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.

  • Kyle Allen

    fell on my knee skateboarding on sunday. had almost like a burning sensation on the right side of my right knee when it occurred but was able to still use it just fine. its now Wednesday and it hurts to bear weight on my right knee and hurts when I touch it against anything. I feel almost no pain though otherwise. still able to stand on it just fine as well

  • Sarah

    Im a dancer at the age 17and1/2. Yesterday I dislocated my left knee going down in the splits. I found it strage that instead of my knee cap going out to the left it went out to the right. Should I be concerned about this?

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

      Dislocations are more common going outward than inward but they can go either way. And either way, if it was fully dislocated then you’re having pain and swelling and should have it checked out by a healthcare provider. Meantime, it’s crutches and RICE. http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

  • Omar Shehadeh

    Actually it was the left side/back of my LEFT knee, not right, sorry :p

  • Omar Shehadeh

    Hi there. In case you still reply… I got kicked by someone on the left side/back of my right knee two days ago, but it’s not serious since I can still walk, run, and even play basketball normally. But, when I put weight on it while stretching, squatting, or just trying to balance on it, it hurts. I wonder if it’s possible that it will heal by itself or if I should visit the doctor? It’s confusing since there’s no pain when playing basketball but there is while stretching, balancing on it, etc…

  • Tyler Brady

    ok I was playing a game of football and we didn’t have any pads anyway I tackled a kid that was probably 300 pounds or so the adding 2 or 3 more kids that were any where from 120 to 100 pounds and when I tackled him he landed on my knee and it bruised but every time I put my hand on the knee and add pressure and push forward slightly I can feel it pop 2 or 3 times and in this process I go into pain adding this is on my right knee on the left side of this knee can you help?

  • Soccer knees are the worst

    I’m a 20 yr old girl. I was playing a pick up soccer game yesterday and the opposing team barreled into my leg as I was running perpendicular to them. I heard cracking noises in my knee (not an ACL pop though, I’ve done that before in my other knee – feels different this time) and the pain was intense. I was able to walk off the field, albeit slowly, and have been icing and resting ever since. I am able to walk, but it’s very slow. My knee is is about 25% bigger/swollen than my other knee. Any twisting and pivoting is impossible and when I do it on accident, sometimes my knee feels like it’s got too much give and is loose and is accompanied by a lot of pain. I’ve got it wrapped and am seeing a doctor soon. What do you think it is in the mean time and is there anything else I should be doing besides ice and ibuprofen?

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

      Sounds like you’re doing everything right. Be sure to used crutches as needed. Here’s a post on RICE http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/
      As for what it is, it could be anything from a tear to a sprain with no tear to a break.

  • Gracie E

    Hey,
    A few weeks ago my knee started to hurt. It hurt to walk up and down stairs, and jumping/landing on my knee. There was no swelling, but it did hurt for 3 days. I don’t remeber doing anything to hurt it. After 3days it went away.
    This morning I woke up with sharp pain in my knee. It was in the same spot and same knee that had hurt a few weeks earlier. But this time the pain was 3 times worse. Still there is no swekking. But it hurts to walk!! I can’t walk, run, jump, or even bend my knee without it hurting! I took ibufrofen and the pain went back to the way it was a few weeks back.
    What should I do? Should I go to the doctor? Should I just take ibuprofen? Help me!
    -Gracie E

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

      Yes, you should have it checked out.

  • Gracie E

    Hey,
    A few weeks ago my knee started to hurt. It hurt to walk up and down stairs, and jumping/landing on my knee. There was no swelling, but it did hurt for 3 days. I don’t remeber doing anything to hurt it. After 3days it went away.
    This morning I woke up with sharp pain in my knee. It was in the same spot and same knee that had hurt a few weeks earlier. But this time the pain was 3 times worse. It hurt sto walk!! I can’t walk, run, jump, or even bend my knee without it hurting! I took ibufrofen and the pain went back to the way it was a few weeks back.
    What should I do? Should I go to the doctor? Should I just take ibuprofen? Help me!
    -Gracie E

  • cheerleader7

    Hey,
    About a couple of weeks ago my knee started to hurt one day. It hurt walking up and down stairs and jumping/landing on it. This pain lasted about 3 days and then went away. This morning I woke up with sharp pain in the same spot on the same knee. But the pain was almost three times as bad as the first time. It hurts to walk and run, basically it hurts to bend it. But I don’t see any swelling. I took ibuprofen around noon and it dosent hurt as much. The pain is the same as It was a couple of weeks ago since Ive taken ibuprofen . Should I go to the doctor? Or should I just ice it and take ibuprofen? I don’t want to go to the doctor and them to tell me I’m fine. What should I do?

  • Jake

    Hi, I am really having problems with my knees. I am only fourteen and the pain is quite unbearing at some points. I have taken medicine and rested and my parents push it off like it is nothing, but I believe there is something more. my knees have been giving me problems for about the past two years to a year. They spike up worse than other times. They get very sore, achy, very unstable(leg gives out). I have been very active in sports and am not in any way overweight. I play catcher for baseball, run a lot, and play soccer. It just hurts a lot and I could use some help

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

      This is the most common problem in teens knees. Do you have a trainer or nurse who could check you out? Did you sit down and talk to your parents about how much trouble they are giving you? Perhaps they could check them when you’re having a flareup.