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.

  • Julie

    I’ve been dealing with knee problems for years but nothing has come of it, slight popping. Two months ago, out walking heard a pop with slight pain. Didn’t really bother me until the next day when it became shift and swelled up. Finally saw a knee doctor as a recommendation from the walk-in clinic. He said I have patella problems. I’ve been doing PT for about a month, my knee has increasing gotten better. The other day as I was standing up, I hear a pop, pop, pop, followed my pain on the inner side of my knee. I have slight swelling, tenderness, and shiftiness. I can still bear weight and move around for the most part, slightly uncomfortable. Nothing as bothersome as before. Should I be worried?

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

      Sounds like it’s time to check back with the ortho to see if further tests are in order.

  • Kathleen

    I was dancing, having a good time, and I felt something in my knee, so I just played it safe but kept dancing. Upon leaving I had to limp to the car. Got home went to bed and when I woke up it was difficult to stand on my right leg, my knee let me know it did not want any weight on it. Have been home all day doing RICE and using crutches. I think I need to have xrays to make sure.

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

      Sounds like you need to have it checked out.

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

    In general, unless an unstable fracture is suspected, or damage to circulation, knee injuries aren’t dire emergencies. However, there should be minimal to no weight bearing, if it hurts to do so, until it’s checked. If you’re uncertain, or need something for pain, an urgent care would be cheaper than the ER. Here’s a post on RICE http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

  • ally

    I bashed my knee trying to get into the back of my jeep on Friday night and was in a good amount of pain, on Saturday morning it had started to bruise but not at the surface it looked to be a deeper bruise, well Saturday night (i work overnights at a desk) going to and from the bathroom and walking around hurt it I kept feeling like my knee was getting “stuck” and had to put a lot of force into getting it unstuck. I know you can’t diagnose but my question is should I go to an urgent care or emergency room or wait until monday to see my doctor?

  • mark smith

    went to the doctor for my knee nothing is broken but still can walk with out crutches and the knee still hurts this happen three months ago the pain is not the knee no more its around one inch on the inside could this be a ligament because I rolled over one night sleeping and the leg went off the bed after this it hurts bad

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

      Mark, yes, it sounds like it could be a ligament. That’s a possibility. Did you ask the doctor who did your exam?

  • Amber

    I fell on my knee a week ago and it still hurts like hell. After a few days of it getting worse and worse I went to the ED. (It was a Sunday) Did an X-ray, was fine. Said I need to see a specialist and def get in MRI.. I have HMO so went to my PCP the next day and they said to wait for the swelling to go down completely and after about two weeks, AFTER there’s no swelling!, if there is still pain or I still can’t bare any weight to come back. That was Monday, today is Thursday and there’s MORE swelling, less bruising.. The swelling is in a specific area and the skin is numb, as if I got a lidocaine injection. It hurts so bad the pain relievers are helping at all. I’ve been off of it since Monday, taking NSAIDs, using RICE.. It also hurts to be straighten or bent a lot. Slight bend is most comfortable. Will the swelling really have that much effect on the MRI? Why prolong this!? Should I go back and demand an MRI or to be referred to the specialist? The 1st pic is like 10 mins after I fell. 2nd pick was 3 days after and last one is right now..

    • Amber

      Also I should say more swelling since Monday. The swelling did go down quite a bit but since is getting worse.

    • Amber

      Although I can’t see pictures now and the pain relievers AREN’T helping.

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

        And so it goes with managed care and modern medicine. Many insurances require a few weeks after injury since most will get better and insurances don’t want to pay for any more MRIs than they can. They’d say, even if something shows up, right now the treatment would be the same–brace, stay off of it, pain relief, etc. True. But, yes, I’d call or go back to your doctor and ask if there is a way to speed up getting the MRI or specialist referral. Or you’re always entitled to a second opinion. Meanwhile, what to do for the pain and to make sure you don’t make the injury worse.

        • Amber

          Also is the numbness of the skin a serious concern?

        • Amber

          Is it likely that this is just a sprain? By reading this article it seems like more so a tear.

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

            Amber, without an exam, all I can do is give you general information to make your own decision. And, many times, a swollen area stretches the skin to make if feel numb, or you could have bruised a nerve.

  • 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.