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.

  • Amaryllis Shafer

    I was running outside about a month ago and my foot got caught on a paving stone for a walkway and I didn’t fall but I almost did. I felt pain in my knee and ankle but it only lasted about 5 minutes. Today bending down I felt extreme pain and it felt as if something slid over my knee cap or out of place. I started walking and the pain lasted about 30 seconds, but it still seems sore, kind of like a numbing dull pain. Should this be something that I should get looked at?

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

      If the pain continues or you have recurrences, you should have it checked out.

  • Corner Three

    I regularly play basketball twice a week. Usually on Tuesdays and Wednesdays (I know, stupid schedule, no choice though). Last week, felt some slight pain in my left knee as I was going up for a jumpshot, but it went away after ~10 s. The next day I played for 2 hours pain-free. Had some sore muscles for a day on Thursday, but nothing else and then, inexplicably, on Friday as I was walking back from work my knee started feeling extremely unstable. There was no poop, no fall. no contact, no twisting motion. It just was walking through the snow and it wasn’t stable, then I felt some sharper pain a few times, when the knee moved irregularly and it was getting harder to walk. I got back though, there was some slight swelling at the front of the knee (slightly below the kneecap) and I had trouble fully extending it (the motion was possible, but there was some slight pain at, as it seemed, right below the kneecap) and fully bending it (the pain would be at the back of knee, at that motion). Gave it a rest for the day. Then on Saturday, all the swelling had gone away, I could fully bend the knee, though the pain still persisted at full extension (it’s not very painful, just very noticeable). The knee still gave me trouble walking, felt unstable. It got a little better with more rest, but as I came back to work on Monday, I had trouble getting to and from work. I walk with a limp, more so using the front of my foot and not fully extending the leg. I’m seeing the traumatologist on Monday, but just from reading and having some knowledge from my friends who’ve had acl tears (multiple surgeries) and meniscus tears, seems like a very unusual case I’m in.

    The instability is the biggest symptom, pain was very seldom and swelling was very little and went away the next day. No contact, no twisting motion. Is it possible a sprain or overuse could’ve caused this. What are the chances of a tear in the ACL, or could this be another ligament or even the meniscus?

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

      Sounds like you should keep the appointment.

  • Brandon Reid

    Saturday night I twisted my knee and I heard the infamous pop and my knee doesn’t hurt as bad when my leg is relaxed but when I stand up I have considerable pain in the top of my knee cap and down the outside of my knee into my thigh. When I first stand up or climb stairs it feels like it could explode also you can feel something move it almost feels like a rubber band being flipped on the outside of my knee. I bought a knee brace from Walgreens but it provides little to no relief.

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

      Sounds like you should have it checked.

  • carolyn mqguire

    the other day my daughter was playing indoor soccer and she and another girl kicked the ball at the same time. Sje went down but then she waved me off saying she was okay then i could see the pain. At home she is having trouble going up and down the stairs should it is her knee that is bothering in one spot and she can barey walk. do you know what this is or should i take her to the doctor

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

      If it twisted her knee, it could be a sprain or a tear. If she’s not getting better she should see a doctor.

  • Ka’mila Mathis

    I fell the other night and landed on a toy I guess hitting my knee cap really hard. There isn’t much swelling but I have trouble with stairs and two spots are very painful to touch sending shocking pain through my knee. The er Dr said I bruised it he guesses. But I have no visible bruises . I’ve has surgery on this knee in the past so not sure what to do now. Any suggestions of what might be wrong? I just don’t agree with the bruise theory

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

      Bruised bones can hurt for weeks and show no external sign of the bruise. But, if it’s not getting better I’d get an appointment to see your regular doctor, or the one that did the surgery.

  • Axelle Knight

    I slipped at awkward position , my left leg sliding left, crashed on the floor on right side on my left leg, felt two pop, doesn’t hurt much, but can’t jump or anything slimilar, because I would feel my knee buckle out of place then back. Fast foward 6 hour later, knee is extremely sore, hard to walk on, can’t really bend my leg much, it’s stiff, ice doesn’t help. What should I do? (doctor appointment only at last resort)

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

      Sorry for the delay. I’ve been traveling. If it’s sill hurting a lot you definitely should have it checked out, preferably by a doctor.

  • Grifftannen

    Dr. Hubbard thank you for this site, diagram, information and commitment to response, very impressive…Unfortunately I injured my left knee stepping up two stairs in one step yesterday, it seemed like I put my weight in the wrong spot as I stepped up and felt this twinge like feeling, I continued up the staircase and throughout my day which consisted of mild walking and minimal weight bearing with slight discomfort, no signs of swelling or continuous pain. When I woke up today I could feel a throb and dull pain as I lied in bed and had difficulty freely moving the leg/knee around to get out of bed. Had minimal activity throughout day and have noticed I have difficulty bending and weight bearing and am now walking with a limp. The knee seems to be tender on the inner side and I have the same dull pain/sensation in the top of my shin when I extend my leg and try to hold it upward for a short while, which doesn’t have full range of motion or strength as well. I have an ortho appt. a week from now, any thoughts on this symptomology? Thank you. Sean R.

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

      Could be a strain or injured cartilage or, of course, something else. RICE may help initially and possibly a cane if it hurts to walk. If it gets bad and you need something before the ortho appt., you could go to an urgent care clinic.

      • Grifftannen

        Thx for your thoughts and timely response, hope it improves sooner than later, have a good day doctor.

  • Dylan

    Hey i need help! I’m 21 years of age, and i play futsal (indoor football) 2-3 times regularly on a weekly basis. Over the past few months, i’ve experienced a pain in my knee after each game i play. The severity of it however is reliant on how heavy the game was. If it wasn’t all that strenuous, i would only feel a bit of pain in my knee, and limp a little for a day after. In the case where the game is more strenuous, i would feel pain in the knee every time i stand up, getting into my car and out, even at times walking down the stairs. I’ve been to the GP, and they have suggested against an MRI and said that it’s nothing serious, and all i needed was time to let it heal. But i’ve tried letting it heal for at least 8 weeks or so, and played again, nothing has changed, the pattern remains. I do use a knee guard fitted by my doctor when i play which helps. But this leads me to ask the question. What really should i do to fix this? Or should it not be much of a concern to me at all and that it would not get much worse? HELP NEEDED! @@drhubbard:disqus I would really appreciate all the help i can get. Cheers.

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

      I’d suggest going back to the gp. Since you haven’t gotten better he may change his opinion on further testing. Or get a second opinion either from another gp or an orthopedist.

      • Dylan

        Thank you so much Sir James! Also actually i was wondering.. Do you think i should be doing that MRI? Eventhough say, if the doc really does not recommend it and says it’s not necessary? His reasoning is that my injuries are not severe and MRI gives radiation that takes away lifespan and things of such nature. Haha, do you suggest i do the MRI even if the doctor remains this way? @drhubbard:disqus

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

          No. In the first place it’s unlikely someone will do an MRI without a healthcare provider’s order. Secondly, if you get a second opinion and they agree you don’t need one, the it’s very likely you don’t.

          • Dylan

            Thank you so much for your advice Mr Hubbard. Really very much appreciated. Cheers!

  • Brandon Fragale

    I was playing baseball a couple of weeks ago and while running my foot got caught in a hole, I fell awkwardly and heard a small pop. I was able to walk off under my own power gingerly and got it immediately wrapped with ice. My main pain location was inside of my knee. I used a brace for about a week and now able to walk without brace but not fully yet. I can squat past a sit no problem but still can’t fully extend without discomfort and also from time to time i can a stabbing pain on the inside of my knee if i twist sharply getting in and out of bed or car.

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

      Sorry to hear that. Maybe you should get a coach or trainer to check it.

  • Jose

    I hurt my right knee in a soccer game. It was a sudden twist and I felt a lot of pain. After a few minutes I could bare my weight and was able to walk. I reentered the game and the first sudden move my knee sorta bent inwards and felt really instable. I got x rays and nothing was wrong. After a few days I was able to walk. I rested about 2 weeks and I was able to run again. But when I started playing a sudden move made my knee feel really unstable and I couldn’t bare my weight and it had happened all over again. After a few days I was walking and I waited 3 weeks this time and I even went for a run and didn’t feel pain. After I ran I played the next day and I felt okay I was scared to hurt it but I thought it was all in my head. One sudden twist/privot and I was back where I started. Any a dive would really help l. Thank you.

    • Jose

      Any advice would really help. Thank you.

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

        You should see a doctor to make sure you didn’t tear cartilage. That way you’ll know if you need it repaired or if it’s just a bad sprain and you need to rest it longer than 3 weeks.