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.

  • Meeshyell Proulx

    I seen a dr today about my knee , I twisted it and it really hurts to walk on it I can barely stand or put weight on it , every time I walk or move my knee I feel something rubbing inside like something is clunking can a simple sprain cause the clunking ? I have some swelling , should I see another dr ?
    Any info appreciated

  • Jilly bean

    I’ve never broken a bone or had a swollen affect on any bone in my life so I don’t know what it is or what to do all I know is the problem is my knee I went fishing n there is this tree we had to jump over so I jumped off the tree n I think I landed wrong but I didn’t feel anything at first (btw we don’t sit we are standing for hours) I started to feel some discomfort in my leg but mostly towards my knee area I didn’t think anything of it at first but after more hours passing it started becoming a little painful to bend my leg but its weird its like if I bend it all the way back it adjust but it will kinda hurt when I try to bend it back straight it’s been 3 days and Its not swollen but when no force is pushed down when I walk it feels just fine but I don’t think me dragging my leg is okay for recovery so what can I do to help it

  • Juan Osorio

    Last night while playing soccer I twisted my knee badly after running full speed and stopping at a weird angle. I felt very horrible pain and still do. It’s swollen and I can barely move it , I’m using crutches because I can’t bear any weight at all much less walk on it. The worst part is I’m in brazil and medical attention is out of the question for now. I’m using the rice technique but can anyone enlighten me as to how long I can go without medical attention if I rest it properly?

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

      Juan, I guess you could go as long as you have to, as long as you’re not putting weight on it. But your muscles will get weaker with time. Certainly you should get a good knee brace, and get expert care as soon as you can.

      • Juan Osorio

        Thank you very much, these symptoms mean it’s most likely a serious injury right?:(

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

          Yes, Most likely.

  • A.dufrene

    my Mri result show
    Traumatic Oedema of acl any one knws what its mean

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

      It means your ACL–Anterior Cruciate Ligament–in your knee is swollen. I’m guessing sprained. Traumatic means from injury, Oedema means swelling. It doesn’t mention a tear which is good.

  • Linda

    I have been feeling sciatic type pain in my left buttock for months then I recently had a deep tissue massage at an Asian reflexology place a few days ago. The masseuse only did a little work on the backs of my legs using forearm. It did not hurt at all at the time but when I woke up the next morning. .. my left knee is hurting. It doesn’t appear swollen and I can walk on it. Going up and down steps is painful because bending and straightening is difficult. ButifI’m laying on my side, I can bend more easily with the sporty of the bed. It’s very tender at the top of my knee. Could it possibly be sciatic related as Nurse Laura described?

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

      Linda, generally, sciatica is not going to cause specific tenderness (tenderness meaning it hurts to touch) in the knee. However, if more than the knee hurts, the odds go up on it being sciatica. Either way, if it’s not going away, you should have it checked out.

    • Linda

      Support of the bed.

  • Bree Marie

    Hello, I stumbled upon your page/blog thing and though I do not expect you to tell me whats wrong with my knees, maybe you could help me with some advise on how to help them =] I moved to Aussie in January with a work and holiday visa, so I don’t have medical insurance till January when I return to america, and there pretty expensive here when it comes to medical help.

    Long story short, Iv always have joint problems, knees would always buckle up and down stairs could barely hold my own weight and at 135 that’s not exactly a good sign. Everyone always told me I needed to exercise my knees more, build muscle so I started that a few years ago, my knees felt a little better but still ached before rain, when it would get cold and still buckle occasionally. When I gained weight my knees stopped doing it as much which was odd but I don’t exactly want to look a gift horse in the mouth so.. I went with it.
    Well recently my knees went from fine for 3 years to suddenly worse with in a day.

    One minute im okay next minute my knees unable to support my weight its unable to bend its going limp when its bending an intense pain filled the left upper side of my right knee cap. When bent it feels like the skins being pulled back and when I release it from a bent position it feels as if someones taking a reflex hammer and hitting it off the center of my knee cap, as it straightens it gets a numb dull feeling and pops then is fine for about 5 minutes before a straight position begins to feel the same as the bent.

    Due to this I have asked my job to not schedule me for the past week and spent most of my time in bed, After the first day of it buckling and resting, It started to get stable enough to lock it in place and put weight on it but rest did not seem to do anything for it other then get rid of the swelling. I read what you wrote up there but I have no idea if any of what I have going on with my knee is the same as up there. I didn’t injure it or fall on it, there was no excessive use it does not hurt under the knee cap in the front or top, it doesnt hurt on the right side of my knee cap or near the joint. Its only on the top of the knee cap and to the upper left of it. Easiest to explain would be bend your knee feel for the pointed part on the left side and that is where it hurts badly. my left knee aches occasionally and buckles cause it has to make up for what the right one can not do currently. but when feeling the joint and bones they feel the same, I know theres no way to really know exactly what it is without a machine looking in to check it out but you never know you might actually have an idea of what it may be and give me the best advise as to how i should go about treating it.

    Well thank you for your time, Sorry this wasn’t as short as I would of liked it to be.
    And like I said if you don’t know its okay =]

    Best regards,
    Bree Marie.

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

      Bree Marie, You’re correct. I can’t tell what’s going on. You should at least see a doctor for a good exam. You can see what extra tests are recommended and what would be the harms in waiting. In general, things that come to mind are arthritis which can flare up and go away. Initial treatment wound be ibuprofen, naproxen, or acetaminophen, and a moderate degree of heat for about 15 mins four times a day. A little foreign body could do it from a tiny piece of bone chipping off in the past (there doesn’t have to be known trauma), or possible a buckle tear of cartilage which can sometimes move out of place and give pain, and sometimes stay in place and not give pain. I do have a couple of more posts here http://www.thesurvivaldoctor.com/2013/02/25/knee-diagnosis/ and here http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

      • Bree Marie

        Ill check them out, thank you for your response and help, I plan on seeing a doctor first thing when I either get insurance or go back to america. Not the best choice and im aware, But its my only option for now. But I at least feel a bit more at ease without the worry of loosing a limb. jokes.. of course but none the less. =]

        Have a lovely day! and again thank you for your time.

  • Scott

    Hello, I fell and smashed my knee into the ground. I can do just about anything without any pain, run, jump, anything except kneel on it and bend it all the way without it hurting really bad. It swells a little if im kneeling down a lot during the day. Any ideas?

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

      Bruises of the bone can be very tender to pressure and can last a long time. Bruises of the kneecap can be especially be tender because there is no padding. But, of course, that’s generalization. If you have concerns, you should have it checked.

      • Scott

        Thank you for your response. Why would the knee keep stiffening up if I keep it in one position too long? Last question is after a day at work my knee is swollen just around the top right below the leg muscle and the outside of the knee is swollen also. What causes the swelling. Thank you.

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

          injured muscles or joints stiffen up. I’m not sure the exact cause but almost all do. Swelling is usually from inflammation and injury. In the legs, it usually will get worse toward the end of the day because of gravity and being on it more.

          • Scott

            Is it a concern that the knee still gets stiff? I was told I could’ve severely bruised my knee or knee cap. Its been 6 weeks, could it be a really severe bruise? Thank you for answering my questions, I really appreciate it.

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

            If it’s still giving you trouble, you should should have it checked out.

  • John Smart

    Hi, I twisted my knee playing soccer , by changing direction a bit too quickly , when it got twisted I fell to the ground and couldn’t move , 3 weeks on , I can walk properly even run but every time I straighten my whole leg , something at the back of my knee hurts , what injury do you think I have ?

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

      John it could be anything from a tear at the back of some cartilage to a sprain or tear of the post. cruciate ligament. You need an exam to pinpoint it better.

  • Pingback: Knee Injury Prevention: Lessons Learned From Girls Soccer «

  • Phil

    I was sitting on my couch, knee bent, with my leg under me while I played on the laptop. Was in this position for 30- 45 minutes, as I am quite often. When I went to get up and walk, I felt a very painful sensation in my inner knee, kind of like where you can feel that tendon or ligament with your fingers. In fact, it is painful to the touch. Absolutely no swelling. When I straighten it out (lying position) or walk for a minute, the pain is not as intense. My question is, could I have damaged something just by sitting funny, and then getting up quickly?

    • Phil

      The pain is somewhere between the inside of the knee and the inner thigh.

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

        Phil, yes you could have injured something. More likely it’s an area is a little inflamed or stretched, or you injured something sometime prior. Hopefully, moving around will relieve the pain. If not, you should have it checked out.