bruising or hematomas more easily and they may be more severe.

What Is A Hematoma?

A hematoma is a larger collection of blood, usually caused by surgery,
injury, or a greater trauma. Hematomas will usually reabsorb into the body, like
a bruise. However, depending on the size, location and cause of the hematoma, the
area may need to be drained surgically, or take a longer period of time to resolve.

You May Get A Blood Disorder, Bruising or Hematoma If:

• You have had trauma or injury to a certain area from a sports accident or from falling
  down.
• You may have been struck by a blunt object.
• You may have hit your leg or arm on a chair or a table, which caused bleeding under
  the skin.
• People who bruise easily may have blood clotting problems and have a tendency to
  bleed easily as well. If you notice that you are bruising or bleeding easily, notify
  your health care provider of potential bleeding problems.

Symptoms:

• You may have tiny red dots on your skin, called petechiae (pe- TEEK- ee- ay). These
  are commonly found on your lower legs. This is a sign of low blood platelets.
• You may have frequent nosebleeds
  (epistaxis).
• You may bleed easily, which may be a sign of a blood disorder, or low blood platelets.
• You may be overly tired, or very weak (fatigue), if you have anemia due to your
  bleeding problems, or another underlying disorder. It may be hard for
  you to do any kind of your normal activities.
• For many individuals, frequent, unexplained bruising or nosebleeds are the first sign of a bleeding disorder.

Things You Can Do About Bruising or Hematoma:

• If you develop bruising: apply ice to the area for about 20 to 30 minutes. This
  will help to constrict, or shrink the blood vessels that may be damaged and bleeding.
• After the first 48 hours, you may use heated compresses (which may be a heating
  pad, or a very warm wash cloth), 2 or 3 times a day, to help reabsorb the blood.
• If you have pain at the site, you may take Acetaminophen (Tylenol^®)
  up to 4000 mg per day (two extra-strength tablets every 6 hours). If you have a
  bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID) drugs,
  as well as aspirin, because these drugs may interfere with blood platelets, or prolong
  your bleeding.
• If you notice that you are bruising or bleeding easily, notify your health care
  provider of potential bleeding
  problems.
• Make sure you tell your doctor, as well as all health care providers, about any
  other medications you are taking (including over-the-counter, vitamins, or herbal
  remedies). Do not take aspirin or products containing aspirin unless your
  health care provider permits this.
• Remind your doctor or health care provider if you have a history of diabetes, liver,
  kidney, or heart disease.

Medications or Recommendations for Treatment of Bruising:

• Treatment of bruising consists of applying ice packs, and an analgesic
  such as Acetaminophen (Tylenol^®) for comfort. If
  you have an underlying bleeding disorder causing blood disorder bruising, or problems
  with your blood clotting factors, your healthcare provider may treat your disorder
  with additional medications.
• Analgesic (pain medication)- If you have pain at the site where you were
  bleeding, you may take acetaminophen (Tylenol^®)
  up to 4000 mg per day (two extra-strength tablets every 6 hours). It is important
  not to exceed the recommended daily dose of Tylenol^®,
  as it may cause liver damage. As with all medications, you should discuss this with
  your healthcare provider before taking any medications.
• If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory
  (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood
  platelets, accentuate bleeding
  problems.

When to Contact Your Doctor or Health Care Provider:

• Bleeding that does not stop after a few minutes, or new, unexplained bruising.

Other Common Bleeding Problems:


Bruising (Hematoma) | Injury
| Nosebleeds (Epistaxis)
| Rectal Bleeding
| Vaginal Bleeding

Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website about bleeding problems and other medical conditions is meant to
be helpful and educational, but is not a substitute for medical advice.

A Clinical Problem of Adhesion to the Surrounding Tissues

Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion.

1. Introduction

Hematomas are usually reabsorbed, slowly decreasing in size over time. In rare cases, hematomas slowly increase in size and are then referred to as chronic expanding hematomas [1, 2]. The chronic expanding hematoma is characterized by a mixture of old and new blood, accompanied by necrotic degradation and liquefaction and a fibrous pseudocapsule [2]. An association with trauma has been reported [2]. Chronic expanding hematomas occur in various locations [1, 2]. In this report, we analyze patients with chronic expanding hematomas of the extremities.

2. Case Series

The clinical data are summarized in Table 1. In 7 patients with chronic expanding hematomas in the extremities, 6 were male and 1 was female. The mean age at the time of resection was 65.6 years, ranging from 54 to 79 years. The location of the chronic expanding hematoma was in the lower extremity in all patients: the thigh was involved in 4 patients and the knee region in 3 patients. Six lesions occurred in the subcutaneous tissue (Figure 1), while 1 occurred in the deeper tissue of the thigh (Figure 2). Laboratory examination, including C-reactive protein levels, revealed no remarkable findings. A history of trauma was present in 2 of the 7 patients, and only a single patient was taking anticoagulation medication.

Case Age (yr)/gender Location Shallow/deep Size Duration Trauma Anticoagulation Cystic findings Adherent tissue #1 67/M Knee Shallow 7 cm 10 years − + − Fascia #2 69/F Thigh Deep 25 cm 10 years − − + Nerve, fascia #3 61/M Thigh Shallow 9 cm 3 years + − + Skin, fascia #4 68/M Thigh Shallow 17 cm 23 years + − − Skin, fascia #5 54/M Thigh Shallow 20 cm 15 years + − + Fascia #6 61/M Knee Shallow 10 cm 30 years − − + Skin, fascia #7 79/M Knee Shallow 7 cm 9 years − − + Fascia

M: male; F: female.

Patients were evaluated using either magnetic resonance imaging (MRI) or computed tomography (CT). The lesion was well defined in all patients. The diameter of the hematoma ranged from 7 to 25 cm, with a mean of 13.5 cm. In patients who underwent MRI, the lesion had a heterogeneous low to intermediate signal on T1-weighted imaging; the intermediate signal intensity was higher than that of skeletal muscle. T2-weighted imaging demonstrated low to high signal intensity. The MRI findings were consistent with those of typical hematomas. A pseudocapsule was characteristic of all chronic expanding hematomas in this series; the pseudocapsule was characterized by low signal intensity on T1- and T2-weighted images (Figures 1 and 2). In patients who underwent CT, the CT value of the lesion was lower than that seen in muscle, while the CT values for the pseudocapsule and any septum were the same as muscle (Figure 3). Cystic features were seen in 5 of the 7 patients.

All patients underwent lesion resection that included the pseudocapsule. The diagnosis of hematoma was pathologically confirmed in the resected material, and the pathologic findings were consistent in all patients. The resected specimens showed organizing hematomas with peripheral neovascularization and papillary endothelial hyperplasia. The cyst wall was thickened with fibrous connective tissue with inflamed granulation tissue. It also contained foreign body-type multinucleated giant cells and aggregates of histiocytes. In the 6 subcutaneous lesions, the adjacent fascia was adherent to the pseudocapsule, and it was necessary to resect this fascia. No patients experienced complications from this fascia resection. In 3 of these 6 patients, the overlying skin was also adherent and required partial resection in order to avoid skin necrosis. In the patient with the deep-seated lesion, the common peroneal nerve was completely adhered to the pseudocapsule. The nerve was not able to be identified and thus was inadvertently resected. This patient experienced the drop-foot phenomenon from absence of the common peroneal nerve after surgery. There was no improvement after 1 year of follow-up. The duration of follow-up ranged from 12 to 77 months, with a mean of 36.8 months. No patients experienced recurrence during the follow-up period.

3. Discussion

The current case series describing chronic expanding hematoma in the extremities is male-dominant, with a mean age at time of resection of 65.6 years. The duration of the hematoma’s presence ranged from 3 to 30 years, with a median duration of 10 years. All chronic expanding hematomas occurred in the lower extremities, predominantly in the subcutaneous tissue. These findings all seem to be characteristic of chronic expanding hematoma.

Chronic expanding hematoma is a mixture of old and new blood with time-related changes present. The histological features are reportedly a mixture of blood breakdown products, granulation tissue with capillary ingrowth, and inflammatory tissue [3]. Corresponding to the various histological findings, MRI shows heterogeneous low to intermediate signal intensity. A pseudocapsule with low signal intensity on T1- and T2-weighted imaging is characteristic of chronic expanding hematomas. Histologically, the pseudocapsule is composed of fibrous tissue with hemosiderin deposits and iron-laden macrophages [1, 4]. In the current series, the preoperative imaging modality was CT in 2 patients; these patients were seen early in the study period, when the superiority of MRI was not recognized. Although a characteristic pseudocapsule is seen on CT, the use of MRI is preferred for an accurate imaging diagnosis of chronic expanding hematoma.

Although the MRI diagnosis of chronic expanding hematoma is relatively easy, the findings are similar to those of hemorrhagic soft-tissue sarcomas [2, 5]. Careful examination of every MRI section to detect a nonhemorrhagic portion of a possible neoplasm is necessary. Not only imaging results but also clinical information (e. g., speed of growth) is important in the diagnosis of chronic expanding hematoma. The continuous, long-term endothelial stimulation in a chronic hematoma could contribute to neoplastic transformation. A previous report noted that angiosarcoma can arise from chronic expanding hematomas at the periphery of the pseudocapsule. Therefore, a thick pseudocapsule wall could be a finding either of malignant transformation or of sudden or uncontrolled hematoma enlargement [6].

A possible association with trauma has been reported [2], but only 3 of 7 patients in our series had a history of trauma. Interestingly, anticoagulation medication was taken by only 1 patient, even though anticoagulation medication is a risk factor for bleeding. Formation of a fibrous pseudocapsule seems to be necessary for the creation of a chronic expanding hematoma; therefore, a normal coagulation status might be favorable to its formation.

The ideal treatment for chronic expanding hematoma is complete removal, including the pseudocapsule [7]. In a previous report, follow-up revealed that 2 of 9 chronic expanding hematomas recurred after marginal excision [8]; however, none of our 7 patients experienced recurrence. However, complete removal is reportedly difficult in patients with thoracic lesions because of abundant new vascularization beneath the pseudocapsule and the presence of fibrous adhesions to the chest wall [9]. In our patients with subcutaneous hematomas, the adjacent fascia was adherent in all, and skin resection was required in half. However, the removal of the fascia, with or without the skin, seemed not to affect subsequent functional ability. On the other hand, in the patient with a deep thigh lesion, the adjacent nerve was adherent to the pseudocapsule and dissection of the nerve was not possible. One report details resection of a chronic expanding hematoma, leaving the pseudocapsule in situ, as adequate treatment for a thoracic lesion [10]. In our patient with deep thigh involvement, leaving the pseudocapsule in situ could have avoided the subsequent nervous complications. However, because of the massive cystic features present in this patient’s lesion, removal of the inside of the lesion, without removing the pseudocapsule, may not have been sufficient for treatment.

This study has a few limitations. First, the study was based on a small number of patients (), and only 1 case with a deep-seated hematoma was included. However, in all 7 cases, the adherent nature of the pseudocapsule was a consistent finding. Second, the follow-up periods were relatively short; the mean duration of follow-up was 36.8 months, and the longest follow-up period was 77 months. None of the patients recurred during the follow-up period. A longer follow-up period is needed for determining the recurrence rate.

In conclusion, chronic expanding hematoma of the extremities predominantly occurs in the subcutaneous tissues of the lower extremities. The clinical problem of adhesions to the surrounding tissue should be recognized during resection, especially in patients with deep-seated lesions.

Conflicts of Interest

There are no conflicts of interest.

Authors’ Contributions

Akio Sakamoto drafted the manuscript. Akio Sakamoto performed the treatments. All authors participated in the design of the study. Takeshi Okamoto and Shuichi Matsuda conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Changes in coagulation functions and hemorheological parameters may predict hematoma formation after total knee arthroplasty | Journal of Orthopaedic Surgery and Research

Patient information

No significant differences were found in terms of sex, age, body mass index (BMI), and presence of diabetes or hypertension between patients in the hematoma group (n = 32) and those in the non-hematoma group (n = 114; Table 1). However, a significantly higher percentage of patients in the hematoma group had joint deformity (100 vs. 66.7 %, P < 0. 001), and accordingly, the operation time was significantly longer for these patients (83.9 ± 3.1 vs. 70.5 ± 4.2 min, P < 0.001) than for patients in the non-hematoma group.

Table 1 Comparison of baseline data between patients in the hematoma group and the non-hematoma group

Comparison of coagulation functions

No significant differences were observed in APTT, PT, TT, and FIB between patients in the hematoma and non-hematoma groups preoperatively (P > 0.05). In comparison to preoperative values, APTT was significantly increased in the hematoma group on postoperative days 1, 3, and 7 and in the non-hematoma group on postoperative days 3 and 7 (P < 0.05, Fig. 1). In addition, the hematoma group showed a significantly higher APTT than the non-hematoma group on postoperative days 1, 3, and 7 (P < 0.05). Also, in comparison to preoperative values, PT was significantly increased in the hematoma group on postoperative days 1, 3, 7, and 14 (P < 0. 05) but not in the non-hematoma group. In addition, FIB was significantly increased in the non-hematoma group on postoperative days 3, 7, and 14 but only on postoperative day 7 in the hematoma group (P < 0.05).

Fig. 1

Changes in APTT, PT, TT, and FIB in the hematoma group and the non-hematoma group. Triangle P < 0.05 vs. preoperative values, asterisk P < 0.05 vs. the other group at the same time point

Comparison of hemorheological parameters

The whole blood high shear rates, whole blood low shear rates, plasma viscosities, and hematocrit levels did not differ significantly between the hematoma and non-hematoma groups at baseline or from postoperative days 1–14 (P > 0.05). However, the hematocrit level was significantly decreased on postoperative days 1, 3, and 7 in the hematoma group compared with the baseline value (P < 0.05, Fig. 2).

Fig. 2

Changes in whole blood high shear rate, whole blood low shear rate, plasma viscosity, and hematocrit in the hematoma group and the non-hematoma group. Triangle P < 0.05 vs. preoperative values, asterisk P < 0.05 vs. the other group at the same time point

Bruise: First aid – Mayo Clinic

A bruise forms when a blow breaks blood vessels near your skin’s surface, allowing a small amount of blood to leak into the tissues under your skin. The trapped blood may cause a bruise that at first looks like a black-and-blue mark and then changes color as it heals.

You can enhance bruise healing with a few simple techniques. Remember RICE, for rest, ice, compress and elevate:

• Rest the bruised area, if possible.
• Ice the bruise with an ice pack wrapped in a towel. Leave it in place for 10 to 20 minutes. Repeat several times a day for a day or two as needed.
• Compress the bruised area if it is swelling, using an elastic bandage. Don’t make it too tight.
• Elevate the injured area.

If your skin isn’t broken, you don’t need a bandage. Consider taking an over-the-counter pain reliever if needed.

Consult your doctor if you:

• Notice very painful swelling in the bruised area
• Are still experiencing pain three days after a seemingly minor injury
• Have frequent, large or painful bruises, particularly if your bruises appear on your trunk, back or face, or seem to develop for no known reasons
• Have easy bruising and a history of significant bleeding, such as during a surgical procedure
• Notice a lump (hematoma) form over the bruise
• Are experiencing abnormal bleeding elsewhere, such as from your nose or gums
• Suddenly begin bruising, but have no history of bruising
• Have a family history of easy bruising or bleeding

These signs and symptoms may indicate a more serious problem, such as a blood-clotting problem or blood-related disease.

Nov. 12, 2020

Show references

1. Muscle contusion (bruise). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00341. Accessed Sept. 14, 2017.
2. Approach to sports injuries. Merck Manual Professional Version. http://www.merckmanuals.com/professional/injuries-poisoning/sports-injury/approach-to-sports-injuries. Accessed Sept. 14, 2017.
3. Buttaravoli P, et al. Contusion (bruise). In: Minor Emergencies. 3rd ed. Philadelphia, Pa.: Mosby Elsevier; 2012. https://www.clinicalkey.com. Accessed Sept. 14, 2017.
4. Kraut EH. Easy bruising. https://www.uptodate.com/contents/search. Accessed Sept. 14, 2017.

Products and Services

1. Book: Mayo Clinic Book of Home Remedies

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The Danger of Spontaneous Hematoma – Consult QD

By Michael J. Joyce, MD, Steven Lietman, MD, and Nathan W. Mesko, MD

It happens all too frequently — an elderly patient sustains a low-energy fall from standing and hits his or her arm/leg on the ground. The patient may also happen to be on Plavix® or Coumadin® for medical comorbidities. The history matches up with the physical exam, and advanced imaging shows a superficial fluid collection in the area where the contusion injury occurred. But what happens in the same scenario when Mrs. Jones presents with an area of ecchymosis and fullness without the history of trauma? Suppose advanced imaging then shows a large fluid collection that appears consistent with blood. Do you, as the medical caretaker, chalk this up to “poor protoplasm” and assume that this person “bruises” easily and send her on her way? What is in your differential diagnosis?

Here are two case examples of patients in whom the “spontaneous hematoma” was more than met the eye.

Case 1

A 64-year-old female presented with a chronic draining distal thigh mass, painless and without a clear trauma history. She was abstinent of Coumadin or other anticoagulant. She reported a 10-year history of slow growth, with increased rapidity over the past eight months. Follow-up in local emergency rooms and with her general surgeon culminated in bandage changes and oral antibiotic treatment due to the perceived “hematoma” that was being treated. When symptoms failed to resolve and MRI was obtained, it showed heterogeneous signal characteristics within a 19-cm mass that suggested a clinical suspicion for something more than a hematoma. A referral was placed to Cleveland Clinic. Because of her troubling history of a “spontaneous” hematoma that did not match her imaging/exam, the mass was biopsied. The first four frozen section specimens revealed bland capsular tissue, but the fifth specimen revealed high-grade myxoid liposarcoma. She was taken for resection and local flap coverage, followed by 60 Gy radiation postoperatively. She is now at five years with no evidence of disease.

Case 2

A 66-year-old male presented with sudden-onset pain and fullness in his left posterior thigh. He denied history of blood thinner medications. An MRI showed a 24-cm mass located in the posterior compartment of his proximal thigh, with a thick rind of low-intensity tissue completely surrounding the mass. Initial MRI findings suggested an evolving hematoma, but clinical suspicion was high. He was admitted and underwent a needle biopsy, which showed only red blood cells and no concerns for malignancy. A subsequent open biopsy, dictated by a clinical suspicion, evacuated more than one liter of blood, and a capsular tissue review revealed a high-grade pleomorphic soft tissue sarcoma. Because of the mass location, the patient underwent a hip disarticulation with a negative margin resection and is now at seven years with no evidence of disease.

Disproving the spontaneous hematoma

Figure 1. Coronal T1 (top left) and STIR (top right) imaging show a complex, cystic mass with a high degree of heterogeneity on STIR imaging, more homogeneous in appearance on T1 (this can be typical of “hematomas”). The mass is adjacent to the medial knee joint capsule but does not violate the knee joint. Axial T1 (bottom left) and fat saturation [FS] (bottom right) imaging show a large mass that is adjacent to the medial knee tissues, surrounded by a dark rind on T1/FS sequences. This was thought to represent a “spontaneous hematoma,” but was proven to be a high-grade soft tissue sarcoma following open biopsy. It was later resected and the defect covered with a lateral gastrocnemius flap.

When clinicians find themselves in the position of evaluating for a spontaneous hematoma in the extremity without a history that matches the patient’s presentation, clinical suspicion should lead to further imaging and/or biopsy. The differential of a spontaneous hematoma must also include intramuscular aneurysm, intramuscular hemangioma, chronic expanding hematoma and soft tissue malignancy, such as sarcoma or (rarely) soft tissue carcinoma metastases. A history of bleeding tendencies also may increase the chance for a true spontaneous hematoma.

While an MRI is typically the best test to assess for soft tissue characteristics of a mass, it is not perfect in distinguishing a hematoma from a soft tissue neoplasm. As a rule of thumb, acute hematomas will show low-intensity T2 and low-to-mid-intensity T1 signal intensity characteristics, while chronic hematomas will be hyperintense to muscle signal on both T1 and T2 imaging sequences. Additionally, a definitive diagnosis can be made especially difficult when a large portion of the tumor is occupied by intratumoral hematoma.

Figure 2. Axial T1 imaging (top left, right) shows a large mass within the posterior compartment of the thigh, with heterogeneous signal characteristics. This was biopsy-proven to represent a high-grade soft tissue sarcoma after multiple needle biopsy passes were nondiagnostic. The patient ultimately underwent a hip disarticulation with a negative margin resection.

Beyond imaging, biopsy technique can also help determine an accurate diagnosis, as it has been shown in the past that needle biopsy and cytology review can be misleading. A high degree of clinical suspicion should trigger discussion whether an open biopsy should be conducted if a “negative” needle biopsy does not match the clinical picture. Confirmation with the pathology team should be made, and an abundant amount of tissue should be sent to the lab in order to make an appropriate diagnosis.

A tumor center that is happy to help

Because soft tissue sarcoma and muscle malignancies are a rare variant of cancer, high clinical suspicion must be maintained with soft tissue masses. In the setting of a blood-filled mass, it is important to ascertain whether a history of trauma can be correlated. If not, appropriate imaging and biopsy techniques should be planned. A “spontaneous hematoma” is rare, and should not be settled upon as a true diagnosis until cancer has been objectively disproven. At Cleveland Clinic, we have a multidisciplinary team specialized in diagnosing and treating suspicious masses, and we are happy to help expedite the care of your patient in a manner that gives the patient his or her best chance of a successful outcome.

References

1. Niimi R, Matsumine A, Kusuzaki K, et al. Soft-tissue sarcoma mimicking large haematoma: a report of two cases and review of the literature. J Orthop Surg Hong Kong. 2006;14(1):90-95.

2. Imaizumi S, Morita T, Ogose A, et al. Soft tissue sarcoma mimicking chronic hematoma: value of magnetic resonance imaging in differential diagnosis. J Orthop Sci Off J Jpn Orthop Assoc. 2002;7(1):33-37.

Drs. Lietman and Joyce are Co-Directors of the Musculoskeletal Tumor Center. Dr. Mesko is a member of the Department of Orthopaedic Surgery.

90,000 Feeling of instability in the knee

When walking, running, in everyday life or when playing sports, we are confident that the legs are
our reliable support. And it is especially uncomfortable to feel that
appears under load on the leg.
feeling of instability, insecurity. Sometimes it is because of the pain, sometimes because of the fact that
there is some kind of excessive mobility of the joint, its instability. More often it is
characteristic of the knee joint.
The knee joint is surrounded by a large number of powerful ligaments, muscles, has additional protection
in the form of a kneecap, menisci.But a strong simultaneous load on the joint can cause
damage to ligaments and menisci – sprain, rupture. Abrupt braking, “twisting” in
knee joint, direct blow to the knee area, sports overloads are the cause of
damage to the structures of the knee joint and the appearance of a feeling of instability in the knee. Gap
ligaments are manifested by acute pain, swelling of the knee in the area of ​​rupture. Concomitant hematoma
can form not only in the tissues surrounding the damaged ligament, but also in the knee itself
joint – hemarthrosis of the knee joint.
Limitation of range of motion in the knee joint, feeling of instability in the knee, pain in
knee – all these are symptoms that require prompt referral to a specialist. Traumatic
damage to ligaments, meniscus, joint capsules cannot be left untreated, complications can
significantly limit mobility in the knee and in the leg in general.
A feeling of instability in the knee can also appear on the background of diseases not related
directly with the injury.Diseases of the tendons, menisci, articular surfaces of the knee joint
sometimes cause a feeling of instability in the knee and uncertainty when walking.
The effectiveness of treatment and restoration of impaired functions of the knee joint depends on
timely diagnosis. In the clinic “Eleos” experienced specialists – traumatologist,
a therapist, a neurologist will conduct an examination, find the causes of the disease and prescribe a treatment.
Physiotherapy, massage, physiotherapy exercises, acupuncture and other treatment methods
will restore normal range of motion and restore stability in the knee
joint.

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What to do with a bruised knee joint? Treating a bruised knee can be done in a variety of ways.MBST therapy is most effective. Knee contusion treatment. A common injury is a contusion, that is, a closed injury to soft tissues. The knee joint suffers the most. How to treat a knee injury: ointments and gels? A knee injury is a soft tissue injury sustained during sports, falls, or in everyday life. To treat a bruise, ointments are used – they effectively fight the inflammatory process, reduce hematoma and accelerate the recovery of damaged tissues. First aid for injury.First aid is essential for effective treatment and recovery of the knee joint after a fall. The delay in its provision can lead to severe complications of injury – hemorrhage inside the joint, inflammatory deformation of the synovial articular membrane. Step-by-step algorithm for first aid. Degrees of bruises: 1 degree – minor injuries. They do not require special treatment and heal on their own within a few days; Grade 2 – tissue damage. As a treatment, special ointments will help; Grade 3 – characterized by damage not only to the skin, but also to muscles and tendons.In this case, dislocation is possible upon impact, therefore it is recommended to consult a specialist; 4 degree – severe swelling appears at the site of the impact, there are disturbances in the work of internal organs. Such injuries require hospital treatment of the victim. Symptoms for bruises: Sharp painful sensation; Hemorrhage; The appearance of edema and hematoma. What ointments are effective? Medication. When treating a bruised knee joint, pain relievers are prescribed in the form of ointments and tablets. Anti-inflammatory drugs are also used.Surgery. In severe cases, the patient is prescribed a puncture to remove fluid that has accumulated in the knee joint. The procedure can be carried out several times. At the time of treatment, it is recommended to give up alcohol, smoking, and taking narcotic drugs. Everything. Manual therapy. An ointment for bruises, bruises and swelling will help with various injuries. When soft tissue is damaged or bruised, swelling or inflammation occurs, which causes pain to the victim. Damage can be accompanied by hemorrhage.We treat bruises and injuries. During the treatment of traumatic bruises, during prevention, hyperemic ointments, drugs with an anti-inflammatory effect are used: Mobilat; Brufen Injury to the soft tissue in the knee area can occur from a fall or impact. Doctors attribute a bruise to minor injuries, in the treatment of which they use ointments. The best of them have effective healing properties. Prescribing drugs depends on the prevailing symptoms. Classification of ointments for bruises. The best topical agents are used for treatment.Ointments help restore joint function, eliminate bruising symptoms. Depending on the composition, there are three groups of drugs: Synthetic. They are characterized by speed, high efficiency, active penetration into the affected area. Knee anatomy Knee pain after sports Knee pain and shoes Help with chronic knee pain Why knee pain appears at a young age. Knees hurt at any age. Pain can appear in both sick and healthy people.On the first day after the injury, decongestant ointments are shown. Use heparin-containing topical preparations every other day. For 3-5 days, apply warming local irritating ointments to the area of ​​the hematoma. Before starting treatment for diseases of the knee joints, a correct diagnosis is needed. This is the doctor’s task. Knee pain cannot be ignored. A bruised knee is swollen and hurts what to do Diagnostics Causes Treatment and prevention in a network of clinics Hello !. The main symptom is severe knee pain that does not improve even after first aid.About what to do if the knee is bruised, swollen and sore. Kazmishchev K.N. Traumatologist-orthopedist. Sign up for a consultation. A knee injury is a common injury for people of all ages. It is enough to slip and fall into the ice to receive a strong blow to the kneecap. In most cases, the victims get off with bruises, which eventually disappear without medical assistance. Knee contusion is a closed traumatic injury to the soft tissues of the knee joint.It is one of the most common injuries and belongs to the category of minor injuries. The cause is usually a fall or bump in everyday life or during sports. Less commonly, there is a knee injury due to work accidents, traffic accidents and falls from a height. It manifests itself as pain, bruising, swelling of the joint, limitation of support and movement. Often accompanied by hemarthrosis. The diagnosis is clarified using radiography, MRI, and arthroscopy. Treatment is conservative.Ointments for bruises and other injuries not only eliminate pain, but also counteract inflammatory processes. They also dilate blood vessels, warm tissue and help nourish it. Therefore, the therapeutic effect occurs already in the first 30-40 minutes after application. The most popular drugs for adults and children are discussed below. Contents: Ointment for bruises with anesthetic effect: Diclofenac. Stimulates blood circulation, eliminates the symptoms of neuritis and sciatica, as well as rheumatic pathologies of the joints.You can buy the ointment at the pharmacy without presenting a prescription. It can be used by both adults and children over 12 years old (over 6 – with caution).

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Artidex Joint Treatment Cream is a universal remedy that is suitable for almost all people, regardless of gender or age.The drug does not contain synthetic substances, therefore it has no contraindications for use. Cases of side effects from the use of the ointment were also not recorded. In the 19th century, the local people destroyed deer for their needs, but now the animal population has become too small. Reindeer are no longer killed, so antlers for preparing medicine can only be obtained in spring. Because of this, Artidex is produced by the manufacturer in limited quantities – only 1500 packs per year. If you are interested in the drug, hurry up to order the package while it is on sale! On the Artidex consumer forum, men and women will always find a useful formation related to joint treatment.Here clients share stories of miraculous healing with this ointment and other life hacks.

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How to treat a bruised knee joint at home, in a hospital, how to provide first aid. … First aid, how to quickly help with a bruise and cure it, what to do at home. Types and treatment of knee injuries. … 4. A knee injury caused by a fall changes gait.If not properly treated at home, the joints will begin to crackle and click painfully. Knee joint injury is a closed soft tissue injury in the knee area. The cause of the damage is a fall or blow. As a result, the tissues surrounding the joint are damaged, and a bruise or hematoma (bruise, hemorrhage from damaged vessels), edema, swelling are formed in the affected area. What changes occur with a bruised knee? Contusion – damage to the soft tissues of a specific area. With a bruised knee joint, both the skin and subcutaneous tissue can be injured, as well as muscles, cartilage, ligaments and even blood vessels.In case of damage to the skin and fiber, the appearance of a wound is noted. A hematoma on the knee is a collection of thickened blood under the skin. It appears from small capillaries that. If left untreated, large bruises can remain under the skin, disrupting the knee joint. Even small formations tend to thicken and. Knee contusion is a closed traumatic injury to the soft tissues of the knee joint. It is one of the most common injuries and belongs to the category of minor injuries.The clinical picture of a bruised knee joint. How to properly provide first aid to a person who has received a bruised knee. … A knee injury is a dangerous injury, so it’s important to know how to treat it at home. You can get a bruised knee under different circumstances. … New hematomas have a bluish tint and after a few days change color to. Medication. If you do not know how to treat a knee injury, use various drugs: Painkillers (Analgin. Knee injury, knee joint, symptoms and first aid…. For this reason, it is required to deal with the treatment of a bruise in the knee area in time. Prevention of damage has not yet been invented, but there are measures that reduce the risk of complications. The content of the article. Effective home treatment for a knee injury in a fall. A common injury under various circumstances is a knee injury from a fall.

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Hemarthrosis of the knee joint

Basic data about the disease, as called

Hemarthrosis is the result of an accumulation of blood clots in the synovium of the joint. Blood enters the articular cavity as a result of internal damage to soft tissues or due to a hereditary severe disease – hemophilia. In the first case, we are talking about traumatism, and in the second, about a congenital bleeding disorder.Hemarthrosis of the right knee joint or hemarthrosis of the left knee joint occurs, depending on which leg was injured.

Small internal hemorrhages are common in medical practice. Examples are subcutaneous hemorrhages and hematomas that result from severe blows, falls, or severe weakness of the vascular wall. Also, the tendency to hemorrhage is associated with a deficiency of vitamin C and bioflavonoids. Small subcutaneous hematomas always resolve on their own, so no specific therapy is needed.

If a blood clot enters the articular cavity, it can cause some problems associated with the appearance of hemarthrosis. When this pathology occurs, the joint visually increases in size and takes on a spherical shape. When probing, signs of fluctuation (instability) are felt. The diagnosis is made after examination, anamnesis collected with confirmation of an x-ray picture or CT, MRI. Treat the disease with a puncture or plaster cast.

Why does the disease occur

Any type of injury provokes the occurrence of hemarthrosis.If, after a knee injury, blood accumulates, then this indicates a fall or blow. If hemarthrosis appears as a result of a rupture of ligaments or a meniscus, then this is more indicative of a sports injury. Hemarthrosis that occurs as a result of a joint fracture indicates a severe impact from a fall to the knee or the result of an accident. Serious injuries are associated with injuries in other parts of the body – fractures of the ribs, spine, pelvic bones.

Large accumulations of blood can occur after inaccurate surgical interventions.Examples are removal of the meniscus, stitching of the cruciate ligaments, connection of the joint to the femur with plates or screws. If the patient suffers from diseases associated with reduced blood clotting, then internal hemorrhage occurs even with the slightest jolt. An example is hemophilia, a severe genetic disease associated with a lack of synthesis of clotting factors.

Other similar conditions – scurvy (vitamin deficiency of ascorbic acid), hemorrhagic diathesis. Less often, joint hemorrhages occur with hemorrhagic fevers, which are not characteristic of development in northern latitudes.

Symptoms of hemarthrosis

Depending on the amount of accumulated blood in the joint, the symptoms and stages of the disease vary.

What degrees of hemarthrosis are distinguished:

1. If there is a slight bruise or sprain, the patient has a slight hemorrhage. For this reason, the symptoms are smoothed out and have minor manifestations.
2. If a patient has a meniscus rupture or significant damage to soft tissues has occurred, then due to a rupture or severe sprain of the ligaments, 20-100 ml of blood gets into the joint cavity.At this stage, the disease can be detected by external examination – the joint will visually become larger. Movements in the joint capsule become painful due to the hematoma that has arisen inside.
3. The third stage is the result of a fracture or dislocation. The volume of hemorrhages exceeds 100 ml, therefore, hemarthrosis occurs when it is started with severe symptoms. The articular bag completely acquires a spherical shape, and the patella seems to bulge out. Mobility in the knee joint is severely limited, the muscles around it spasm.The skin around the knee becomes bluish. This is due to the fact that the volume of the hematoma is large and can be seen through the skin. The temperature often rises above 38 degrees, which indicates an active inflammatory process.

The main symptom of fluid accumulation in the joint is the presence of fluctuations. The symptom is characterized by the fact that when pressing on the knee, a springy movement occurs in response in the skin area.

Signs of profuse bleeding in the joint are manifested as follows:

1. Severe and bursting pains are felt in the knee area.
2. Knee shape and volume vary. The joint becomes spherical and round.
3. The leg is not fully extended. I want to be in a position without straightening my leg completely, as this causes severe pain.
4. If the increase in the amount of internal fluid is very large, then there is a sensation of the patella floating. To detect this symptom, the doctor may squeeze the patella tightly, which will cause the knee to “float” higher. When tapping on the knee, characteristic jolts occur, when pushed to the condyles of the thigh.

All of the above symptoms appear in most cases.

Potential complications and consequences

With an excessive accumulation of blood in the joint cavity, there is a violation of blood circulation, which can provoke the development of pathological dystrophic changes, as in true degenerative arthrosis. The risks of this type of deterioration, especially, increase with the recurrence of hemarthrosis. Also, as a result of the accumulation of blood, there is a natural decay of hemoglobin particles, plasma, which are deposited in the capsule and hyaline cartilage.These inclusions negatively affect the structure of the knee, which reduces its elasticity.

What does hemarthrosis look like, comparison

Over time, an excess of hemosiderin, a pigment, accumulates in the tissues, which is formed during the breakdown of blood cells. This leads to the appearance of focal destruction on the surface of the articular membrane, which leads to a gradual and further injury to the cartilage. Over time, destructive arthrosis occurs, resulting in loss of mobility, stiffness, and chronic knee pain.Hemarthrosis can turn into coxarthrosis.

Another variant of complications is the occurrence of synovitis, the so-called inflammation of the synovial membrane in the joint. In response to an inflammatory reaction, joint effusion is released, which causes aseptic synovitis, an infectious complication characterized by the ingress of bacteria into the effusion with flow of lymph or blood. If you do not start therapy for the disease on time, purulent arthritis occurs. Antibiotic therapy is required.

Diagnosis of pathology

Based on complaints and initial examination, an orthopedic traumatologist makes a preliminary diagnosis.To confirm it, it is necessary to conduct a number of laboratory and instrumental studies. To consider pathological changes from the inside, the patient may be assigned one of the procedures:

1. Radiography to detect gross structural changes in bones and joints.
2. MRI. To address soft tissue lesions, if necessary.
3. ct. The method allows you to examine the lesions in the joints and bones, which cannot be seen by an x-ray machine.
4. ultrasound.With the help of ultrasound diagnostics, it is possible to detect traumatic lesions of soft tissues if the cause of hemarthrosis is a fall or a bruise. If blood vessels are damaged, other diagnostic methods confirm the presence of blood in the knee joint after injury.

Joint puncture should be considered separately. It is both a diagnostic and a curative method. The procedure is carried out under local anesthesia (anesthetics – Lidocaine or Novocaine are injected around the joint into soft tissues).When the anesthesia works, an intra-articular puncture is made with a thick needle. Fluid accumulates inside the joint, which is pulled out using a piston. Immediately after the introduction of the needle into the cartilaginous cavity, a slight discomfort is felt, which is accompanied by a pulling sensation. They pass over time.

Joint inflammation in hemarthrosis

Then the doctor carefully examines the contents of the syringe and draws certain conclusions by the presence of liquid:

1. If the blood is fresh, then it is a hemarthrosis that has recently arisen.
2. If there is synovial fluid in the blood admixture, then the hemarthrosis occurred earlier, not later than two or three days ago.
3. A mixture of blood and fat – signs of an intra-articular fracture.
4. If the synovial fluid is opaque and there are blotches of pus, then the hemarthrosis is neglected and old.

Another diagnostic and therapeutic method is arthroscopy. This is a minimally invasive surgery that involves inserting a microscopic camera through an incision in the skin.Arthroscopy should be used when it is necessary to examine the joint in detail from the inside and, if possible, remove bone fragments, dead tissue, excess fluid and restore the ligamentous apparatus.

Additional tests, which in most cases are not necessary, but if the doctor believes that they are necessary in the acute period, they should be taken. There are several types of laboratory tests that a patient must carry out if a complication develops in the form of bleeding or severe pain:

1. Complete blood count.If there is an increase in leukocytes, then this indicates a pronounced development of the inflammatory process associated with the addition of a secondary bacterial infection. An increase in ESR is a sign of severe inflammation. If hemoglobin and erythrocyte indices fall below normal, and the level of platelets rises, then this is a sign of acute blood loss and the development of iron deficiency anemia.
2. Hemostasiogram or coagulogram. This is a specific set of tests that determine the ability of blood to clot.There are people who have a tendency to bleeding, which causes certain difficulties in the treatment of hemarthrosis. For complete recovery, it is necessary to normalize the function of hemostasis.

If necessary, the doctor will list other types of studies prescribed to identify hemarthrosis and its complications.

How is hemarthrosis treated

Disease therapy takes place in several stages. When the first symptoms of the disease appear, it is necessary to quickly contact the trauma office.After a bruise or sprain in the right or left knee, ice should be applied, preferably several times. Then the patient takes the most calm position, trying not to move the injured leg.

Hemarthrosis – treatment

After contacting a doctor, provide details of the injury and describe the troubling symptoms. Then the doctor will diagnose and if hemarthrosis is confirmed, the specialist will perform the following algorithm of actions to treat the limb:

1. For the next few days, apply a special pressure bandage and ensure complete rest of the limb.When a few days have passed, the joint will need to be developed. This is a necessary item included in the rehabilitation scheme. Ignoring active restorative methods will lead to the formation of dense fibrous adhesions and severe limitation of mobility.
2. A puncture is then performed to pump out blood. Without this stage, suppuration and further infection of the joint will occur in the knee. Blood is pumped out with a syringe under local anesthesia. If the injury is extensive, then arthroscopy is prescribed.You may need to perform several procedures to pump blood.
3. Next, medications are prescribed according to the situation. To stop bleeding, hemostatics are used (Ditsinon, Vikasol), for anesthesia with NSAIDs or narcotic or non-narcotic analgesics. Also, for narrower indications, corticosteroids, antibiotics, chondroprotectors, vitamins and minerals can be used.
4. Then, using a splint or a plaster cast, the leg is fixed. The duration of wearing the limiting device is no more than three weeks, as long-term wearing of the cast causes problems with the mobility of the joint.

In difficult situations, if the bone or joint is completely crushed, it is necessary to perform surgery. After removing the splint or plaster, recovery procedures must be carried out. The patient is prescribed a course of physiotherapy, in particular shock wave therapy is useful. This method of treatment is aimed at restoring blood circulation in tissues and improving mobility. It is also necessary to carry out physiotherapy exercises in order to restore normal mobility in the articular bag.

The patient starts walking on crutches a month after the injury.Full recovery, if there are no complications, occurs in 2-3 months. With a timely visit to a doctor, the prognosis is favorable.

Editorial Opinion

Hemarthrosis is a lesion of the articular bag of the knee associated with trauma and hemorrhage. The disease can cause serious problems without seeking medical attention. It is recommended to study other articles with photos on diseases of the musculoskeletal system if there are problems with joints.If you have any questions, please leave comments.

Knee hematoma, how to get rid of? – Question to the surgeon

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How to get rid of a bruise when a hematoma becomes a cause for panic

There is no escape from bruises, and many of us are so used to them that they do not even react to the appearance of another “spot”. In fact, hematomas (the medical name for bruises) are not all that harmless. Interfax.by found out what is the nature of these painful spots, how to treat them, and when you need to sound the alarm.

What is hematoma

Hematomas are, roughly speaking, subcutaneous hemorrhages that occur as a result of a bruise. Any blow damages blood vessels, as a result of which “released” blood spreads and causes swelling – slight swelling of soft tissues

At risk are:

• Elderly people, as their vessels lose elasticity;
• Vacationers who do not follow the measures on the beaches, scalded skin is prone to bruising;
• Athletes;
• People who abuse antipyretics and pain relievers, they thin the blood.

In addition to blows, the cause of bruising is vitamin deficiency. If you notice that you regularly appear “marks”, most likely the matter is in the deficiency of vitamins C and K. But you do not need to immediately go to the pharmacy and start self-medication, get tested to avoid hypervitaminosis.

Why are hematomas dangerous

At first glance, bruises are not dangerous, except that they spoil your appearance, but in fact, regular microtrauma leads to a weakening of the vascular network, which is fraught with varicose veins.

Also, you should not neglect medical help if you get a bruise after a serious injury. Especially if the hematoma is very painful and affects mobility.

Contact your doctor (traumatologist, surgeon, hematologist) immediately if you notice that the bruises do not go away for a long time or appear on their own. It is necessary to exclude thrombocytopenia – a blood clotting disorder in which platelet function is suppressed. Weakened cells of “quick response” cannot timely close the site of vascular damage and block bleeding.

A large postoperative hematoma should also become a reason for contacting doctors.

What to do with a bruise

So, if you have determined that your bruise is not the result of any serious disturbances in the body, then you can try to either hide it or speed up healing.

As a rule, bruises on the trunk disappear within two weeks, on the face – within a week – nine days. They stay on their feet for as long as possible – for a month.

If you suddenly bump and feel that you are about to have a bruise, first try to prevent it: fill a bag or heating pad with ice and apply it to the damaged area for the first few hours. The main thing is not to overcool! You should be especially careful with the areas of the face, neck, armpits, groin. Cool the bruise for 15 minutes, then give the skin a break for 10-15 minutes – remove the ice. Remember to “cool down” until the bruise develops. As soon as the hemorrhage nevertheless became noticeable on the skin, on the contrary, it should be warmed up.The heat will improve blood microcirculation and help the small hematoma to dissolve. If you don’t have time to sit with a heating pad, apply pepper plaster, which has good warming properties.

The injured limb is best positioned vertically to reduce swelling.

Watch your hematoma, it should change shades. If the bruise remains the same as on the first day, see your doctor. By the way, persistent redness and swelling is evidence of infection.

If you need to get rid of the bruise as quickly as possible, you can use the “grandmother’s” methods. But be careful here, not all methods are suitable for everyone:

• Make a compress from the strongly brewed tea;
• Wrap the bruised area with mashed cabbage leaves and tie tightly;
• Apply finely grated potato gruel to the injured area;
• buy dry bodyag at the pharmacy, grind it in a mortar, add a spoonful of vegetable oil.Apply the resulting mass to the sore spot. Be careful – the crushed water stick gets nibbled. It can also provoke dermatitis;
• Rub the bruise with a piece of butter;
• Apply iodine mesh (not suitable for people with hyperthyroidism).

Do not overtighten the bruised area, this can slow down the recovery process for a long time.
90,028 90,000 How bruises and joint pain are related, Myasnikov told

Dr. Alexander Myasnikov told about what numerous bruises on the body can talk about, and how they are associated with a deadly disease.Recalling a case from his practice, the doctor told how bruises on a woman’s body helped doctors determine the cause of pain in the patient’s knee joint.

On the air of the Russia 1 TV channel, Myasnikov spoke about a hereditary disease that only men suffer from, but it is transmitted only through the female line. Hemophilia, or as it is also called the “royal disease”, has long been considered a “privileged” disease of the ruling dynasties of Europe. It was mainly only kings and emperors who were sick with her, paying for closely related marriages.Decreased blood clotting led to frequent bleeding, from which the patient usually died, rarely living up to 30 years. Through the kinship of the wife of the last Russian emperor Alexandra Feodorovna with the famous carrier of the hemophilia gene, Queen Victoria of England, the disease also spread to Russia. The heir to the crown, Tsarevich Alexei, suffered from a severe form of hemophilia, when any bruise of a playing child could become fatal, causing internal bleeding.

Now doctors have learned to increase blood clotting, and hemophilia patients live long enough.However, many do not even know about their fatal illness. So, a patient who came to Myasnikov for an appointment complained of anemia. The survey showed that she complains of prolonged bleeding from the gums after visiting dentists, as well as a large number of bruises all over her body. The mysterious case was deciphered after numerous analyzes and anamnesis.

“If at the same time there are more than five bruises on the body, each one centimeter in size, you can suspect something. They did a blood test for clotting, suspected lupus, etc.Among other things, the patient remembered how she went in for sports, but quit due to a knee injury. There have also been cases of hemophilia in the family. But we know that women do not get hemophilia, “Myasnikov told about the difficult case.

Doctors suggested that due to a clotting disorder in a woman, periodic bleeding occurs in the cavity of the injured knee joint, which caused his inactivity and, as a result, a decrease in the quality of life. This entails other problems – such patients begin to lead a sedentary lifestyle, this category increases mortality from heart attacks and even from cancer.

“It so happens that hemophilia can manifest itself,” acquire “during life. We know the genetics of hemophilia very well. It is bad when you bleed at the slightest injury. internal bleeding begins – in the head, in the stomach, in the liver, in the joints.