Tear Vs. Knee-Sprain Symptoms

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8 Tips for How to Treat a Knee Injury and How to Know If It’s Bad

by James Hubbard, MD, MPH

It’s football season and prime time for knee injuries. But truth be told, I see them all year long—in athletes and the rest of us.

They happen at home, at work, and during any recreation at any age. Sometimes they happen when you’re just standing still and twist the wrong way.

When you hurt your knee, it may be evident you’ve done major damage. Often, though, it’s not so clear. Knee-sprain symptoms can be the same as symptoms from something more serious.

Even we doctors sometimes have a tough time telling a sprain from a tear. One reason is it’s hard to try to move a swollen, painful knee.

So what can you do when no one medical is around? There are a few things, but first, it helps to know the anatomy.

An Inside Look at Your Knee

In this plastic replica of the right knee, the kneecap, muscles, and tendons have been removed. The femur (thighbone) sits on top of the tibia (big bone of the lower leg.) You can see the fibula (smaller outside bone, lower leg) has little to do with supporting your weight. Now here are the parts of the knee you’ve probably heard about being injured in sports: Between the femur and the tibia are the cushioning left (lateral) and right (medial) meniscuses, also called cartilage. The lateral collateral ligament (LCL) is brown and to the extreme left. The medial collateral ligament (MCL) is to the extreme right. The brown piece in the middle is the anterior cruciate ligament (ACL.)

The knee is a hinge joint. It uses tendons attached from muscles to bones to flex and extend your lower leg.

Ligaments connect bone to bone, and the knee has four. Without them, your knee would buckle with the least little shift in weight.

A thick cartilage, called meniscus, separates and cushions the thighbone (femur) and lower leg bone (tibia) so they won’t crunch together and wear down.

Both how you get injured and your symptoms help indicate which part of the knee you’ve damaged.

A twisting of the knee or a direct hit on the side can tear the cartilage. This can cause pain and swelling. Walking may be difficult. Sometimes the torn cartilage can twist out of position and cause your knee to lock.

Tearing a ligament usually takes more force, either with a direct hit or falling awkwardly. It, too, can cause pain and swelling, and sometimes the knee feels unstable.

In addition, with any of this trauma, you can fracture a bone. The most common fracture would be a crack in the upper tibia.

And of course, you can sprain a knee ligament, tendon, or muscle without tearing it.

 

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Fracture Vs. Tear Vs. Knee-Sprain Symptoms

 

Symptom/Sign Possible Injury
One area aches, knee feels stable, there’s no swelling. Sprain.
Knee feels unstable. Torn ligament (the stabilizing bone-to-bone connection).
Knee locks up. Torn meniscus (the cartilage cushion between your upper and lower leg bones).
Area has a lot of swelling (especially if it comes on quickly). Something serious (fracture, tear, or dislocation; probably not a sprain).
You feel a lot of pain with weight bearing, even when the leg is straight. Fracture.
Bone or joint looks distorted. Fracture, dislocation, or both.
Area looks distorted and you can’t feel a pulse in the foot. Injury to an artery. This is an emergency. Get help immediately. If that’s impossible, at least put the joint or bone back in place, or you may lose a limb. (I’ll need to do a separate post sometime to show how to do that.)

Any time you have these symptoms or the pain is bad even without weight bearing, you need to see a doctor. (See “When Should I Get to a Doctor?”)

Treatment for When There Is No Doctor
How to Stabilize a Knee

Here are four ways to stabilize a knee when you have a tear, break, or dislocation:

  1. Use a brace (preferred).
  2. Use an elastic bandage.
  3. Make a knee immobilizer with two Sam Splints, one on the outside and one on the inside of the knee. Bandage them in place with the leg straight. If you don’t have two Sam Splints, you could use sticks.
  4. Wrap the knee with a sweater or a blanket or anything that will keep it extended.

If getting to a doctor is impossible, here are some things you can do until it is possible.

1. Get off your knee. Sit or lie down where you are. The first steps with any sprain or tear are RICE (rest, ice, compression with an elastic bandage, and elevation).

Next, evaluate what may be wrong.

2. Look at the injury. If the area looks distorted, you’ve broken a bone or dislocated your knee joint, and you’re going to need to stabilize and stay off of it. Get to a doctor if at all possible.

3. Feel around the joint and the bone. If there’s one spot of exquisite tenderness there’s a good chance you’ve broken or torn something.

4. Move the knee around by flexing it and extending it. If you can’t or it hurts really badly, you’ve probably got a significant injury.

In these next steps, you’ll keep evaluating the injury but also deal with your mobility.

5. If the leg is not distorted, slowly get up to see if weight bearing hurts badly or the knee feels unstable. If it does, don’t try to walk. You’re going to need help or a makeshift crutch or cane.

6. If you’ve stabilized the knee in the straight position (per step 2) and it still hurts to bear weight, a bone may be broken. You need a crutch or crutches so you can walk without bearing weight on the injured leg. (Putting weight on it may make things worse.)

7. If it only hurts badly when you try to walk with the knee flexing, and the knee seems stable, something still may be torn. (A lot of swelling is another sign of a possible tear.) It’s not as essential, but a brace, even an ace bandage may help.

8. If you’ve stabilized the knee and it doesn’t hurt to bear weight, you may still benefit from some sort of cane. Use it in the hand of the unhurt side, swinging the hurt leg forward and bracing with the cane on the opposite side to keep your balance as you walk.

Tearing a cartilage or ligament is not in itself an emergency. Most people end up having surgery, especially if the knee is unstable or severe pain continues, but I know many who do just fine without ever succumbing to the scalpel.

What’s been your experience with knee injuries? How did you injure your knee? What were your symptoms? What was the treatment? What was the outcome?

** UPDATE: Got Questions? I’ve answered four FAQs here. **

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Photo of knee splint by Andrea Lofthouse on Flickr. Photo of plastic knee by April J. Gazmen on Flickr.

  • MayThom1

    I fell on my leg badly whilst skiing yesterday, I now cannot walk on it without severe pain and can not bear weight well at all, my leg cannot extend or bend without pain either, there is lots of swelling and a purple mark is appearing on my upper calf where there is lots of sharp pains and tenderness, should I see a doctor or just continue with RICE?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      See a doctor.

  • Romano

    I hit my knee 12 days ago on a motor accident, had mild pain and swelling, and mild instability. Now i can bear weight and walk with limp. There’s only very little swell. But my problem is that there is pain in my calf, as that pain after a cramps. The pain slowly subsides after i try to exercise and walk, but it comes back again when I wake up from sleep. What could be the cause??

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Anything from a strained muscle to a blood clot. Sounds like you should have it checked out.

  • maejohns

    I’m 20 years old. I was sitting on the couch with my legs close to my chest but my right leg crossed over my left, which I put down to rest on the couch and I was twisted wierdly I believe while checking my phone. I stayed in that position for a good minute (probably 20-30) and when I was getting up from that position my new felt funny. I stood up and tried to take a step and felt a very sharp pain. I stop to rest than tried again. After a couple of steps I felt another sharp pain and stumbled as if my new was giving out on me. Do you have any clue what is the problem with my knee and has it’s only a tad bit swollen

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Other than the typical leg falling asleep, no I don’t know. If it continues to bother you, you should have it checked.

  • Peyton or Pey pey

    My friend pushed me into a chair knee first and my knee felt like it snapped back, I have Osgood Schlatters disease, but the pain has never been this bad. I don’t want the treatment to cost a lot of money and there to be nothing wrong, but I need help. My smptoms are:
    Severe Pain
    Swelling
    Inability to straighten knee
    Inability to bend knee
    Weight bearing possible, but painful
    Pain is along the back of my knee
    Please help, I am in a great deal of pain.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sorry, but I can’t give specific advice without an exam. In general for bruises, ice packs, limited weight bearing, and ibuprofen can help. And there’s this. http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/
      Sounds like you need to have it checked out. Certainly if it doesn’t get better soon.

  • boo

    i got out of bed to let dog out the kitchen is only five feet from my room by the time i hit kitchen door i couldnt bear to stand on right knee bending it up wards dont hurt but bending leg straight out kills me shocking pain it feels like grinding and poping its not swollen but has pain to it what should i do

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If this is still going on, you should see your doctor or go to an urgent care clinic for an exam and an xray. It could be anything from a small crack to a flareup of arthritis.

  • preeti

    On 19 december 2014 i slipped on ice and fell on my back, waist, but i felt a pain from my knee and for few minutes i could not get up at all. My eyes became teary as i was unable to lift myself even after that. I stood up with the help of 2 girls. Later I had pain around my back lower waist and my thighs and was very tired. Now in January one day i felt sharp pain on my right knee so much that i rubbed myself. My leg was up on the bed while i was sitting in the chair. But still the pain was very sharp and it went away after sometime. But after couple of days again i cannot walk now. I feel immense pain suddenly while going to school and i limp on my right leg. I cannot absolutely bend my right knee while boarding and getting off bus and i cannot go on the stairs. After some time when sun comes up my leg gets better i dont limp but i have pain bending. But the sharp pain in my leg returns everyday 4-5 times a day. What is it- a sprain? What is the cure?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sorry, but I can’t make a specific diagnosis without an exam. You should tell your parents and have it checked further. Here’s another couple of posts on general knee problems. http://www.thesurvivaldoctor.com/2013/02/25/knee-diagnosis/ http://www.thesurvivaldoctor.com/2012/10/02/osgood-schlatter-treatment/
      The problem you’re having good be anything from residual inflammation from a bruise or sprain, to a tear or crack.

      • preeti

        Thank you and just to let you know iam 43 years old

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          Oops. You said school and I assumed. Assumptions are one of the reasons I can’t specifically diagnose and specifically treat. Sorry. So, umm, disregard the parents comment and the possibility of Osgood-Schlatter’s. I’d have it checked by a doctor.

  • Alejandra Sánchez

    Hi! I had a car accident and I hurt my left knee. I felt like a hot liquid was inside my knee and after that I have a big pain and it feels hot in the inside. What should be? Is it something to worry about? Should a go to see a doctor?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Yes.

  • immobile & hating it

    hi. im 44, overweight and yesterday while doing zumba my left knee buckled. It was extremely painful for about 10-15 minutes. I elevated & iced it right away. I couldn’t put any weight on it all at. It is not swollen. I do not have a fever. it doesn’t hurt unless unless I try to walk on it. I can bind it. I have a brace on it now and am using crutches to get around. I can handle a little more weight today but it still hurts and feels like it’s going to give out if I attempt to try to walk. Any suggestions?

  • lesley

    I hurt my knee about a month ago when it happened my knee swelled and was painfull so i put ice on it rested it then bought a brace to help my knee is still sore the swelling has gone but now i have bruising round front and it is still really sore to bend down and up can anyone give me some advice was thinkin about seeing my gp but unsure because i dont want to waste gp time

    • lesley

      Just to add i use my foot to pull heavy crates out of a lift but stopped doing it plus it hurts to keep my leg straight when sat down and elivate it behind my knee and front and also down my calf

      • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

        If you’re still having symptoms a month after injury, it’s certainly time to see your doctor.

  • shravan234

    Hi,
    I was pushing a treadmill down to the basement. I just pushed and slided it across the stairs and floor mostly. However, since then i’m constatntly worried if i might have hurt my left knee. There hasnt been any pain, i can walk, jog (doing it upto 4mph). It has been nearly 2-3 weeks. There was a little soreness in my left leg initially especially while sitting with knee down or riding upstairs but it has gone now for most part. However i still can’t do away with the thoughts of if my knee is hurt. I keep squatting, take some load upstairs and other such movements looking for if something is hurting. Not sure if im panicking too much or there could be really something. Any range of movements which i can try tp make sure everything is ok?
    Thanks,
    Shravan

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sounds like you should have it checked out for your peace of mind. But, you say there are no symptoms. If that’s the case, maybe you should talk to the doctor also about why your obsessed with this.