Insight from One Colony
Orthopaedics, physical therapy, and related topics

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Pain in the knee. When is it an emergency?

by Dr. Lefkowitz

Understanding knee pain: the important questions.

How long has it been going on? Exactly how did it happen? Was there a definite and sudden injury?  How long after the injury did the pain begin?

Exactly where is the pain? Is it always the same?  Is there an exact place to which you can point where it hurts? Is that place sore when it is touched?

Is the pain severe? Do you take pills for the pain?

What makes the pain worse? Has it stopped you from doing anything? What relieves the pain? Are there positions which make the pain better or worse? Does rest help?

Does it swell?

What could it be?

The pain began with a definite injury, caused by a sudden stop while running or by a twisting of the knee or a direct blow:  it could be a torn ligament, a fracture, damage to the joint surface or damaged meniscus or a torn muscle or tendon.

The pain has been an “on and off”  thing, sometimes worse and sometimes better; it is worse “getting going” as in getting up from a chair: it could be due to wearing out of the joint associated with some inflammation such as arthritic wear of joint surfaces or a degenerating meniscus.

Sometimes it doesn’t hurt at all. But then the knee suddenly “locks” or buckles: a loose piece of cartilage from the joint surface or from the meniscus may be getting between the bones that contact each other and producees pain by interfering with normal joint motion.

What should you do?

When there is a sudden and definite injury which produces severe pain that persists after a few minutes, particularly if the knee swells right after injury, you should be seen by a physician immediately. X rays may be needed to see if there is a fracture.

But when the knee pain begins more gradually, without any dramatic injury, the decision to see a physician may be a bit more difficult. Perhaps the pain began after doing more work or exercise than usual. Or an ache that had been present got worse. Or an ache that had been present may have gone on long enough to have become a concern. When should you see a doctor? When is it OK to try over the counter medication?

If there has been no significant injury and the pain is not very severe, it might be reasonable to try over the counter anti-inflammatory medication such as Ibuprofen (Motrin, Advil) or Naproxen (Aleve for two or three days — but only if there is no problem taking such medications (taking no anticoagulant medication, no history of upset stomach from medications and no kidney disease and no bleeding problems). If pain persists, it is necessary to see a physician.

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