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.

  • Jack F. Snow

    Wow, what a helpful thread.

    I suffered a hyperextension injury to my left knee three months ago exactly, which caused a large bone bruise. I limped around for a month — at first quite badly. In about a month I was able to walk again without a limp, but shortly thereafter (maybe a week after I finally felt I was recovering) my knee began to give out and lock up. I was convinced this was related to the earlier injury but my orthopedist, who saw me a second time five days ago, said it was mostly a flareup of osteoarthritis. I am in my early 40s but have very bad OA from two previous traumatic injuries and two previous arthroscopic surgeries. She (my orthopedist) told me that arthritic growth behind the kneecap renders me incapable of straightening the knee, and this is contributing to the weakness along with the fact that I favored the right leg for about a month after the hyperextension injury, and therefore allowed the muscles in the left leg to weaken.

    I got a cortisone injection (my first), have been icing, taking Meloxicam and Advil, and using Tiger Balm. I feel little relief, but I am perhaps just a touch better. I have PT scheduled but haven’t begun (thanks Obamacare).

    The big issue for me is that I still limp badly. I can’t NOT limp. It used to be that I would limp on purpose to keep the leg straight and avoid the painful instability of a give-out. But now, after all the treatments mentioned above, I feel the knee is a bit stronger. I’m not really fearful of it giving out. But it’s almost as if my body has forgotten how to walk without a limp. I never limped before.

    I guess my question is, will I ever not limp? Can PT help these problems? My orthopedist also suggested (strongly) that I consult with a doctor who performs knee replacements. But I am hoping to at least get back to where I was before the recent injury, when I could (and did) walk just fine.

    Happy to provide any more info, if you are still reading and answering here.

    Thank you in advance.

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

      In general, PT can often help with such problems. So can keeping your weight normal and, sometimes, something like chondroitin/ Glucosamine. But many people with bad knee arthritis eventually end up getting total knee replacements. The problem with those is they may only last around 10 years so a lot of doctors don’t recommend them until you’re in your 50s or 60s. But there are exceptions. I’d suggest you follow your personal doctor’s advice.

  • Elizabeth Olivarez

    I was wrestling and my bf popped my knee we heard it it hurts when I walk

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

      Have someone–parent, nurse, trainer–check it.

  • Bookworm

    My leg really hurts and my DAD is not tacking me to a doctor what surged I do?

  • Tessa

    Also I heard popping sound when I fell also when I try walking on it.

  • Tessa

    I fell in a active class and twisted my knee and fell on it I already have a fractured wrist so I couldn’t caught myself. I went to the ER they said it was sprained and it’s been 3 days and it just hurts worse…

    • Tessa

      I need advice as soon as possible please. ?.

  • lidh

    Well, I don’t even know if this is serious at all, but I slipped in the shower and fell. I had extreme pain for like 4-5 minutes, and it went away. It’s been about 5 days since the event. No significant swelling was noticed. However, when I touch the joint, a part feels tender (almost as if something is moving underneath it.) If I bang the knee a specific way, I experience significant pain for about a minute, and everything’s back to normal. I can walk, flex my knee, and can completely extend it. I could also do those three immediately after falling.
    I’m extremely busy till about mid-March and want to know if I can put off seeing a doctor until then? Also, what’s up with my knee? I’m a teenager, and female, of that helps.

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

      Have a trainer, coach, or nurse check it. Also tell your parents. Unless there’s suspicion of a break, most knee injuries are not emergencies if you’re careful and don’t injure it more.

  • Fonshell Banks

    Fell down stairs. Hurts to walk stand extend bend my knee.Just hurts really really bad

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

      Sorry to hear that, Fonshell.

      • Fonshell Banks

        Went to ER it is sprained.

  • Malu

    Hello, two weeks ago I was on my knee and when I got up my knee dislocated but j managed to put it back. For some reason that kept happening for months so I thought this time it would be the same. But the day after my knee started hurting and I could barely walk so, I put on a brace and it got a little better. Now I can walk but I still have the brace on and when I try to bend my leg, it feels tight. So now I am walking slow because I’m scare it might dislocate again. Should I see a doctor? Or should I wait to see if it gets better?

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

      You should see a doctor.

  • Daniel Poblete

    Hello
    Yesterday I went snowboarding and I jump a big ram when I landed I landed good, but I felt like my whole weight went to my right knee and I had to stop immediately because the awkward feeling I had on my knee. I don’t feel pain it’s just an extra te feelings and every time I move my leg I feel like a pop on my knee
    Like if I was cracking it.
    Should I be worried ? Or just put ice on it
    Because I’m going to start playing tennis on March and I want it to heal the fastest possible

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

      In general RICES and weight bearing only as tolerated (may need a cane or crutches) it’s usually ok to wait a few days. That’s general. Since I haven’t check your knee I can’t give you individual advice.

  • parker “paws” lord

    So im a high school wrestler and regionals is right around the corner and today i hit my top knee on a metal piece while wrestling slamming hard into it by accident my knee stiffenned in a half bent position and i couldnt feel it for a bit i got up and finished practice and i got ice on it but when i bend it at all more than 45 degrees i have a sharp pain just above the knee cap and it feels as if my whole knee front and back of knee stiffens up. What could this be?

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

      It could be a number of things including a bone bruise. I’d have your coach and parents check it to see if you need to see a doctor.