by James Hubbard, MD, MPH

In this post, I’m going to address some of the more frequent questions that are being asked in the comment section of my post “8 Tips for How to Treat a Knee Injury and How to Know If It’s Bad.” The questions seem to center around the following:

“I’ve injured my knee. What’s the diagnosis? What’s the treatment? How long is the injury going to last? Should I see a doctor? If so, when?”

First keep in mind, these types of questions don’t always have cut-and-dry answers when you’re describing symptoms on a comment board. Someone with very little pain and swelling sometimes has a worse injury that someone with severe pain. Everybody’s different. (And I can’t give individual diagnoses anyway.) If in doubt, it’s best to have it checked out.

On the other hand, I know I’m supposed to be giving information for when seeing an expert is delayed, even impossible. So, here goes.


Q.
When should I get to a doctor?
Knee Injury: Your Top-4 Questions, Answered | The Survival Doctor

A. In normal circumstances, it’s better to be safe than sorry.

It’s a true emergency if:

  1. The joint is distorted (looks dislocated or has a break that’s out of place).
    OR
  2. The foot is turning blue or has no pulse.

If there’s any way possible—by air, by ambulance, etc.—you must get to a doctor as soon as possible. Until you can, splint the knee in place (see the “How to Stabilize a Knee” box here) and begin RICE (rest, ice, compression, elevation).

If you think a distorted bone or dislocated joint is impairing circulation to the lower part of the leg and the foot (blue color or no pulse), and you can’t get emergency help right away you may have to try traction—pulling on the foot in the same direction as the angle of the distortion. I have to write more on that in a future post.

In normal circumstances, there are two other reasons you might need to get to the emergency room:

  1. The knee seems unstable—the joint moves uncontrollably when you move your leg.
  2. The pain is unbearable despite RICE and over-the-counter pain relievers.

At other times, the injury doesn’t have to be seen right away, but don’t bear weight on that leg until you can get seen and rule out a broken bone.


Q.
What’s the diagnosis and treatment?

A. In my previous knee-injuries post, I listed some simple signs and symptoms that are clues to certain types of injuries. Think of that as your quick guide. Here, I’ll go more in-depth about fractures, sprains and tears.


Knee Diagnosis 1: Fracture

knee-fracture

Tibial Plateau Fracture

As it has done for ankles, the Ottawa Hospital Research Center has developed a set of rules for knee injuries called the Ottawa Knee Rule to help a doctor decide whether there might be a break and the knee needs X-rays.

You should suspect a fracture if you injure your knee and there’s pain along with any one of the following:

  • You’re 55 years or older.
  • You have tenderness of your kneecap and nowhere else
  • You have tenderness at the head of your fibula. (That’s the bone just below your knee joint on the outside part.)
  • You can’t bend your knee to 90 degrees.
  • You can’t walk for at least four steps without severe pain.

Treatment: Splint the knee, use RICE, and don’t bear weight until you can get it checked out. If you absolutely must bear weight, use crutches or a cane.


Knee Diagnosis 2: Sprain or Tear

If the knee is stable, it’s often hard to tell a sprain from a tear without special testing, such as an MRI. And many insurances won’t approve of tests such as this until you’ve given the knee a few weeks to heal on its own since the initial treatment is the same.

They might make exceptions if you twist your knee and experience pain along with one of the following:

  1. You hear a loud pop during the injury. (Chances are you’ve torn some cartilage or a ligament.)
  2. Your knee feels unstable after the injury. (Chances increase that you’ve torn a ligament.)
  3. The knee swells a lot immediately after the injury

The Survival Doctor's Guides to Wounds and BurnsTreatment: The initial treatment of a sprain or tear is to stabilize the knee with a splint or brace. Also read my post about how to treat a knee injury, paying attention to the RICE part. This treatment, along with acetaminophen or NSAIDs (ibuprofen or naproxen), may last four to six weeks.

Many people ask if you should try to walk even if it hurts. The answer is no unless you absolutely have to. And then try to limit the amount of weight. Use a cane or crutches if at all possible. It is okay to bend and straighten the knee while you’re sitting or lying down, if it doesn’t hurt too badly to do it.

Do not, repeat, do not play sports until you’ve had it checked by a doctor or until there’s no longer any pain or swelling, and the range of motion is back to normal.

>> Disaster with no doctor? Get The Survival Doctor’s Guides. Ready when you are.


Q.
How long will the injury last?

A. A broken bone can take six to twelve weeks to heal. A sprain typically takes four to six weeks.

If it’s a sprain, you should notice gradual improvement. Maybe not every day, but you should be able to compare what your pain and swelling were like maybe three or four days ago and be able to tell, yes, there’s a little less.

One way to do this is give the pain a scale of 1 to 10. Note the movement and the pain with weight bearing. In a few days, note those same things again. It may not improve every day, but there should be a trend. If not, it’s more likely something is torn.

If it stops improving or starts getting worse, or if it’s going to be a big problem to limit your activity, you should get it checked to see if there’s a tear, if that’s an option. If it’s not, it may continue to give you trouble, either constantly, or off and on for a very long time.


Q.
What are the consequences of not getting a knee injury treated?

A. If it’s broken, you could be prolonging the pain. Walking on some properly splinted breaks can be okay, but with others, you can delay the bone from healing or damage the joint more if the bone involves that area, or the broken part of the bone may distort out of place.

If it’s a tear, it may continue to give you pain a lot longer and possibly damage the joint further.

If it’s a sprain, it may delay the healing time significantly.

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Photos: Flickr/Andrea Lofthouse (knee splint), Flickr/jenni_froedrick (knee fracture).