Knee Injury | Advocare Broomall Pediatric Associates

Is this your symptom?

• Injury to a bone, muscle, joint, or ligament of the knee

Some Basics…

• There are many ways that people can injure their knees.
• There are also many types of knee injuries. There are bones, tendons, ligaments, cartilage, and muscles in the knee. These can all be injured.
• Treatment depends on the type of injury.

Types of Injuries

• Abrasion: this is the medical term for scraped skin. This happens when an injury scrapes off the top layer of the skin. A person may say that he or she “skinned” their knee. Pain is usually mild. This can usually be treated at home. Making certain the wound is clean is the most important thing.
• Contusion: this is the medical term for bruise. It is caused by a direct blow to the skin and muscles. The skin is not broken and there is no cut. The bruised skin may first look red, then purple, and finally orange-yellow. These skin color changes are from blood that leaked from tiny torn blood vessels in the bruised area. The skin may also be swollen. Pain is usually mild to moderate. Bruises are tender to touch. Most often this can be treated at home. A cold pack can help reduce the pain and swelling.
• Cut – Superficial: superficial cuts (scratches) only go part of the way through the skin and rarely become infected. A scratch is an injury to the skin made by a sharp edge. For example, scratches can be caused by fingernails, a sharp nail, a piece of metal, or a branch of a tree or bush. This can usually be treated at home. Making certain the wound is clean is the most important thing.
• Cut – Deep: deep cuts (lacerations) go through the skin. A laceration is caused by cutting the skin with the sharp edge of an object. Lacerations longer than ½ inch (12 mm) usually need sutures (stitches).
• Dislocation: this is when a bone comes out of the joint. The joint always looks crooked or deformed. The pain is severe. A person with a knee dislocation will not be able to walk. This is serious and admission to the hospital is always needed. A doctor will treat this by putting the bone back into the joint socket.
• Dislocation of Kneecap (Patella): this is when the kneecap slips off the top of the knee joint. The knee joint will look funny or deformed. A person with a patella dislocation will not be able to walk. The pain is moderate to severe. A doctor will treat this by pushing the patella bone back into the right place.
• Fracture: this is the medical term for a broken bone. It means the same thing as a break or crack in the bone. The pain is severe. A person with a knee fracture usually cannot walk. Surgery may be needed.
• Patellar Tendon Rupture: this is a tear of the tendon just below the knee cap. Often a person cannot lift that foot and completely straighten the knee. Surgery is often needed.
• Quadriceps Tendon Rupture: this is a tear of the thigh tendon just above the knee cap. Often a person cannot lift that foot and completely straighten the knee. Surgery is often needed.
• Sprain: a sprain is the medical term used when ligaments are torn or over-stretched. Ligaments are the bands of tissue that connect bones to each other. This is the same thing as a “twisted knee”. Knee sprains are very common. They happen most often while playing sports. Pain and swelling can range from mild to severe. Most knee sprains heal themselves with time and rest. Crutches and a knee brace are usually needed.
• Strain: a strain is the medical term used when muscles are torn or over-stretched. A more common term for this is a “pulled muscle”. These are common injuries from falling, heavy lifting, and sports. Strains may heal themselves with time and rest. Surgery is rarely needed for a muscle strain.

Pain Scale

• None: no pain. Pain score is 0 on a scale of 0 to 10.
• Mild: the pain does not keep you from work, school, or other normal activities. Pain score is 1-3 on a scale of 0 to 10.
• Moderate: the pain keeps you from working or going to school. It wakes you up from sleep. Pain score is 4-7 on a scale of 0 to 10.
• Severe: the pain is very bad. It may be worse than any pain you have had before. It keeps you from doing any normal activities. Pain score is 8-10 on a scale of 0 to 10.

When to Call for Knee Injury

Care Advice for Minor Bruise, Sprain or Strain

1. What You Should Know:
   • There are many ways that people can injure their knees.
   • There are also many types of knee injuries. There are bones, tendons, ligaments, cartilage, and muscles in the knee. These can all be injured.
   • You can treat a minor bruise, sprain, or strain at home.
   • Here is some care advice that should help.
2. Treatment of Bruise (direct blow to knee area):
   • Cold Pack: For pain or swelling, use a cold pack or ice wrapped in a wet cloth. Put it on the sore area for 20 minutes. Repeat 4 times on the first day, then as needed.
   • Heat Pack:
     • If pain lasts over 2 days, apply heat to the sore area. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed.
     • For widespread stiffness, take a hot bath or hot shower instead. Move the sore knee under the warm water.
   • Rest the injured knee as much as possible for 48 hours.
3. Treatment of Sprains and Strains of Knee:
   • FIRST AID: Wrap with a snug elastic bandage. Put an ice pack on the knee to reduce bleeding, swelling, and pain. Wrap the ice pack in a moist towel.
   • Treat with rest, ice, compression, and elevation (R.I.C.E.). Do this for the first 24 to 48 hours.
     • REST the injured leg for 24 hours. You can then return to normal activity if it is not too painful.
     • Keep using ICE packs for 10-20 minutes every hour for the first 4 hours. Then use ice for 10-20 minutes 4 times a day for the first 2 days.
     • Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If you feel numbness, tingling, or more pain, the bandage may be too tight. Loosen the bandage wrap.
     • Keep injured leg ELEVATED and at rest for 24 hours. Put your leg up on a pillow. Stay off your feet as much as you can.
4. Pain Medicine:
   • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   • Use the lowest amount of a drug that makes your pain feel better.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.
   • Read the instructions and warnings on the package insert for all medicines you take.

5. What to Expect: Pain and swelling most often start to get better 2 to 3 days after an injury. Swelling is most often gone in 7 days. Pain may take 2 weeks to go away.

6. Call Your Doctor If:
   • Pain becomes severe
   • Pain is not better after 3 days
   • Pain or swelling lasts more than 2 weeks
   • You think you need to be seen
   • You get worse

And remember, contact your doctor if you develop any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

How Long Should Swelling Last After an Injury?

Whether you’re a professional athlete or a senior trying to slow down and relax, injuries do happen. When they do, swelling is almost always sure to follow. In most cases, swelling clears up after a few days, but what happens when it doesn’t? How long should swelling last after an injury before you should become concerned or alert your doctor?

After you suffer an injury, swelling usually worsens over the first two to four days. It can then last for as long as three months as the body attempts to heal itself. If the swelling lasts longer than this, your physical therapist or doctor may need to take a closer look to determine the cause of the delayed healing.

What causes swelling after an injury?

Ethan Anderson is a physical therapist at Foothills Sports Medicine Physical Therapy. After years of helping people recover from injuries, he notes that general tissue damage tends to cause cellular debris to “leak out.” He adds that there is also, “a disturbance of microcirculation and lymphatic vessels” leading to congestion of the surrounding tissue.

While most people become alarmed when the body shows signs of swelling, it’s important to remember that this is a natural part of the healing process. When swelling occurs, it’s just the body requesting reinforcements to speed up the healing process. Without swelling, the body would have a difficult time determining what areas need repairing and the extent to which they do.

Even so, swelling can become excessive, can last for too long, or can lead to other complications. Your physical therapist can help you determine what symptoms and severity are just normal parts of the process and when to be concerned.

When should someone seek medical attention?

Not all injuries require medical attention, but athletes and seniors may require it more than others. Athletes need injuries addressed immediately to ensure they are able to return to practice as soon as possible. Seniors may require immediate attention because the body becomes less resilient as it ages.

Regardless of age or hobbies, if the injured area becomes painful, warm to the touch, or red, this could be the sign of an infection. It could also be symptoms of deep vein thrombosis. It is crucial to your health that you contact your physical therapist or primary care physician if you notice any of these signs.

What can patients do to reduce swelling?

Most people immediately turn to ice to numb the pain and reduce swelling after an injury, but does it really work? Ethan Anderson says yes. “Perhaps more effective than ice is the process of elevating the injured body part to allow gravity to pull some of the fluid away from the area,” he adds.

Here are some additional tips to reduce swelling:

• Move the joints above and below the injury site, so it can help improve lymphatic drainage, as noted by Casley-Smith in 1997.
• Use short stretch compression garments to reduce tissue edema and swelling.
• Apply heat after the first few days to improve the mobility of the lymphatic system and improve swelling.
• Try to avoid putting weight or pressure on the affected area.

Are there any precautions injured persons should take at home?

When applying ice, be mindful of leaving the ice in one spot or falling asleep with it on the affected area. The length of time that you should leave the ice varies depending on the body part and the person. An acronym to describe the “phases” of applying ice to an injured area is CBAN. It stands for cold, burn, ache, numb. First the area will feel cold, then it will start to burn a little bit, then it will get achy, and finally it will go numb. Once you get the numb feeling, it is time to remove the ice, regardless of the length of time it’s been on your body.

There are some over-the-counter medications injured persons can use to reduce pain and swelling, but it might be wise to speak to a doctor first. For example, pain medications are discouraged for some injuries within the first 24 hours of injury because they can increase the risk of bleeding. Pain medications can also negatively impact people with existing health conditions, such as the following:

• Liver disease
• Heart disease
• Kidney disease
• Stomach ulcers
• High blood pressure

How can a physical therapist help reduce swelling?

Chances are that waiting six months for swelling to go away is not your preferred method of handling an injury. Working with a physical therapist can help your body heal at a faster rate and can reduce the risk of complications while healing.

Ethan Anderson says that a physical therapist can perform a technique known as Manual Lymphatic Drainage and other skilled manual therapy techniques. “A 1999 study by Casas and DePoli showed that these techniques can shorten the time to resolve post-surgical edema and tissue fibrosis to 6 weeks to 3 months, down from 9 to 18 months,” he added.

At Foothills Sports Medicine Physical Therapy, we help our patients achieve a full recovery and get their lives back on track. Our physical therapists have served Phoenix and the surrounding communities for more than 20 years and look forward to serving you. Request an appointment today.

Foothills Sports Medicine Physical Therapist Ethan Anderson PT, DPT, ATC, CAFS is from our Peoria clinic.

Ethan joined the Foothills family in 2016 after completing his degree as a Doctor of Physical Therapy at the University of Montana, Missoula. Ethan is a dedicated father, husband, and Physical Therapist who strives to help all of his patients and clients, both young and old, reach and exceed their rehabilitation and fitness goals.

A former NCAA D–I All-Conference Track and Field Athlete and retired Firefighter, Ethan brings an immense drive for success and service in all he does both in the clinic and in the community where he volunteers his time to his church as well as serving as Team Physical Therapist for multiple local high schools. His background as a college athlete, as well as a Certified Athletic Trainer, allows him to connect with his patients and clients on an intimate level regarding their injuries physically, mentally, and emotionally.

Some of Ethan’s other passions include being a handyman around the house, anything that is “Built Ford Tough”, motorcycles, hunting, and fishing. Ethan is thrilled to lead Foothills Sports Medicine Physical Therapy – Agua Fria and continue his service in the West Valley.

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Also known as wear and tear, joint disease or degenerative arthritis, is a common problem for many people after middle age. Knee osteoarthritis is the most common type of osteoarthritis and ranked as the most common cause of disability in the U.S. It can be caused by previous knee injuries, fractures, ligament tears, repetitive strain on the knee, obesity, etc.

Symptoms:

• Pain
• Stiffness
• Limited range of motion
• Localized swelling

Chondromalacia patella is a common knee problem that affects the patella and the groove when it slides over the femur (thigh bone). This action takes place at the patellofemoral joint.
This condition occurs when the patellofemoral joint that has been structurally damaged. The commonly used term, patellofemoral pain syndrome (PFPS) refers to the earlier stages of the condition. Symptoms are more likely to be reversible with PFPS.

Symptoms:

• Grinding sensation when the knee is flexed
• Front knee pain when getting up after sitting for a long period of time
• Knee pain that worsens when you climb stairs or get out of a chair
• Knee tenderness

Plica syndrome is a problem that occurs when an otherwise normal structure in the knee becomes a source of knee pain due to injury or overuse. The diagnosis can sometimes be difficult.

Symptoms:

• Knee pain
• Swelling
• Clicking sensation
• Locking
• Weakness of the knee

Rheumatoid arthritis of the knee causes the joints to become tender, warm, and swollen. Although knee osteoarthritis causes pain and stiffness, joint pain with knee RA is more severe.

Symptoms:

• Pain
• Swelling
• Inflammation
• Stiffness
• Warmth around the knee joints
• Fever
• Flu-like symptoms
• Fatigue

The meniscus is a commonly injured structure in the knee. The injury can occur in any age group. In younger people, the meniscus is fairly tough and rubbery, and tears usually occur as a result of a forceful twisting injury. The meniscus grows weaker with age, and meniscal tears can occur in aging adults as the result of fairly minor injuries, even from the up-and-down motion of squatting.

Symptoms:

• Pain
• Stiff/ swelling
• Locking
• No range of motion

Anterior Cruciate (ACL) Injury & –Posterior Cruciate (PCL) Injury

The posterior cruciate ligament (PCL) is one of the less commonly injured ligaments of the knee. The anterior cruciate ligament (ACL) is more commonly injured.

Symptoms:

• Pop or crack when injured
• Instability, followed by swelling
• Extremely painful
• Unable to straighten leg
• Tenderness
• Pain at the time of impact, extended to calves later on.
• Swelling
• Instability

Medial and Lateral Collateral Ligament Injuries

The medial collateral ligament (MCL) is more easily injured than the lateral collateral ligament (LCL). It is most often caused by a blow to the outer side of the knee (such as occur in contact sports) that stretches and tears the ligament on the inner side of the knee.
The classic sign of this injury is hearing a “pop” and feeling the knee buckle sideways. Pain and swelling are immediate. To diagnose a collateral ligament injury, a medical professional will perform several manual tests (applying pressure on the side of the knee to determine the degree of pain and looseness of the joint) and possibly order an MRI to confirm the diagnosis.

Symptoms:

• Bleeding
• Swelling
• Stiff and painful
• Unstable
• May give away and not support body weight.

Dislocation/ Patellar Subluxation

Patellar Subluxation happens when the kneecap is pulled towards the outside of the knee. As this happens, the kneecap does not slide centrally within its groove.
Also called patellar subluxation, patients who experience an unstable kneecap have a kneecap that does not slide centrally within its groove. Depending on the severity of the patellar subluxation, this improper tracking may not cause the patient any problems, or it may lead to dislocation of the patella (where the kneecap fully dislocates out of the groove). Most commonly, the tracking problem causes discomfort with activity, and pain around the sides of the kneecap. Patellar subluxation is a condition that usually affects adolescent and sometimes younger children.

Symptoms:

• Painful
• Kneecap pops or gets out of the socket

The patellar tendon is prone to rupturing in individuals with a history of patellar tendon injury such as jumper’s knee or degeneration due to age. Injuries of this type serve to weaken the patellar tendon and in the event of strong eccentric quadriceps contraction (contraction during lengthening of the muscle), such as landing from jump, the patella tendon may snap or rupture most commonly at the lower end of the patella.

Symptoms:

• Extremely painful an
• Clear pop at the time of injury
• Swelling
• Inability of holding weight
• Inability to straighten the knee or hold it straight
• Fracture and Stress Fractures

PFS/ Patellofemoral Syndrome/Runner’s Knee

Patellofemoral pain syndrome is pain in the front of the knee. It frequently occurs in teenagers, manual laborers, and athletes. It sometimes is caused by wearing down, roughening, or softening of the cartilage under the kneecap.

Symptoms:

• Pain under or around the kneecap
• Pain hurt after bending to running, climbing stairs, leg exercises etc.
• Clear knee cracking or a need to be cracked to decrease pain.
• Incapable of sitting for long periods of time without straightening out the knee to make it crack.

ITB (IlioTibial Band Syndrome)

liotibial band syndrome is inflammation and pain on the outer side of the knee. The iliotibial band is a layer of connective tissue. It begins at a muscle near the outer side of your hip, travels down the outer side of your thigh, crosses the outer side of the knee, and attaches to the outer side of your upper shin bone (tibia).

Symptoms:

• Pain over the outside of the knee joint
• Swelling at the spot of discomfort
• Snapping or popping feeling as knee bends

Patellar tendonitis is the condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called “jumper’s knee.”

Symptoms:

• Dull ache
• Tenderness
• Mild swelling

Knee bursitis is inflammation of a bursa located near your knee joint. Knee bursitis causes pain and can limit your mobility. Treatment for knee bursitis often includes a combination of self-care practices and doctor-administered treatments to alleviate pain and inflammation.

Symptoms:

• Feels warm when knee is touched
• Appears swollen or feels spongy when knee is touched
• Painful or tender

Osgood-Schlatter Disease/ Jumper’s Knee

Osgood-Schlatter disease can cause a painful lump below the kneecap in children and adolescents experiencing growth spurts during puberty. Osgood-Schlatter disease occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet.

Symptoms:

• Pain at the bony edge below your knee
• Tibial tuberosity swollen or inflamed
• Tenderness and pain becomes worse during and after exercise.
• Pain when contracting the quadriceps against resistance or when contracting the muscles with the leg straight.

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Acute Knee Effusions: A Systematic Approach to Diagnosis

MICHAEL W. JOHNSON, MAJ, MC, USA, Madigan Army Medical Center, Tacoma, Washington

Am Fam Physician. 2000 Apr 15;61(8):2391-2400.

Knee effusions may be the result of trauma, overuse or systemic disease. An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation. The most common traumatic causes of knee effusion are ligamentous, osseous and meniscal injuries, and overuse syndromes. Atraumatic etiologies include arthritis, infection, crystal deposition and tumor. It is essential to compare the affected knee with the unaffected knee. Systematic physical examination of the knee, using specific maneuvers, and the appropriate use of diagnostic imaging studies and arthrocentesis establish the correct diagnosis and treatment.

Family physicians are increasingly being called on to evaluate musculoskeletal disorders. The knee is susceptible to traumatic injury and is often the site of systemic disease. An understanding of these disorders and injury patterns is critical to making an accurate diagnosis and an effective treatment plan for knee effusions.

A thorough history and a meticulous physical examination establish the diagnosis in a vast majority of cases. The appropriate use of manual testing, diagnostic imaging studies and arthrocentesis can further assist the clinician in arriving at the correct diagnosis (Table 1).

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TABLE 1

Etiologies of Knee Effusions

TABLE 1

Etiologies of Knee Effusions

History

Evaluation of an acutely swollen knee must begin with a thorough history. It is important to know if an acute injury to the knee has occurred or if the swelling evolved atraumatically (Table 2). A history of previous injury and treatment, including surgery, should be determined in every patient who presents with knee swelling.

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TABLE 2

Key Findings of the History in Patients with Knee Effusion

TABLE 2

Key Findings of the History in Patients with Knee Effusion

If trauma is involved, the clinician should inquire about the date and mechanism of injury, what sport, if any, was involved, and whether a direct blow caused the injury. Historical findings suggestive of fracture include a mechanism of injury involving a high-velocity collision, the occurrence of a “pop” at the time of injury, age greater than 55 years and inability to bear weight immediately after the injury. Anterior cruciate ligament (ACL) injuries typically present after a noncontact deceleration, a “cutting” movement or hyperextension, often accompanied by a “pop,” with the inability to continue sports participation and associated knee instability.

The posterior cruciate ligament (PCL) is injured far less frequently than the ACL. The typical mechanism of injury of the PCL is a blow to the anterior proximal tibia with the knee flexed, such as tripping over a hurdle or striking the dashboard in a motor vehicle accident. Patients with PCL injuries tend to report less instability and swelling than patients with ACL injuries.

Collateral ligament injuries present with effusion or localized swelling. Lateral collateral ligament injuries result from a medial-to-lateral force on the knee, while medial collateral ligament injuries result from a force in the opposite direction. The amount of pain reported depends on the severity of the injury. A severe sprain is typically less painful than a partial tear, and instability is the major complaint. Meniscal injuries can occur in isolation or in combination with ligamentous injuries. The typical mechanism of injury involves weight bearing associated with a twisting of the knee, as in cutting or squatting movements. The patient may describe postexertional swelling, clicking and locking, and pain with rotational movements.

In all cases, it should be determined how quickly swelling occurred after the injury. If an effusion evolved within four hours of injury, there is a high likelihood of major osseous, ligamentous or meniscal injury.1 In a prospective study2 of 106 cases of hemarthrosis caused by sporting injury, 71 patients (67 percent) had complete or partial disruption of the ACL. Another prospective study3 of acutely injured yet clinically stable hemarthrotic knees revealed that patellar dislocation and ACL disruption accounted for 35 percent and 34 percent of the diagnoses, respectively.

If swelling occurred without a history of trauma, questioning should be directed at uncovering both local and systemic disorders. Overuse injuries, or repetitive microtrauma, occasionally present with knee swelling. Important questions to ask include which recreational or occupational activity was involved, how quickly the swelling occurred or resolved, and if any self-treatment had been attempted.

Systemic disorders often cause knee effusion. A variety of infectious diseases may present as monoarticular arthritis with joint redness, effusion and pain. Infiltrative disorders such as gout and pseudogout often present in a similar fashion. Immunologic diseases such as Reiter’s syndrome, rheumatoid arthritis and rheumatic fever can also cause knee effusion. The knee is the most common joint involved in both benign and malignant tumors.4

Anatomy

As with any musculoskeletal assessment, a precise understanding of knee pathoanatomy is essential. The knee is a compound condylar joint formed by three articulations: the first, between the medial femoral and tibial condyles, the second, between the lateral femoral and tibial condyles, and the third, between the patella and the femur. The knee moves through flexion and extension, internal and external rotation and a small degree of anterior-posterior glide.

Four major ligaments support the knee, which is the largest joint in the body. The anterior and posterior cruciate ligaments provide anterior and posterior stability, preventing dislocation of the tibia on the femur. The medial and lateral collateral ligaments provide stability to lateral and medial stresses, respectively (Figure 1).

FIGURE 1.

Anatomy of the knee: anterior view.

The patella is the largest sesamoid bone in the body and provides increased mechanical advantage for knee extension. It is held in place by the medial and lateral retinaculae, and its posterior surface is covered with articular cartilage. The quadriceps muscles act on the knee through the quadriceps and patellar tendons.

The medial and lateral menisci are curved fibrocartilaginous structures located between the tibial and femoral articulating surfaces. They are connected to the joint capsule at their periphery and attached to the tibia via the coronary ligaments. The menisci act as shock absorbers within the knee joint. They also assist in lubrication of the joint and increase its elasticity. The medial meniscus is much less mobile than the lateral meniscus, accounting for its higher rate of injury.5,6

Physical Examination

The knee examination should be approached in a systematic manner, and comparison with the unaffected knee is essential. Examination of the entire lower extremity is required to assess alignment, sensory and motor function, and vascular integrity.

Assessment begins with a careful inspection, looking for abrasions, ecchymosis and localized swelling, which provide clues to the magnitude of force and the mechanism of injury. Active range of motion is then attempted. If complete extension or 135 degrees of flexion is not achieved, passive range of motion is then attempted and, again, compared with the normal knee. Palpation of the knee is best accomplished with the patient supine and the knee flexed to 90 degrees to enhance patient relaxation. The patella and its supporting structures, bilateral joint lines and collateral ligaments are palpated for tenderness, crepitus and localized swelling.

The presence or absence of effusion must be determined and differentiated from edema or other extra-articular swelling. In the supine position, intra-articular effusion can be differentiated from conditions such as prepatellar bursitis, Baker’s cyst, inferior fat pad irritation and patellar tendonitis, which can all present with swelling about the knee. Intracapsular swelling is evident over the entire joint, while extra-articular swelling tends to be more localized.

If significant intra-articular fluid is present, the knee will assume a resting position of 15 to 25 degrees of flexion. Effusion is assessed by “milking” fluid distally from the suprapatellar pouch and palpating the area adjacent to the patellar tendon for fluid accumulation. A ballotable patella may be palpated after similar effusion milking and is positive with as little as 10 to 15 mL of fluid.7

FRACTURE

Physical examination findings suggestive of fracture include a tense effusion, deformity, crepitation and ecchymosis. If a fracture is suspected, the hip and ankle joints should be examined, as should the leg’s neurovascular status. Fractures about the knee may be open or closed, displaced or nondisplaced. If a break occurred in the skin overlying the fracture, it must be considered an open fracture, necessitating orthopedic referral.

Common injuries include supracondylar femur fractures, tibial plateau fractures and patellar fractures. Growth plate injuries (Salter-Harris fractures) and tibial tubercle avulsion fractures may occur in skeletally immature patients.8

LIGAMENTOUS INJURIES

The ACL is particularly prone to injury. Physical findings include effusion, positive ACL tests and chronic quadriceps atrophy. The Lachman’s test is performed with the knee in 20 degrees of flexion. The tibia is pulled anteriorly on a secured femur. A positive test result is indicated by increased tibial translation compared with the unaffected knee. The quality of the end point should also be noted; a soft end point indicates an ACL tear. The anterior drawer test (although much less specific) is performed with the knee in 90 degrees of flexion. Similar to the Lachman’s test, the tibia is drawn anteriorly, and asymmetric translation is an indicator of ACL injury (Figure 2). The most specific test for ACL disruption is the pivot shift test,9 but this test is often difficult to perform because of patient guarding and apprehension.

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FIGURE 2.

Assessment of anterior cruciate ligament (ACL) stability. The anterior drawer test (top) is performed with the knee in 90 degrees of flexion. Similar to the Lachman’s test (bottom), where the knee is in 20 degrees of flexion, the tibia is drawn anteriorly, and asymmetric translation is an indicator of ACL injury.

FIGURE 2.

Assessment of anterior cruciate ligament (ACL) stability. The anterior drawer test (top) is performed with the knee in 90 degrees of flexion. Similar to the Lachman’s test (bottom), where the knee is in 20 degrees of flexion, the tibia is drawn anteriorly, and asymmetric translation is an indicator of ACL injury.

Physical findings of a PCL injury include effusion, positive posterior drawer and tibial sag tests, and abrasions or ecchymosis over the proximal anterior tibia. The posterior drawer test is performed with the knee in 90 degrees of flexion and the proximal tibia directed posteriorly. Comparison with the uninjured knee reveals increased tibial translation posteriorly. The sag test is performed with the patient supine, hips flexed to 45 degrees and both knees flexed to 90 degrees. In this position, the affected tibia drops back or sags on the femur if a PCL injury has occurred.

Collateral ligament sprains often present with localized medial or lateral tenderness, along with ligamentous laxity to lateral or medial stress testing. The knee should be stressed in full extension and at 30 degrees of flexion (Figure 3). Severity of injury is based on the amount of opening compared with the opposite knee. Laxity in full extension indicates major knee disruption.

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FIGURE 3.

Assessment of collateral ligament stability. The knee should be stressed in full extension and at 30 degrees of flexion. The amount of opening compared with the opposite knee indicates severity of injury.

FIGURE 3.

Assessment of collateral ligament stability. The knee should be stressed in full extension and at 30 degrees of flexion. The amount of opening compared with the opposite knee indicates severity of injury.

MENISCAL INJURY

Examination reveals joint line tenderness, inability to squat or hop because of pain, and positive results on the McMurray’s test or the Apley’s test. If an extension lag is present on motion testing, a displaced vertical tear, often called a bucket-handle tear, should be suspected.

McMurray’s test is performed with the patient supine and the knee flexed and extended, while medial and lateral tibial rotation are applied. A “pop” or click palpated in the joint line, often accompanied by pain, indicates a meniscal injury. In the Apley’s compression test, the patient lies prone with the knee flexed to 90 degrees. An axial compressive load is applied to the foot, along with medial and lateral rotation. Pain on compression that is relieved with distraction is a positive test for meniscal injury.

Imaging

The use of plain radiographs is often necessary to assess a swollen knee. In an acute injury, selecting the appropriate radiographic series is critical. The most common views are the anteroposterior (AP), lateral and axial patellar images to assess for fracture, dislocation and effusion. Oblique views may be necessary to assess for tibial plateau fractures, and osteochondral lesions are often visualized utilizing the “tunnel” AP (intracondylar) view. Standing AP views are helpful to assess compartment space narrowing associated with a chronic meniscal tear or osteoarthritis. The lateral view obtained at 15 to 30 degrees of flexion is ideal for visualization of knee effusion. The suprapatellar bursa normally measures less than 5 mm in width and will widen in proportion to the amount of intra-articular fluid present.10

Recent research using clinical decision rules for the use of radiography in acutely injured knees has identified historical and examination criteria that reduce the need for radiography.11  These criteria include the inability to bear weight, presence of effusion and ecchymosis. If all these clinical criteria were absent, the sensitivity for excluding fracture was 100 percent. Other groups have developed similar rules, the most well-known being the “Ottawa rule,” which has similar sensitivity (Table 3).12

Radiographs should be obtained in patients with suspected ACL injuries to rule out associated intra-articular fractures and possibly determine the presence of a marginal avulsion fracture off the lateral tibial plateau (Segond fracture), which helps confirm the diagnosis. Magnetic resonance imaging (MRI) is not necessary to diagnose ACL disruption but may be helpful in diagnosing associated meniscal pathology.

MRI has become an increasingly popular tool to assess soft tissue damage of the knee. Studies have shown MRI to be quite accurate in diagnosing meniscal and ligamentous injury,13 although some authors have questioned the routine use of MRI when physical examination combined with plain radiographs have similar accuracy.14–18

Diagnostic Testing

Arthrocentesis can be used as a diagnostic tool and a therapeutic procedure. Knee swelling within four to six hours of injury is indicative of hemarthrosis. Not all effusions require aspiration, although drainage of the bloody effusion provides symptomatic relief, improves examination accuracy and confirms injury severity. Arthrocentesis should be performed in patients with knee effusion without a history of trauma and with a clinical suspicion of infectious etiology.

Arthrocentesis can be accomplished quickly and easily with minimal patient discomfort. The knee is prepared in sterile fashion and anesthetized with local anesthetic to facilitate the use of a large-bore needle. The choice of the site of aspiration is a matter of operator preference. Accepted locations include the level of the joint line, 1 cm medial or lateral to the patellar tendon, with the patient seated. Alternatively, a location 2 cm medial or lateral to the anterior-superior patella can be used, with the patient supine. An 18-gauge needle is needed for aspiration of the viscous or bloody fluid.

TABLE 3
Ottawa Knee Rule for Obtaining Radiographs in Knee Injuries

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

The fluid obtained from arthrocentesis should be sent for analysis, although a hemarthrosis associated with acute injury is often evacuated only for patient comfort. A hemarthrosis without associated trauma may well be the result of hemophilia, synovioma, pigmented villonodular synovitis or oral anticoagulant therapy. 19  Nonbloody fluid should be sent to the laboratory for cell count and determination of glucose and protein levels, Gram stain, bacterial culture and special tests, such as crystals, as indicated (Table 4).

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TABLE 4

Synovial Fluid Findings

TABLE 4

Synovial Fluid Findings

Nontraumatic Effusion

If the patient has no history of trauma, a careful clinical assessment must be made to determine the diagnosis. While the patient may present acutely with effusion, it must be determined historically whether this effusion is an exacerbation of a chronic disorder.

Joint effusion is the most specific sign of joint inflammation. Other symptoms that suggest joint inflammation include joint pain, warmth, erythema and swelling. Common nontraumatic causes of effusion include infection, systemic rheumatic disease, infiltrative disorders, tumors and osteoarthritis-overuse syndromes.

INFECTION

Infectious arthritis, if untreated, often leads to irreversible joint damage. Typical historical clues include acute onset of symptoms, history of previously abnormal joint, immunocompromised status or intravenous drug use. Physical findings such as fever, warmth and erythema over the involved joint, coupled with the absence of ligamentous or meniscal findings, suggest an infectious etiology. Radiographs are typically obtained, although they often fail to reveal any abnormality.

The most important test is joint fluid evaluation. Findings indicating infection include effusion, white blood cell (WBC) count greater than 50,000 per mm³ (50 × 10⁹ per L), organisms present on Gram stain and positive cultures. An elevated peripheral WBC and erythrocyte sedimentation rate also point to an infectious process. If the effusion recurs despite appropriate therapy, evaluation for fungal infection, tuberculosis and Lyme disease should be undertaken.

RHEUMATIC DISEASE

Swelling, whether an effusion or synovial thickening, is present in rheumatic disease and often presents with acute exacerbations. Symptoms are varied depending on the disease process, and articular complaints are often present in multiple joints. Examination reveals swelling, warmth, effusion, synovial thickening and tenderness. Elevated synovial fluid protein levels, decreased glucose levels and synovial fluid WBC count ranging from 2,000 to 50,000 per mm³ (2 to 50 × 10⁹ per L) suggest an inflammatory process. More importantly, serum laboratory testing often reveals markers of rheumatic disease. Radiographs often reveal a specific pattern based on the disease process. Rheumatoid arthritis leads to characteristic marginal erosions and osteopenia about the affected joint.

INFILTRATIVE

Crystal-induced arthritis can present in a similar fashion as infectious arthritis. The patient often describes periodic exacerbations of joint erythema, edema and swelling in the past. A history of diuretic use, a high purine diet, increased alcohol intake or renal stones is often associated with gouty arthritis. A diagnostic evaluation of the inflamed joint fluid is essential. Joint aspirate WBC count is in the range of 3,000 to 50,000 per mm³ (3 to 50 × 10⁹ per L), and crystals are present when the fluid is examined with a polarizing microscope. The urate crystals seen in gout appear as negative birefringent rods or needles, while the calcium pyrophosphate crystals of pseudogout are weakly positive birefringent rectangles or rhomboids. 20 The presence of crystals does not rule out an infectious cause, as the two may co-exist. The fluid should always be sent for Gram stain and culture.

TUMOR

Benign and malignant tumors can present as knee effusion. Unless this entity is considered, significant delay in diagnosis and treatment can occur. Worrisome symptoms include fever, night sweats, unintentional weight loss and night pain. If the patient’s clinical course is prolonged or atypical, plain radiographs should be ordered to rule out a bone lesion. Symptoms of joint pain and effusion may antedate the diagnosis of cancer and may be the presenting symptom of advanced cancer.

OSTEOARTHRITIS AND OVERUSE SYNDROME

Osteoarthritis is characterized by pain with use and relief with rest. It tends to occur in weight-bearing joints and in those that have sustained previous injury. Onset is insidious, and the course is progressive with occasional exacerbations. Effusion can occur in joints subjected to repetitive microtrauma or overuse. Effusion can also occur with degenerative meniscal tears. Physical examination may reveal effusion and palpable osteophytes. Effusion, erythema and warmth tend to occur with osteoarthritis exacerbations. Radiographs reveal characteristic joint space narrowing and osteophytic spurring. Serum laboratory testing is not necessary unless the diagnosis is unclear.

Final Comment

A complete history, a thorough physical examination and judicious laboratory and radiologic testing can simplify evaluation of knee effusion (Figure 4). Traumatic knee injury with immediate effusion indicates severe intra-articular injury, the most common being ACL disruption. Osseous, ligamentous and peripheral meniscal injuries present with hemarthrosis. Arthrocentesis should be performed when the etiology of the effusion is unclear, when infection is suspected or to provide patient comfort and facilitate physical examination. The etiologies of nontraumatic effusion range from degenerative disorders to metastatic disease.

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Examination of the Swollen Knee

FIGURE 4.

Algorithm for the assessment of a swollen knee. (IV = intravenous; WBC = white blood cell; ACL = anterior cruciate ligament)

Examination of the Swollen Knee

FIGURE 4.

Algorithm for the assessment of a swollen knee. (IV = intravenous; WBC = white blood cell; ACL = anterior cruciate ligament)

Knee Pain, Clicking & Crunching

The knee is a joint that bears the weight of your body on a day-to-day basis, so it’s unsurprising that knee injuries are extremely common. You are more likely to suffer knee injuries if you play sports that involve sudden turns, like football, tennis or running. Knee pain can also be caused by wear and tear from everyday activities.

Causes of Knee Pain

Common conditions that can cause the above symptoms include:

Most often caused by trauma from a sudden change of direction. The knee has four ligaments at the front, back and on both sides. If damaged, the ligament will be swollen, cause pain on movement, and you may be unable to put weight on the knee.

A meniscus tear is a common injury among athletes, and can happen when the knee is suddenly twisted. The tear occurs to a piece of cartilage located between the femur and the tibia, which absorbs shock in the knee. This condition causes pain, swelling and sometimes a crunching sound can be heard when moving the knee.

A bursa is a small sac of fluid which protects the knee joint, so that the tendons and ligaments can move easily. If this is damaged, the knee can become swollen.

A wear and tear condition caused by the loss of cartilage in a degenerating knee. People with osteoarthritis may experience pain, stiffness and perhaps clicking or crunching sound within the knee. With osteoarthritis, the joint in the knee becomes much weaker, this can leave you more prone to fractures.

A knee fracture can be caused by a sudden trauma to the area. This is likely to mean severe pain when touching the area or when moving.

Tendinitis is a direct result of overuse of the patella tendon. The knee may become very swollen and it can hurt to bend the knee normally when going up or down stairs.

• Patellafemoral Pain Syndrome (or ‘Runner’s Knee’)

The most common injury caused by running. Those with runner’s knee may have a pain around or behind the kneecap. This can make everyday activities like walking up or down stairs, or sitting painful.

5 Methods to Help Reduce Swelling From an Injury

Did you throw too many passes and hurt your shoulder? Did you twist your ankle working in the yard? Did you lift too much weight and injure your knees? If your answer is yes to any of these or other injuries, you’ve probably experienced swelling and inflammation. 

When the body is injured, whether from sports or overexertion, the immune system responds with swelling and inflammation. During the inflammatory response, the body rushes white blood cells, proteins, antibodies, and various supportive fluids to the injury. This causes inflammation and swelling.¹

The excess fluid produced by the body helps protect damaged tissues from further injury. Although a certain amount of swelling is unavoidable, it’s important to do what you can to help control the process for these important reasons: 

• Too much swelling may slow down healing.
• Untreated inflammation may lead to even more swelling.
• Excess swelling can be uncomfortable and sometimes limit your range of motion.²
  

How to Help Reduce Swelling After an Injury

There are several methods you can use to help control the body’s natural inflammatory response. Try using any or all of these five tips to help reduce swelling and control pain^2,3:

1. Rest

Using an injured body part may contribute to swelling by encouraging blood flow and irritating damaged cells. For example, trying to walk after an ankle sprain may cause additional excess fluid to build up as your body continues to protect the damaged tissues. Although it may be tempting to try to continue normal activity after an injury, it’s usually a good idea to rest the area for at least a few days.

2. Cold Therapy

Applying cold immediately after an injury helps reduce swelling by restricting blood flow to the area and slowing down cellular metabolism. You can use ice packs, cold therapy systems, ice baths, or cryotherapy chambers to deliver cold to the affected area. Apply cold several times a day for 20-30 minutes at a time to help keep swelling down, especially in the first several days after an injury.⁴

3. Compression

Applying pressure to an injury helps reduce swelling by restricting the flow of blood and other fluids. You can apply compression with static bandages, elastic bandages, or cold and compression devices. When using static or elastic bandages, adjust the pressure as necessary to make sure they provide enough compression without being too constrictive. As swelling increases and decreases, you should adjust the bandages accordingly.

4. Elevation

Elevating an injury above the level of the heart also contributes to reduced blood flow, which may mean less swelling. With leg injuries, it’s important to keep the legs elevated while seated or reclining so that excess fluid is not allowed to collect around the injury. Following a leg injury, the risk of a dangerous blood clot increases if you don’t elevate the injury, especially if you spend a lot of time sitting or in bed.⁵ Comfortably elevate injured areas while sleeping by using soft pillows as props.  

5. Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce inflammation in the body and alleviate the pain of an injury. Always follow the dosage guidelines and ask your doctor about potential interactions with other medications.  

You can get the most benefit from cold and compression by combining the two in a system that delivers consistent cold while helping your body pump excess fluid away from the injured area. The Game Ready cold therapy system can be used after an injury to help control pain, reduce swelling, and help you recover as quickly as possible. Contact us today to learn more about using Game Ready for injury recovery.

Reducing Swelling from Specific Injuries

Although the inflammatory response is consistent throughout the body, there are specific actions you can take to help address it in various areas.⁶

Foot Injuries

Addressing the swelling in foot injuries may include elevating the foot above the level of the heart, applying cold therapy, and using a compression bandage or active compression system to help remove excess fluid from the area. If circulation is poor or you have to be on your feet, it’s important to elevate, ice, and compress regularly throughout the day to keep the swelling down. Wear comfortable shoes, and avoid high heels or pointed toes.

Ankle Injuries

Sprains and strains in ankle tissues are some of the most common injuries.⁷ Reducing swelling in ankle injuries is similar to the approach for foot injuries. In addition to elevation and cold therapy, you might also consider wearing an ankle brace to provide consistent static compression and help prevent the buildup of excess fluid.

Knee Injuries

Swelling from knee injuries can impact your range of motion in the joint and make it difficult to walk.⁸ You can help reduce swelling by applying cold therapy several times a day and wearing an elastic bandage or brace. If mobility is an issue, consider using a crutch, a cane, or another assistive device to keep pressure off the leg while you recover from a knee injury.  

Leg Injuries

It’s difficult to elevate the upper legs. Their larger surface area also makes smaller ice packs less effective, which is why the body-conforming wraps used in cold therapy systems are beneficial. Applying compression to the groin, quadriceps, or hamstrings is also not as easy with elastic bandages, making active compression wraps a good alternative for injuries in leg tissues.

 Swelling is a natural response to injury, but left unchecked, it may prolong your recovery time. Be proactive with tactics such as elevation, cold therapy, and compression to help your body heal faster.

References

1. Immune response. MedlinePlus. https://medlineplus.gov/ency/article/000821.htm.
2. Baumert PW. Acute inflammation after injury: Quick control speeds rehabilitation. Postgraduate Medicine. 1995;97(2):35-49. doi:10.1080/00325481.1995.11945957.
3. Moroz A. Rehabilitative measures for treatment of pain and inflammation. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/special-subjects/rehabilitation/rehabilitative-measures-for-treatment-of-pain-  and-inflammation. Published June 2017.
4. When to use hot and cold to treat a muscle injury. United Hospital Center Orthopaedics. https://wvorthocenter.com/when-to-use-hot-and-cold-to-treat-a-muscle-injury/. Published July 20, 2017.
5. Deep vein thrombosis (DVT). Mayo Clinic.
   https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557.
           Published March 6, 2018.
6. Campagne D. Overview of sprains and other soft-tissue injuries. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/overview-of-sprains-and-other-soft-tissue-injuries. Published August 2017.
7. Sprains. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sprains/symptoms-causes/syc-20377938. Published December 22, 2018.
8. Cronkleton E. Causes of knee tightness, and what you can do. Healthline. https://www.healthline.com/health/tightness-in-knee. Published July 24, 2018.

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inflammation of the shoulder joint symptoms and treatment Contusion of the knee, knee joint, symptoms and first aid.We will tell you how a bruised knee, knee joint is treated, what to do and how to recover from an injury. Accurate diagnosis of fractures and other injuries. The injury heals on its own without the use of medication. Varieties. Doctors distinguish several degrees of severity of a knee injury, depending on the nature of the damage. Sources. The structure of injuries and diseases of the knee joint Deikalo. Boloboshko B. Results of modeling injuries of the ligamentous apparatus of the knee joint M. KarpinskyYu. Karpinskaya E. D. Shchikota R. A. Tyazhelov, A. Goncharova L.D. Patient reviews. First aid in the treatment of injuries of the ligamentous apparatus of the knee joint should consist of applying ice, giving the limb an elevated position and applying a pressure bandage of soft tissue from the middle of the lower leg to the middle of the thigh (Jones bandage). A back splint can be used as an alternative method. If there is slight instability and slight sprain, conservative treatment is indicated.Surgical treatment is indicated when there is damage to multiple ligaments or moderate joint instability. The most important thing is that the initial damage assessment is accurate. In SportKlinik you will receive treatment for any injuries of the knee joint: ruptures of the knee joint and joint, meniscus, dislocations and bruises of the patella, etc. One of the most common types of injuries is damage to the knee joint. At risk are professional athletes, as well as people leading an active lifestyle, including football players, cycling, alpine skiing, snowboarders, etc. However, those who are far from sports are quite often injured – after a car accident, with an unsuccessful fall, a sharp load on the knee joint. 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. Knee hurts after falling. A bruise is formed – a closed injury in which only soft tissues are damaged, and not the joint itself.Pain appears, then swelling, hematoma. What to do for minor, moderate and severe bruises. For minor bruises: Limit movement of the limb, no running or jumping. 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. Knee injury is damage to the soft tissue and bone structures that make up the knee joint. Refers to the category of common injuries. It can vary significantly in severity – from mild bruises to intra-articular fragmented and multi-splinter fractures. Most often occurs when falling or hitting the knee. It is accompanied by swelling, pain, and limitation of movement. Hemarthrosis is usually observed. For diagnostics, X-ray, ultrasound of the joint, arthroscopy, CT, MRI and other studies are used. Therapeutic tactics depend on the type of damage. The knee joint is one of the most vulnerable to arthrosis, as it experiences high stress on a daily basis. Even if you do not run or jump, but simply work in an uncomfortable position for a long time or move little, the risk of illness increases.Obvious signs of inflammation in arthrosis of the knee – edema, hot skin, redness and stiffness – usually appear already at the 2nd stage of the disease. How to remove inflammation from the knee joint? For the treatment of inflammation, local agents are used in parallel, drugs for oral administration. For generalized or extremely severe inflammation, the doctor may add injections. 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.Treating a bruised knee. A common injury is a contusion, that is, a closed injury to soft tissues. The knee joint suffers the most. Treating a damaged knee joint: what you need to know. Almost any knee injury is painful, so it is necessary to relieve the pain before seeing a specialist. The first aid, which must be provided even before going to the doctor, includes the following actions: – it is necessary to provide optimal conditions for the injured leg: limit mobility.In the event of a knee injury or severe knee pain, it is important to provide prompt first aid to the injured athlete. It consists in exposure to cold and fixing immobilization of the joint with a knee pad made of special fabric or with a regular elastic bandage. Before a medical examination, you should refrain from other medication. With improper treatment or severe injuries, a dangerous pathology is possible: inflammation in the synovial bag. For an injured knee joint, this is practically a sentence. This disease becomes chronic and leads to immobility. How to treat correctly. Here’s everything about the types, early symptoms and treatments for knee injuries. The joints of the knee joint cannot withstand mechanical stress and are damaged. A microcrack is instantly formed. In addition, other injuries of the knee ligaments are associated with the following factors: a sharp turn of the torso without changing the position of the legs, rapid rotation of the knee the best pain relievers for pain in the joints temporomandibular joint dysfunction treatment of knee arthrosis treatment drugs injections

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Capsules Artrofish – a complex of cartilage tissue of marine organisms. The advantages of natural chondroitin and glucosamine have long been known: the anti-inflammatory activity of cartilage tissue components is 50-100 times higher than that of similar substances from cattle. The drug must not be taken in early childhood, as well as women during pregnancy. It can be prescribed only by doctors and only in extremely rare cases – if the benefits of taking the drug are higher than the potential risk. In order to avoid the development of undesirable effects, it is recommended to consult a doctor before using the drug.2 years ago I took teraflex. I liked the drug. Recently I tried the arthrophish effect the same. A few days later, there was a feeling of lubrication in the joints. The crunch disappeared. But this is not a medicine, but a dietary supplement. Supplementary nutrition of the joints. If the joint is already seriously destroyed by arthrophish and should not do anything heal, but other joints can be preserved. Arthritis of the fingers: causes and symptoms. Effective treatment of joint diseases: nutrition, folk remedies, drugs, ointments and exercises. Arthritis of the fingers is a characteristic symptom of rheumatoid arthritis, but it can also be one of the manifestations of some other disease.It is very important to seek medical help in a timely manner, identify the cause of the disease and begin treatment in order to avoid serious complications and disability. In this article you will find all the necessary information on this disease. General information about the disease. Finger arthritis is an inflammation of the metacarpophalangeal and interphalangeal joints of the fingers. What is hand arthritis: causes and symptoms of the disease. Rheumatoid and other types of hand arthritis. How to forget about the problem forever: home treatment, massage, medications, exercise therapy.Folk remedies (herbal decoctions and tinctures) are also actively included in the complex treatment as additional methods. But the doctor prescribes them, self-medication should be excluded. Folk recipes: compresses from dry elm bark; grind the raw materials, grind into powder, dilute with water to a mushy state, transfer to a napkin and apply to the affected joints; put polyethylene and insulation on top, leave overnight; perfectly relieves pain and swelling Symptoms of arthritis of the fingers.Symptoms for arthritis of the joints of the hands are: pain, and if at first it occurs with movements of the hands and fingers, then later the pain in the joints torments the patient even at rest. Symmetrical deformities – walrus flippers – are considered specific for rheumatoid arthritis of the joints of the fingers. The brushes are made like a spindle. In addition to joint pain, there are dizziness, stinging eyes, chest pains, numbness in the fingers, and body weight falls. Chondroprotective agents with chondroitin and glucosamine are also used for treatment.They are designed to help repair the damaged cartilage tissue in the fingers. Arthritis is a generalized name for inflammatory diseases, the localization of the processes of which can occur in any joint of the human body. Arthritis of the hands is considered to be one of the most common types of pathological process. Rheumatoid arthritis of the hands can occur and develop in a person of almost any age and gender. Progress is characterized by the presence of inflammation, the disease is predominantly secondary.Arthritis in the hands often occurs during adolescence and is accompanied by severe deformities. Each exercise contributes to the development of mobility in the fingers and hands. IMPORTANT! Arthritis of the fingers – symptoms and treatment, photo. Typical symptoms of the disease. Depending on the underlying causes of the onset of the disease, patients may be disturbed by various symptoms. But there are also characteristic signs of arthritis. Photo of arthritis. Help with folk remedies. For arthritis, it is recommended to take apple cider vinegar.It is mixed with water (a teaspoon per glass) and drunk up to five times a day. Rheumatoid arthritis suggests joint stiffness in those affected by this ailment in the morning. Autoimmune disease affects the joints, causing an inflammatory process in them. To avoid unpleasant painful sensations, keep prescribed medications near your bedside table. Accept them, and when the morning getting out of bed begins, their effect on the body will already begin to act, they will help to weaken the unpleasant sensations.Folk remedies will help. Medicinal plants with analgesic and anti-inflammatory properties are an effective way to reduce pain in the morning with RA. Arthritis of the fingers is a disease that most often affects women. The reasons for this are in the peculiarities of a number of purely female professions and everyday tasks, as well as in the fact that the female body as a whole is more susceptible to osteoarthritis than the male due to its hormonal background. For this, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are used, they eliminate inflammation in the joint, as a result of which the pain subsides.In addition to NSAIDs, with severe pain syndrome, the patient may require additional intake of pain medications. In particular, when diagnosed with rheumatoid arthritis of the fingers, treatment also includes the use of immunosuppressive drugs. After the main treatment for rheumatoid arthritis, doctors are allowed to use folk remedies. Compresses, ointments, vodka rubbing, oil tinctures and herbal teas have a mild anti-inflammatory, analgesic, decongestant effect. Unlike traditional medicines and the latest systemic drugs, they do not have a negative effect on the condition of the liver, kidneys and stomach.But for pain in the feet, you can use foot baths. And in case of discomfort with the defeat of the fingers, only the hands should be immersed in the water. Baths are best taken within 20 minutes an hour before bedtime because of their pronounced relaxing effect. Rheumatoid arthritis is a serious disease that affects 0.5 to 2% of people around the world (Fig. 1) [1] The situation in Russia is also disappointing: according to the pharmaceutical company Roche, about a million people suffer from rheumatoid arthritis. Women are in the majority among them: according to statistics, they get sick five times more often than men.So, changes in the joints of the hands, characteristic of rheumatoid arthritis, are visible. The fact is that these drugs have immunosuppressive properties, that is, the ability to suppress the activity and division of immune cells, as well as joint cells. Knotty swollen fingers – such a nuisance awaits those who have developed and progressed arthrosis of the hands. According to statistics, women suffer from this disease ten times more often than men. With the help of simple preventive actions, you can protect yourself as much as possible from such a hand defect, which, unfortunately, cannot be dealt with by any cosmetological method.Wrap your hand around your finger and rotate as if you were sharpening a pencil. Bend and unbend your fingers at a fast pace, without clenching them into a fist, 15-20 times. Finger massage takes only a few minutes. What to do if the first signs of arthrosis appear.

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Collagen and hyaluronic acid act as additional elements – sources of youth, as well as a complex of vitamins that saturate the tissues of the joints with useful components from the inside, which further enhances the effect of Artrofish.Treatment of joint diseases. Preparations that replace synovial fluid. Prevention and Supplements. All subcategories. You can buy Preparations for the treatment of joints in undefined in the Apteka.ru online store. Delivery of Preparations for the treatment of joints in 0 pharmacies. By name or substance among 50,000 drugs and products, for example, Voltaren. Find. Medicines. Allergy. Alopecia / Hair Loss. First aid kit. Diseases of the joints. Anti-inflammatory and pain relievers for joint diseases. Nurofen. Diclofenac. Voltaren.Nise. Fastcaps. Mirlox. The use of medicine for the joints. The most common joint disease is arthritis. This definition includes diseases affecting the synovium, cartilage, capsule and other articular elements. Depending on the location of the diseased joint, various types of arthritis are distinguished [1]. Pain relievers are primarily used for treatment. In the early stages of the development of the disease, invasive methods can be dispensed with. There are 4 groups of drugs for the treatment of joints: Non-steroidal anti-inflammatory drugs.Prescribed in a short course, they can relieve pain and reduce inflammation. Drugs for the treatment of arthrosis – which drugs are effective? Joints undergo a great deal of stress throughout life, so with age, their condition worsens, pains appear and the range of motion decreases. The cause is often degenerative changes caused by arthrosis. Osteoarthritis medications can help stop the breakdown and repair damaged tissue. However, you need to understand which pills will be beneficial and which will only be a waste of time and money.Causes and mechanism of development of arthrosis. joint diseases (internal). drugs that replace synovial fluid. restoration of cartilage tissue. regenerating. protection and nutrition (external) for the joints. with osteoporosis. with the deposition of salts in the joints. remedies for muscles and joints of natural origin. transdermal therapy. solutions for external use. for pain in joints, muscles (internal). with bruises and bruises. for pain, inflammation and spasms (injection forms). The drugs used to treat the disease are called chondroprotectors.They act as a building material to improve the structure of the articular cartilage, the function of which is to cushion the joint and provide glide during movement. It is chondroprotectors that help stop the development of the disease, influencing not only its symptoms, but also the mechanisms. Chondroprotectors are: in the form of a solution for injection and are prescribed by a doctor; in the form of capsules or tablets, external – ointments or gels. How to choose a remedy for joints. Consider the most studied substances with the properties of chondroprotectors: Chondroitin sulfate. The basis of the cartilage framework, its matrix. Any medications for the treatment of joint lesions should be prescribed only by a doctor. He will select those pills for joint pain that are most effective in each case, taking into account all possible contraindications. Popular questions and answers. The pharmacist, teacher of pharmacology, editor-in-chief of MedKorr Olga Zorina answered the questions regarding the treatment of pain in joints, their occurrence and tactics of patient management. Read also. Radiculitis. How to navigate the treatment of osteoarthritis of the joints with drugs? Form of release of drugs for osteoarthritis.A wide range of medications are used to treat arthrosis – the patient can choose the form of release that best fits into his lifestyle. Tablets and capsules. Oral systemic agents are easy to use, easy to dose, and suitable for the treatment of polyarthrosis that affects multiple joints. Most drugs for osteoarthritis in tablets have a high availability for the body – up to 90% of active substances are absorbed. Tablets, capsules and powders are prescribed for routine treatment in courses 2-3 times a year. knee joint injury treatment drugs . dysfunction of the temporomandibular joint treatment.

90,000 Approaches to the treatment of purulent – inflammatory diseases of large joints

Dear visitors of our site! This article is devoted to the surgical treatment of pyo-inflammatory diseases of the joints complicated by the destruction of bone tissue (osteomyelitis), purulent complications of endoprosthetics.

This group of diseases is a serious, not completely resolved problem of modern orthopedics.There are no uniform standards for the treatment of this pathology. Treatment approaches are based on the personal experiences of individual authors and clinics. We would like to highlight the fundamental aspects of diagnosing this group of diseases and share our personal experience in their treatment.

The incidence of septic arthritis ranges from 2 to 10 cases per 100,000 population. The knee joint is affected (up to 55%), followed by the hip and ankle joints. Mostly children and the elderly suffer from such diseases.

What are the prerequisites for the development of purulent arthritis? These are injuries to the joint area, degenerative and rheumatoid diseases of the joints, injections in the joint area, arthroscopic interventions, a history of joint arthroplasty, pyoinflammatory diseases, trophic ulcers of the distal extremities, sexually transmitted infections, systemic administration of glucocorticoids.

Clinical picture of the disease. Manifestations of the disease are quite distinct when the joints are affected, close to the skin (elbow, knee, ankle).These are swelling of tissues in the joint area, local redness and an increase in skin temperature. With the defeat of large, deep-lying joints, such as the shoulder and hip, local changes may not be pronounced, and the patient will only be bothered by pain in the joint area. An increase in body temperature also may not appear immediately. The photo below shows a typical clinical picture of arthritis of the knee joint: the contours of the right knee joint are smoothed, the joint is enlarged in volume.

Laboratory diagnostics of the disease. The scope of examination of a patient with a suspected purulent process must necessarily include a clinical blood test with the calculation of the leukocyte formula and erythrocyte sedimentation rate, a blood test for C-reactive protein. Among the laboratory indicators, I would like to dwell separately on the level of procalcitonin. The procalcitonin test is currently the most objective method for determining the generalization of a bacterial infectious process. A dynamic increase in this indicator in the patient’s blood tests is an indicator of the spread of the purulent process outside the joint, the development of sepsis.

Instrumental diagnostics: – X-ray of the affected joint; – spiral computed tomography of the joint; -puncture of the joint with subsequent microscopy and cultures of the discharge to determine the infectious agent and its sensitivity to antibiotics. This manipulation must be performed before starting antibiotic therapy.

Treatment. In the treatment of purulent – inflammatory diseases of the joints, our task is to stop the inflammatory process as soon as possible and, if possible, preserve the function of the joint.According to various authors, with a purulent process in the joint, the articular cartilage is affected 4-6 days from the onset of the disease and finally dies off at the 4th week of the disease, after which the effectiveness of joint-preserving operations is sharply reduced. In the absence of signs of bone tissue damage, joint-preserving operations are now preferred. With the defeat of superficially located joints in the early stages of the disease, it is possible to use puncture methods and antibiotic therapy of a wide spectrum of action.If puncture methods are ineffective within 48 hours from the onset of the disease, it is recommended to perform joint drainage. Ideally – most modern authors are inclined to this – the use of arthroscopic techniques.

Our personal experience: Treatment of septic arthritis of the ankle in a 19-year-old patient with a 3-week flow-lavage drainage. The flushing system was installed through the accesses up to 2 cm. The result of the treatment is the complete relief of the inflammatory process, the patient’s recovery.During two years of follow-up, no recurrence of the disease was noted. When the purulent process spreads to the bone tissue, non-viable tissues are removed and the joint area is stabilized using an external fixation device. As a result, the inflammatory process is arrested and arthrodesis of the affected joint is formed, i.e. fusion between the bones that form the joint, which subsequently provides adequate supporting function of the limb.

Personal experience: A patient, 81 years old, was admitted to the clinic with pain in the hip joint, which worried for 4 months after falling from a height.During the week before admission to the clinic, the pain steadily increased, the supporting function of the limb was impaired. She did not notice an increase in body temperature, she constantly took anti-inflammatory drugs (Movalis) in large doses.

X-ray at admission.

Areas of destruction in the body of the ilium, in the head of the femur are determined.

When puncture of the hip joint – thick purulent contents.

On an emergency basis, the patient was operated on: the joint was opened, the focus of osteomyelitis was sanitized, the head of the femur was removed, the joint was fixed with a rod extrafocal apparatus.Installed a flow-wash drainage system. For 6 weeks, the patient was treated with broad-spectrum antibiotics. During treatment, pain in the hip joint area was arrested, in clinical laboratory tests – a decrease in the inflammatory response.

The external fixation device was removed 8 weeks after the operation. The hip joint is fixed with an orthopedic fixator. The retainer was removed 3 months after the operation. The patient can walk independently with full load on the operated leg.The inflammatory process was arrested.

Results of spiral computed tomography of the pelvic bones of the patient 3 months after surgery.

Signs of the formation of fusion between the femur and the body of the ilium are determined. This fusion provides an adequate support function of the limb in the future.

Currently, purulent complications of arthroplasty are a serious problem in modern orthopedics. According to CITO data, in 2012, 80,000 large joint endoprosthetics were performed in Russia.The ratio of primary and revision endoprosthetics was 9: 1. The complication rate in primary arthroplasty of large joints was 2.4%. Of these, 40.6% are infectious complications. The complication rate in revision arthroplasty was 12.9%. Of these, 51.4% are infectious complications.

In case of early deep suppuration after hip arthroplasty , it is possible to preserve the endoprosthesis . Chronic infection of the endoprosthesis area and destructive osteomyelitis in adults, which developed against the background of septic arthritis, are indications for radical surgical debridement, removal of endoprosthesis components, and necrotic areas of bone tissue.

Approaches to performing operations with suppuration of endoprostheses vary. In our practice, we use articulating spacers (temporary “substitutes” for the prosthesis) – individually made from bone cement with the addition of antibiotics. The use of these devices allows to preserve the length of the limb, to provide walking with support on the operated leg, to improve the patient’s quality of life in the postoperative period, and to facilitate subsequent re-endoprosthetics .

Clinical example: Patient 65 years old.History of total hip arthroplasty performed abroad in 2002. No dynamic observation of the joint was carried out. Over the past two years, since 2012, recurrent pain in the hip joint has been troubling. Since September 2013, within 3 months, he has noted a gradual increase in pain. Two weeks before admission to the clinic, at home, massage of the joint area and acupuncture were performed. After the course of these procedures, a sharp increase in pain was noted, a rise in body temperature up to 39 degrees.

Radiographs of the patient upon admission.

Signs of destruction of the swivel component of the prosthesis, signs of destruction of bone tissue along the femoral component of the prosthesis are determined.

During the puncture of the joint, a thick purulent content was obtained. The joint cavity was opened, the components of the endoprosthesis were removed, and the focus of osteomyelitis was radically treated. Revision revealed purulent fusion of the proximal femur. Articulating spacer installed.

X-ray of the patient after surgery.

Model of the proximal femur, formed from bone cement with antibiotics, reinforced with a proximal femoral nail.

The postoperative course is smooth. The inflammatory process was arrested. Re-endoprosthetics is planned to be performed. This clinical example clearly demonstrates the need for timely referral to a specialist traumatologist – orthopedist and the inadmissibility of performing physiotherapeutic procedures without prior adequate diagnosis of the cause of joint pain.

Orthocenter specialists are familiar with all methods of surgical treatment of purulent – inflammatory diseases of the joints and are ready to come to your aid.

90,000 Ice: Beware of Injury! – City polyclinic of Belgorod

Alas, the sidewalks and roads in our country sometimes do not have time to clean. Therefore, you have to walk on slippery streets. And this is a risk – after all, you can easily fall and get a bruise, fracture or concussion. To avoid all these troubles – follow the safety rules.

What to do when it’s slippery?

1. Discard the heels . Wear boots with grooved soles. Its surface is covered with grooves. This will make you feel more confident on the ice.

Advice! If the sole is smooth, take it to a workshop for anti-slip prevention. Stick on a rubber pad. Either place it on pieces of felt or use an adhesive plaster. You will slide less. But keep in mind, the patch gets wet and peels off quickly.

2. Take your time . Walk slowly, in small steps. Bend your knees slightly. Put your foot on the entire foot and do not raise it high. Better shuffle – as if you are skiing. And be sure to watch your step. See that there is ice in the center of the path – go along the edge where the snow lies. Use support whenever possible: hold onto the railing as you walk up the stairs. Place both feet on the step. Then move on to the next one.

Important! Do not run after departing vehicles and walk away from the roadway.Otherwise, there is a risk of slipping and falling under the wheels.

3. Hands free . Wear a backpack instead of a bag. Do not put your hands in your pockets. Spread them slightly to the sides. Swing as you go. This will help keep your balance if you slip. You should not talk on a mobile phone while walking – attention should be focused as much as possible on the sidewalk.

Not able to stay on your feet and fall? Then:

¨ Tighten the muscles.This will protect your bones.

¨ Press your chin against your body. Avoid head injury.

¨ Try to sit down. The drop height will be less.

¨ Roll onto your side. This is the safest method of falling.

Fell – roll over! Feel like you are losing balance – try to bend your knees and group. And if you fall, roll over – this will soften the force of the blow and protect you from fractures.

It is absolutely forbidden to do this!

Ø put your hands forward.So you will fall on your elbow or palm. You can easily get fractures.

Ø fall flat on the back or on the “fifth point”. There is a risk of severe bruising or fracture.

When everything turns white and white around, it pleases the eye, but, unfortunately, with a beautiful sparkling snow on the streets, ice also appears on the roads. One careless movement and … a leg or arm in a cast.

If you fall on the ice, and in winter any, even a small puddle turns into a mini-skating rink, you can get not only banal bruises, but also a serious injury, up to a fracture.

Tensile

When falling, we instinctively stretch our arms out in front of us and get damage to the wrist ligaments, and if we twist the leg, then, as a rule, the ligaments of the ankle and knee joints suffer. When the ligaments are sprained, any movement of the injured joint causes severe pain. Moreover, edema at the site of injury may not appear immediately, but gradually over several hours. With a complete rupture of the ligament, the joint becomes unnecessarily mobile.

How to help . To reduce swelling and relieve pain, ice wrapped in a cloth should be applied in the first days after the injury. Apply an elastic bandage to the damaged area, but not too tightly so that the limb does not become numb and turn blue. In case of severe pain and swelling, it is necessary to consult a doctor, since along with severe stretching, you can get a crack or bone fracture, which cannot be diagnosed without an X-ray.

Fracture

In case of an unsuccessful fall, you can get damage to the bone, and the fracture can be both closed and open.The victim experiences severe pain, and a bluish swelling appears at the site of the fracture.

How to help. First of all, the victim must be provided with rest. To do this, lay it on a flat surface. To reduce pain, a splint is applied to the fracture site – you need to fix the limb with boards, sticks, umbrellas, etc. In the event of a fracture of the bones of the hand, the clavicle should hang the injured hand on a scarf or bandage it tightly to the body.And then be sure to call an ambulance or independently deliver the victim to the emergency room.

Contusion

Often, when falling at the site of impact, soft tissues are damaged and a hematoma (bruise) appears. After a severe bruise, subcutaneous hemorrhage can be quite massive with swelling, accompanied by severe pain.

How to help. Cold must be applied to the injury site. Abrasions and scratches must be washed and disinfected with any antiseptic.In case of severe pain, see a doctor. Bruises to the head and abdomen are extremely dangerous, therefore, if dizziness, nausea, and pain in the abdomen appear, urgent medical attention is needed.

Take care of yourself! Be healthy!

Department of Medical Prevention, OGBUZ “City Polyclinic of Belgorod”

How to quickly get rid of a bruise

What is a contusion

A bruise is a soft tissue injury that does not affect the bone.In case of a bruise, the integrity of the skin is not violated, and the subcutaneous tissue and small blood vessels “suffer” in the first place.

Determining that you “got” a bruise is quite simple. Moderate pain is felt at the site of the injury. To the touch, the bruised area becomes denser, reddens and slightly swells. If you bruise a joint (such as a knee or elbow), swelling may appear on the affected leg or arm, and a bruise may develop after a couple of days.

Why does a bruise appear after a bruise? The blow to the body damages the blood vessels, and blood flows from them into the soft tissues.”Holes” in small vessels quickly tighten special cells. But it takes time to remove blood from soft tissues. Blooming hematoma – the process of decay of hemoglobin, which gives the area of ​​damage the appropriate color: first red, purple, then green, yellow, and then no trace remains.

If you are hurt, it is important to make sure that the impact does not damage the bone. If the swelling is large, and it is scary to even touch the bruised area, it is better to consult a traumatologist.The doctor will send you for an x-ray. If the bones are intact, you can heal yourself.

How to reduce bruised pain

If you have just hit, the best thing to do is to apply cold to the area of ​​the injury. Cold slows down bleeding under the skin and cools pain-sensitive receptors, decreasing the strength of the pain signal that the receptors transmit to the brain. As a result, bruising and swelling will be less than they would be without cooling.

A plastic bag with crushed ice, frozen meat and any product from the freezer will work well for cooling a bruise, but you can only apply it through a cloth.Special cryopackages are sold in pharmacies. If there is no ice, you can substitute the affected area under a stream of cold tap water for 1-5 minutes.

How to quickly get rid of a bruise

The most important thing to do when dealing with bruising is to reduce inflammation. Then you need to help the body get rid of the blood that has got under the skin and restore damaged cells. For this, external treatments are used – ointments and gels.

It is important to remember that the ointment should not be applied to abrasions and scratches that could appear with a bruise.You can spread the area around the abrasions by gently rubbing the product into your skin.

Two types of ointments are used to treat bruises and bumps.

1. Ointments for pain

“Cooling” ointments that reduce discomfort after injury can reduce inflammatory symptoms.

It is worth paying attention to ointments containing menthol and eucalyptus oil.