Knee Problems and Injuries
Knee Problems and InjuriesSkip to the navigationTopic OverviewMost people have had a minor knee problem at one
time or another. Most of the time our body movements do not cause problems, but
it's not surprising that symptoms develop from everyday wear and tear, overuse,
or injury. Knee problems and injuries most often occur during sports or
recreational activities, work-related tasks, or home projects. The
knee is the largest joint in the body. The upper and lower bones of the knee
are separated by two discs (menisci). The upper leg bone (femur)
and the lower leg bones (tibia and fibula) are connected by
ligaments,
tendons, and muscles. The surface of the bones inside
the knee joint is covered by
articular cartilage, which absorbs shock and provides
a smooth, gliding surface for joint movement. See a picture of the
structures of the knee. Although a knee problem is often caused by an
injury to one or more of these structures, it may have another cause. Some
people are more likely to develop knee problems than others. Many jobs, sports
and recreation activities, getting older, or having a disease such as
osteoporosis or arthritis increase your chances of
having problems with your knees. Sudden (acute) injuriesInjuries are the most common
cause of knee problems. Sudden (acute) injuries may be caused by a direct blow
to the knee or from abnormal twisting, bending the knee, or falling on the
knee. Pain, bruising, or swelling may be severe and develop within minutes of
the injury. Nerves or blood vessels may be pinched or damaged during the
injury. The knee or lower leg may feel numb, weak, or cold; tingle; or look
pale or blue. Acute injuries include: - Sprains,
strains, or other injuries to the ligaments and
tendons that connect and support the kneecap.
- A tear in the
rubbery cushions of the knee joint (meniscus).
- Ligament
tears, such as the anterior cruciate ligament (ACL). The
medial collateral ligament (MCL) is the most commonly
injured ligament of the knee.
- Breaks (fracture) of the
kneecap, lower portion of the femur, or upper part of the tibia or fibula. Knee
fractures are most commonly caused by abnormal force, such as a falling on the
knee, a severe twisting motion, severe force that bends the knee, or when the
knee forcefully hits an object.
- Kneecap
dislocation. This type of dislocation occurs more
frequently in 13- to 18-year-old girls.
- Pieces of bone or tissue (loose bodies) from a fracture or dislocation that may get caught in the joint and
interfere with movement.
- Knee joint
dislocation. This is a rare injury that requires great
force. It is a serious injury and requires immediate medical care.
Overuse injuriesOveruse injuries occur with
repetitive activities or repeated or prolonged pressure on the knee. Activities
such as stair climbing, bicycle riding, jogging, or jumping stress joints and
other tissues and can lead to irritation and inflammation. Overuse injuries
include: - Inflammation of the small sacs of fluid that
cushion and lubricate the knee (bursitis).
- Inflammation of the tendons
(tendinitis) or small tears in the tendons
(tendinosis).
- Thickening or folding of the knee ligaments (plica
syndrome).
- Pain in the front of the knee from overuse, injury,
excess weight, or problems in the kneecap (patellofemoral pain syndrome).
- Irritation and inflammation of the band of
fibrous tissue that runs down the outside of the thigh (iliotibial band syndrome).
Conditions that may cause knee problemsProblems not
directly related to an injury or overuse may occur in or around the
knee. - Osteoarthritis
(degenerative joint disease) may cause knee pain that is worse in the morning
and improves during the day. It often develops at the site of a previous
injury. Other types of arthritis, such as
rheumatoid arthritis,
gout, and
lupus, also can cause knee pain, swelling, and
stiffness.
- Osgood-Schlatter disease causes pain,
swelling, and tenderness in the front of the knee below the kneecap. It is
especially common in boys ages 11 to 15.
- A
popliteal (or Baker's) cyst causes swelling in the
back of the knee.
- Infection in the skin (cellulitis),
joint (infectious arthritis), bone (osteomyelitis),
or
bursa (septic bursitis) can cause pain and
decreased knee movement.
- A problem elsewhere in the body, such as a
pinched nerve or a problem in the hip, can sometimes cause knee
pain.
- Osteochondritis dissecans causes pain and decreased
movement when a piece of bone or cartilage or both inside the knee joint loses
blood supply and dies.
TreatmentTreatment for a knee problem or injury may
include first aid measures, rest, bracing, physical therapy, medicine, and, in
some cases, surgery. Treatment depends on the location, type, and severity of
the injury as well as your age, health condition, and activity level (such as
work, sports, or hobbies). Check your symptoms to decide if and when
you should see a doctor. Check Your SymptomsDo you have a knee injury or other knee problem? Yes Knee problem or injury How old are you? Less than 5 years Less than 5 years 5 years or older 5 years or older Have you had knee surgery in the past month? If a cast, splint, or brace is causing the problem, follow the instructions you got about how to loosen it. Yes Knee surgery in the past month No Knee surgery in the past month Have you had a major trauma in the past 2 to 3 hours? Yes Major trauma in past 2 to 3 hours No Major trauma in past 2 to 3 hours Do you have symptoms of shock? Is the leg blue, very pale, or cold and different from the other leg? If the leg is in a cast, splint, or brace, follow the instructions you got about how to loosen it. Yes Leg is blue, very pale, or cold and different from other leg No Leg is blue, very pale, or cold and different from other leg How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine? 5 to 10: Moderate to severe pain Moderate to severe pain 1 to 4: Mild pain Mild pain Has the pain: Gotten worse? Pain is increasing Stayed about the same (not better or worse)? Pain is unchanged Gotten better? Pain is improving Do you have any pain in your knee? How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine? 8 to 10: Severe pain Severe pain 5 to 7: Moderate pain Moderate pain 1 to 4: Mild pain Mild pain How long has the pain lasted? Less than 2 full days (48 hours) Pain less than 2 days 2 days to 2 weeks Pain 2 days to 2 weeks More than 2 weeks Pain more than 2 weeks Has the pain: Gotten worse? Pain is getting worse Stayed about the same (not better or worse)? Pain is unchanged Gotten better? Pain is getting better Have you had a knee injury in the past month? Yes Knee injury in the past month No Knee injury in the past month Are you having trouble moving your knee normally? Yes Difficulty moving knee Can you move the knee at all? No Unable to move the knee Have you had trouble moving your knee for more than 2 days? Yes Difficulty moving knee for more than 2 days No Difficulty moving knee for more than 2 days Did the knee or kneecap get twisted out of shape or pop out of its normal position? This is called dislocation. Yes Knee was out of normal position No Knee was out of normal position Is the knee still out of place? Yes Knee is still out of position No Knee is still out of position Is this the first time the knee has ever popped out of place? Yes First time that knee has been dislocated No First time that knee has been dislocated Does the knee feel loose or unstable when you try to walk? Yes Knee feels loose or unstable No Knee feels loose or unstable Is there any swelling or bruising? Did you have swelling or bruising within 30 minutes of the injury? Yes Swelling or bruising within 30 minutes of injury No Swelling or bruising within 30 minutes of injury Has swelling lasted for more than 2 days? Yes Swelling for more than 2 days No Swelling for more than 2 days Do you have trouble moving your knee? Yes Difficulty moving knee Is it very hard to move or somewhat hard to move? "Very hard" means you can't move it at all in any direction without causing severe pain. "Somewhat hard" means you can move it at least a little, though you may have some pain when you do it. Very hard Very hard to move Somewhat hard Somewhat hard to move How long have you had trouble moving your knee? Less than 2 days Difficulty moving knee for less than 2 days 2 days to 2 weeks Difficulty moving knee for 2 days to 2 weeks More than 2 weeks Difficulty moving knee for more than 2 weeks Has the loss of movement been: Getting worse? Difficulty moving is getting worse Staying about the same (not better or worse)? Difficulty moving is unchanged Getting better? Difficulty moving is improving Has the knee been swollen for more than 2 full days (48 hours)? Yes Knee swollen for more than 48 hours No Knee swollen for more than 48 hours Do you think that the knee problem may have been caused by abuse? Yes Knee problem may have been caused by abuse No Knee problem may have been caused by abuse Do you think the problem may be causing a fever? Some bone and joint problems can cause a fever. Are there red streaks leading away from the area or pus draining from it? Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area? "Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps. Yes Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area No Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area How long have you had knee symptoms? Less than 1 week Symptoms for less than 1 week 1 to 2 weeks Symptoms for 1 to 2 weeks More than 2 weeks Symptoms for more than 2 weeks Many things can affect how your body responds to a symptom and what kind
of care you may need. These include: - Your age. Babies and older
adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
disease, you may need to pay closer attention to certain symptoms and seek care
sooner.
- Medicines you take. Certain
medicines, herbal remedies, and supplements can cause symptoms or make them
worse.
- Recent health events, such as surgery
or injury. These kinds of events can cause symptoms afterwards or make them
more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
use, sexual history, and travel.
Try Home TreatmentYou have answered all the questions. Based on your answers, you may be
able to take care of this problem at home. - Try home treatment to relieve the
symptoms.
- Call your doctor if symptoms get worse or you have any
concerns (for example, if symptoms are not getting better as you would expect).
You may need care sooner.
Pain in adults and older children - Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.
- Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.
Major trauma is any event that can
cause very serious injury, such as: - A fall from more than
10 ft (3.1 m) [more than
5 ft (1.5 m) for children under
2 years and adults over 65].
- A car crash in which any vehicle
involved was going more than
20 miles (32 km) per
hour.
- Any event that causes severe bleeding that you cannot
control.
- Any event forceful enough to badly break a large bone (like an arm bone or leg bone).
When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood
supply to the area. This can be serious. There are other reasons
for color and temperature changes. Bruises often look blue. A limb may turn
blue or pale if you leave it in one position for too long, but its normal color
returns after you move it. What you are looking for is a change in how the area
looks (it turns blue or pale) and feels (it becomes cold to the touch), and
this change does not go away. Pain in children under 3 years It can be hard to tell how much pain a baby or toddler is in. - Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
grimace.
- Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.
Pain in children 3 years and older - Severe pain (8 to 10): The pain
is so bad that the child can't stand it for more than a few hours, can't sleep,
and can't do anything else except focus on the pain. No one can tolerate severe
pain for more than a few hours.
- Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and
sleep, but the child can tolerate it for hours or days.
- Mild pain (1 to 4): The child notices and may complain of the pain,
but it is not bad enough to disrupt his or her sleep or activities.
Symptoms of infection may
include: - Increased pain, swelling, warmth, or redness in or
around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and
illness. Some examples in adults are: - Diseases such as diabetes, cancer, heart disease,
and HIV/AIDS.
- Long-term alcohol and drug
problems.
- Steroid medicines, which may be used to treat a variety
of conditions.
- Chemotherapy and radiation therapy for
cancer.
- Other medicines used to treat autoimmune
disease.
- Medicines taken after organ transplant.
- Not
having a spleen.
With severe bleeding, any of these may
be true: - Blood is pumping from the wound.
- The
bleeding does not stop or slow down with pressure.
- Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may
be true: - The bleeding slows or stops with pressure but
starts again if you remove the pressure.
- The blood may soak through
a few bandages, but it is not fast or out of control.
With mild bleeding, any of these may be
true: - The bleeding stops on its own or with
pressure.
- The bleeding stops or slows to an ooze or trickle after
15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury. Symptoms of shock (most of which will be present) include: - Passing out (losing consciousness).
- Feeling very dizzy or
lightheaded, like you may pass out.
- Feeling very weak or having
trouble standing.
- Not feeling alert or able to think clearly. You
may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury. Symptoms of shock in a child may include: - Passing out (losing consciousness).
- Being very sleepy or hard
to wake up.
- Not responding when being touched or talked to.
- Breathing much faster than usual.
- Acting confused.
The child may not know where he or she is.
Seek Care NowBased on your answers, you may need care right away. The problem is likely to get worse without medical care. - Call your doctor now to discuss the symptoms and
arrange for care.
- If you cannot reach your doctor or you don't have
one, seek care in the next hour.
- You do not need to call an
ambulance unless:
- You cannot travel safely either by driving
yourself or by having someone else drive you.
- You are in an area
where heavy traffic or other problems may slow you down.
Make an Appointment Based on your answers, the problem may not improve without medical
care. - Make an appointment to see your doctor in the
next 1 to 2 weeks.
- If appropriate, try home treatment while you
are waiting for the appointment.
- If symptoms get worse or you have
any concerns, call your doctor. You may need care sooner.
Seek Care TodayBased on your answers, you may need care soon. The
problem probably will not get better without medical care. - Call your doctor today to discuss the symptoms
and arrange for care.
- If you cannot reach your doctor or you don't
have one, seek care today.
- If it is evening, watch the symptoms and
seek care in the morning.
- If the symptoms get worse, seek care
sooner.
Call 911 NowBased on your answers, you need
emergency care. Call911or other emergency services now. Call 911 NowBased on your answers, you need
emergency care. Call911or other emergency services now. Put direct, steady pressure on the
wound until help arrives. Keep the area raised if you can. Postoperative Problems Home TreatmentHome treatment may help relieve
pain, swelling, and stiffness. - Rest and protect an
injured or sore area. Stop, change, or take a break from any activity that may
be causing your pain or soreness. When resting, place a small pillow under your
knee.
- Ice will reduce pain and swelling.
Apply
ice or cold packs immediately to prevent or minimize swelling. Apply the ice
or cold pack for 10 to 20 minutes, 3 or more times a day.
- For the first 48 hours after an injury, avoid
things that might increase swelling, such as hot showers, hot tubs, hot packs,
or alcoholic beverages.
- After 48 to 72 hours, if swelling is gone,
apply
heat and begin
gentle exercise with the aid of moist heat to help
restore and maintain flexibility. Some experts recommend alternating between
heat and cold treatments.
- Compression, or wrapping the
injured or sore area with an elastic bandage (such as an Ace wrap), will help
decrease swelling.
- Don't wrap it too tightly, since this can
cause more swelling below the affected area. Loosen the bandage if it gets too
tight. Signs that the bandage is too tight include numbness, tingling,
increased pain, coolness, or swelling in the area below the
bandage.
- Don't expect the bandage to protect or stabilize a knee
injury.
- Talk to your doctor if you think you need to use a wrap for
longer than 48 to 72 hours. A more serious problem may be present.
- Elevate the injured or sore
area on pillows while applying ice and anytime you are sitting or lying down.
Try to keep the area at or above the level of your heart to help minimize
swelling.
- Reduce stress on your sore knee (until you can get advice
from your doctor):
- Use a cane or crutch in the hand opposite
your painful knee.
- Use two crutches, keeping weight off the leg
with the sore knee. You can get canes or crutches from most pharmacies.
Crutches are recommended if a cane causes you to walk with a limp.
- Gently massage or rub the area to relieve pain and
encourage blood flow. Do not massage the injured area if it causes
pain.
- Try the following exercises to maintain flexibility:
- Avoid high-impact exercise, such as running,
skiing, snowboarding, or playing tennis, until your knee is no longer painful
or swollen.
Do not smoke. Smoking slows healing because it decreases blood
supply and delays tissue repair. For more information, see the topic
Quitting Smoking. Medicine you can buy without a prescription Try a nonprescription
medicine to help treat your fever or pain: |
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Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine. | Safety tips Be sure to follow these
safety tips when you use a nonprescription medicine: |
---|
- Carefully read and follow all directions
on the medicine bottle and box.
- Do not take more than the
recommended dose.
- Do not take a medicine if you have had an
allergic reaction to it in the past.
- If
you have been told to avoid a medicine, call your doctor before you take
it.
- If you are or could be pregnant, do not take any medicine other
than acetaminophen unless your doctor has told you to.
- Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.
| Symptoms to watch for during home treatmentCall your doctor if any of the following occur during home
treatment: - Signs of infection
develop.
- Your knee becomes hard to move or swelling lasts for more than 2 days.
- Your
knee, lower leg, or foot becomes pale or cool or looks
blue.
- Symptoms do not improve with home
treatment.
- Symptoms become more severe or frequent.
PreventionThe following tips may prevent knee
problems. General prevention tips- Wear your seat belt in a motor
vehicle.
- Don't carry objects that are too heavy. Use a step stool.
Do not stand on chairs or other unsteady objects.
- Wear knee guards
during sports or recreational activities, such as roller-skating or soccer.
- Stretch before and after physical exercise, sports, or
recreational activities to warm up your muscles.
- Use the correct
techniques or positions during activities so that you do not strain your
muscles.
- Use equipment appropriate to your size, strength, and
ability. Avoid repeated movements that can cause injury. In daily routines or
hobbies, look at activities in which you make repeated knee
movements.
- Consider taking lessons to learn the proper technique
for sports. Have a trainer or person who is familiar with sports equipment
check your equipment to see if it is well suited for your level of ability,
body size, and body strength.
- If you feel that certain activities
at your workplace are causing pain or soreness from overuse, call your human
resources department for information on other ways of doing your job or to talk
about using different equipment.
Tips specific to the knee- Keep your knees and the muscles that support
them strong and flexible. Warm up before activities. Try the following
stretches:
- Avoid activities that stress your knees, such as
deep knee bends or downhill running.
- Wear shoes with good arch
supports.
- Do not wear high-heeled shoes.
- When playing
contact sports, wear the right shoes that are made for the surface you are
playing or running on, such as a track or tennis court.
- Replace
running shoes every 300 to 500 miles (480 to 800 kilometers).
Experts recommend getting new athletic shoes every 3 months or after 500 miles
of wear.
Tips specific to female athletes Sports trainers
recommend training programs that help women learn to run, jump, and pivot with
knees bent to avoid knee injuries. In sports such as soccer, basketball, and
volleyball, women who bend their knees and play low to the ground have fewer
knee injuries than women who run and pivot with stiff legs. Knee brace useSome people use knee braces to prevent
knee injuries or after a knee injury. There are many types of knee braces, from
soft fabric sleeves to rigid, metal hinged braces, that support and protect the
knee. If your doctor has recommended the use of a knee brace, follow his or her
instructions. If you are using a knee brace to help prevent problems, follow
the manufacturer's instructions for use. Keep bones strong- Eat healthy foods such as milk, cheese, yogurt, and dark green, leafy vegetables like broccoli. For more
information, see the topic
Healthy Eating.
- Exercise and stay active. Talk to your doctor about exercises and activities that are right for you. Begin slowly, especially if you have been inactive. For more information, see
the topic
Fitness.
- Don't drink more than 2 alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are a woman. Drinking alcohol increases your chances of having weak bones (osteoporosis). It also increases your chances of falling.
- Do not smoke or use other tobacco products. Smoking increases your chances of having osteoporosis. It also causes problems with the blood supply in your legs and slows healing. For more information, see the topic
Quitting Smoking.
Possible abuseKnee injuries such as bruises, burns, fractures, cuts, or punctures may be caused by abuse. Suspect possible abuse when an injury cannot be explained or does not match the explanation, repeated injuries occur, or the explanations for the cause of the injury change. You may be able to prevent further abuse by reporting it and seeking help. Preparing For Your AppointmentTo prepare for your appointment, see the topic Making the Most of Your Appointment. You can help your
doctor diagnose and treat your condition by being prepared to answer the
following questions: - What are your main symptoms?
- How long
have you had your symptoms?
- What were you doing when your symptoms
started?
- Have you had this problem in the past?
- What was the diagnosis?
- How was
it treated?
- How and when did an injury occur? How was it
treated? Were illegal drugs or alcohol involved in your
injury?
- Have you had any injuries in the past to the same area? Do
you have any continuing problems because of the previous
injury?
- Have you ever had knee surgery?
- What
activities, related to sports, work, or your lifestyle, make your symptoms
better or worse?
- Do you think that activities related to your job
or hobbies caused your symptoms?
- What home treatment measures have
you tried? Did they help?
- What nonprescription medicines have you
taken? Did they help?
- Do you have any
health risks?
CreditsByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine Kathleen Romito, MD - Family Medicine Specialist Medical ReviewerAdam Husney, MD - Family Medicine Current as ofMarch 20, 2017 Current as of:
March 20, 2017 Last modified on: 8 September 2017
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