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.

  • Rachel

    I’m 19 years old and just a little over a year ago I went ice skating with some friends and I was spinning in a circle and I fell and my knee went the opposite direction and I heard a pop. As soon as it happened my knee swelled up and I basically had to limp. I wasn’t able to straighten my knee at all. And it hurt to bend it as well. But I never went to a doctor. Well it took it a couple months for the swelling to finally go down. And I was able to straighten and bend my knee. But with just a little pain every now and then. Well now the pain has just gotten worse. And it hurts when I bend and now I can feel it popping in and out of place when I go to straighten it and it hurts… Why is this happening??

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

      It could be anything from a flareup of inflammation to a new, unrelated injury. One possibility is with the injury a year ago, cartilage may have been partially torn in what’s called a buckle tear. If that were the case, the tear may feel fine if it stays in place but if it gets displaced (it can do that at random) it will hurt until it’s back into place (at random). Since you don’t have any control on when that happens, you should see a doctor. But that’s only one guess. It sounds like you should be checked to get to the real problem so you’ll know the right treatment.

  • Bilal Ahmed

    Hi
    im 19 yrs old
    playing football 3 weeks ago I landed funny or turned too quickly and there was a pop sound. i couldnt carry on and my knee swelled quickly. I went to the ER and was told to rest. Now the swelling has reduced mostly, i can walk and put weight on my leg like normal. There is little if no pain. Sometimes theres a throbbing (like a healing pain). The only problem is I can’t straighten my knee fully, when i try there is no pain but it feels restricted. when i touch that area it feels jelly- like, like there’s fluid. What do you think it is? I am scheduled to have a MRI scan soon. The specialist on examination yday said it could be an ACL injury? I really dont want to have surgery

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

      Sounds like you’re just going to wait on the MRI results since it could be anything from a bad sprain to a full-blown tear.

  • Mr. Joe

    Tell me something I don’t know. I broke it down in denormous detail for you and that’s all you can state? Whatever.

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

      Mr. Joe, I don’t try to diagnose any individual person I have not examined. I give information that may or may not be of general interest for people to make decisions at times when you can’t have access to medical professionals. That’s all I feel I can do writing a blog post. The orthopedist actually examined your leg. He was able to ask you questions he deemed important to the exam. Even if I tried to diagnose you by your description, I would have to go back and forth multiple times, ask you questions that you’d have to reply to, and still I haven’t checked your leg. Although you probably think you told me everything there is to make a diagnosis, you only told me what you think, as a non-medical person, is important. Basically you told me that you injured your leg 5 months ago. This may or may not be related to it starting to feel unstable 1 month ago. Why does it even have to be related? As for your leg feeling unstable, that would mean different things to different people. For instance (and I don’t won’t you to answer this because it would only lead to more questions) does the joint move, is it weak, have you fallen due to the instablity? are you walking nomally? What activities make it feel unstable? Walking, stairs, squatting? Does if feel unstable all times of the day? Is it your knee only or do you feel more like your going to fall in general? X-rays show bone problems (arthritis or breaks). In general arthritis doesn’t make your leg feel unstable. MRIs show soft tissue such as ligaments or cartilage which hold joints together. So, now, you went to an orthopedist who examined you and suggested an MRI, but you’re not going to do one because you perceived he looked at you funny?

  • Mr. Joe

    Ok here’s one for you. While hiking last October I stepped from the bank into the river. What I though was a foot deep was more like two and a half so my left leg/knee dipped and pushed forward into a forward bend very deeply and very suddenly. No pop, quick burst of pain – probably more surprise and I immediately walked it off no problem and did 5 more hours of hiking in the Zion Narrows to complete the two day hike.
    Next day on an uphill climb I had pain on both sides of the knee. I had a very good knee brace so I put it on for the next three days (still hiked) and when I took it off I was absolutely fine.

    Then a month ago (three months later) my knee began to feel unstable, no pain, just not secure, after 30 days of this feeling (off and on, mostly on) I went to see an orthopedic surgeon TODAY.

    Xrays negative, good spacing, no arthritis, nothing. His physical examination (twisting and turning the leg while grasping the calf and thigh) also showed NOTHING. He says “maybe a Meniscus tear” but would need me to have an MRI done to see.

    So…………how does one explain that, especially with the time gap, feeling healed for 3 months, and then suddenly without any further injury, miss-steps or twists the last 30 days the knee feels unstable?

    When I took Alieve each day for a week (and the weather began to warm a bit I’m in Michigan) the knee started feeling fine (AGAIN Xrays showed NO ARTHRITIS). SO WHAT THE HELL IS GOING ON? I’m 55 years old and have always been athletic, blessed with ridiculously muscular calves and big thighs, strong legs, so the support is there. Is this all in my head? Doc looked at me kind of funny, I could tell, like “why is he here? There’s not a damn thing wrong” BTW I am not going for the MRI, screw that, not after Doc looked at me like I was a hypochondriac. Anyone have any insight here?

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

      Sometimes, the only way to diagnosis injuries to the knee, such as meniscus tears, are by an MRI. Even if the physical exam is equivocol.

  • Randy Gleason

    Hello, I am 20 years old and i have just encountered knee pain for the first time. I didnt do anything like sports or get hit. i simply just started hearing a grinding sound about 5 days ago when i was at my dads. i didnt think anything of it and it was just a feeling that made me feel akward because ive never had any kind of feeling like that before in my knee (right knee). five days later. it hurts to put pressure on my knee and Hobble around when i walk. everytime i bend my knee out all the way i hear a nice pop sound. my leg feels like it is slighty heavier then my other leg. Could you please help me out i am not a very big fan of ER’s. is it pssible i just twistedmy knee and that it can get better on its own?

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

      You certainly don’t have to go to an ER but you should get it checked out by your regular doctor or an urgent care clinic.

  • Samantha

    My left knee feels really uncomfortable when I walk but I can put weight on it. It feels like it needs to pop but when i try to extend and pop it, it hurts. I haven’t fallen or injured my legs..what do you think?

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

      Have someone check it.

  • Main28Cas

    i tripped and fell knee first into a concrete floor (onto the bottom part) around 3 weeks ago and its still giving me trouble ….for the first 4-5 days i couldnt put any weight on it all or bend it, it slowly got easier and eventually if it was wrapped or taped it felt fine. but now it gets very sore even just standing in one spot and it travels up my thigh and even into my calf, i get the feeling of a mini muscle spasm…i just dont know if i should be going to see a doctor or just keep riding it out and taping it up? :)

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

      If it’s 3 weeks and not much better, I’d see a doctor.

  • ss

    About 3 wks ago I fell on some ice. I think I strained my foot but since have recovered but about 2 wks ago I started having a numbing sensation in my knee it made it uncomfortable going up or down stairs and walking. My knee in the last few days has began to swell and pop occasionally. Its painful when it pops and difficult to walk on. I can only bend it so far without being in pain. Plz help

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

      You should have it checked. Sometimes, in an injury, other parts of your body may be damaged. For instance, sprain your ankle and don’t notice at first you also sprained your knee.

  • JennM

    Hello,

    Monday I experienced some knee pain in my left knee when I would bend it, it bruised a little and was swollen that night (no known injury or trauma). Overnight, if I turned in my sleep the knee would wake me up with pain. Tuesday I was limping because it still hurt to bend and also twist a certain way. By Tuesday evening my knee was still swollen and my calf had swelled up too. I went to the ER thinking in may be a blood clot. They did an xray and an ultrasound, no clot, nothing on the xray. They said something “muscle related maybe” and told me to follow up with doc. They wrapped it and put me on crutches since I can’t bear a lot of weight on it. I made an appt with an ortho doc for tomorrow afternoon. The swelling has not gone down at all, I’ve been icing it. This afternoon, the pain is becoming worse, sometimes it feels like burning, sometimes it feels like someone is inside the knee squeezing. When sitting and not moving the knee, I feel these “pops” feels like someone is popping popcorn in the knee or like someone is knocking from inside the knee trying to get out (I know that sounds weird, not sure how better to describe). What could be going on? ER said to come back if pain or swelling got worse before I saw the doc but not sure what they can do??

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

      If there’s no history of any injury, possibly gout? or a flareup of arthritis? If it’s red and warm, infection?

  • 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.