Gupte C, St mart JP. The acute swollen knee: diagnosis and management. J R Soc Med. Akbarnia H, Zahn E. Knee Arthrocentesis. Updated December 16, Synovial fluid analysis. J Emerg Med. Patel DR, Villalobos A. Evaluation and management of knee pain in young athletes: overuse injuries of the knee.
Transl Pediatr. J Am Acad Orthop Surg. Patient Satisfaction after Total Knee Arthroplasty. Knee Surg Relat Res. Valderrabano V, Steiger C. Treatment and Prevention of Osteoarthritis through Exercise and Sports.
J Aging Res. Gupta, C. Mart, J. J Royal Soc Med. DOI: Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Table of Contents View All. Table of Contents.
Treatment for Joint Effusion. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Marx, J. ISBN Persistent knee swelling in the adult. Updated November Patel DR, Villalobos A. Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Transl Pediatr. J Am Acad Orthop Surg. Patient Satisfaction after Total Knee Arthroplasty. Knee Surg Relat Res. Cleveland Clinic.
Updated December 8, Knee pain in adults and adolescents: The initial evaluation. Am Fam Physician. Approach to septic arthritis.
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We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Table of Contents View All. Table of Contents. Signs of Infection Infections in the joint can be extremely painful and come on rapidly. Frequently Asked Questions Which is better for knee pain, heat or ice? What kind of exercise reduces water on the knee? If the patient has no history of trauma, a careful clinical assessment must be made to determine the diagnosis.
While the patient may present acutely with effusion, it must be determined historically whether this effusion is an exacerbation of a chronic disorder. Joint effusion is the most specific sign of joint inflammation. Other symptoms that suggest joint inflammation include joint pain, warmth, erythema and swelling. Common nontraumatic causes of effusion include infection, systemic rheumatic disease, infiltrative disorders, tumors and osteoarthritis-overuse syndromes. Infectious arthritis, if untreated, often leads to irreversible joint damage.
Typical historical clues include acute onset of symptoms, history of previously abnormal joint, immunocompromised status or intravenous drug use. Physical findings such as fever, warmth and erythema over the involved joint, coupled with the absence of ligamentous or meniscal findings, suggest an infectious etiology.
Radiographs are typically obtained, although they often fail to reveal any abnormality. The most important test is joint fluid evaluation. An elevated peripheral WBC and erythrocyte sedimentation rate also point to an infectious process. If the effusion recurs despite appropriate therapy, evaluation for fungal infection, tuberculosis and Lyme disease should be undertaken.
Swelling, whether an effusion or synovial thickening, is present in rheumatic disease and often presents with acute exacerbations. Symptoms are varied depending on the disease process, and articular complaints are often present in multiple joints. Examination reveals swelling, warmth, effusion, synovial thickening and tenderness.
More importantly, serum laboratory testing often reveals markers of rheumatic disease. Radiographs often reveal a specific pattern based on the disease process. Rheumatoid arthritis leads to characteristic marginal erosions and osteopenia about the affected joint. Crystal-induced arthritis can present in a similar fashion as infectious arthritis. The patient often describes periodic exacerbations of joint erythema, edema and swelling in the past.
A history of diuretic use, a high purine diet, increased alcohol intake or renal stones is often associated with gouty arthritis. A diagnostic evaluation of the inflamed joint fluid is essential. The urate crystals seen in gout appear as negative birefringent rods or needles, while the calcium pyrophosphate crystals of pseudogout are weakly positive birefringent rectangles or rhomboids.
The fluid should always be sent for Gram stain and culture. Benign and malignant tumors can present as knee effusion. Unless this entity is considered, significant delay in diagnosis and treatment can occur. Worrisome symptoms include fever, night sweats, unintentional weight loss and night pain.
If the patient's clinical course is prolonged or atypical, plain radiographs should be ordered to rule out a bone lesion. Symptoms of joint pain and effusion may antedate the diagnosis of cancer and may be the presenting symptom of advanced cancer.
Osteoarthritis is characterized by pain with use and relief with rest. It tends to occur in weight-bearing joints and in those that have sustained previous injury. Onset is insidious, and the course is progressive with occasional exacerbations.
Effusion can occur in joints subjected to repetitive microtrauma or overuse. Effusion can also occur with degenerative meniscal tears. Physical examination may reveal effusion and palpable osteophytes. Effusion, erythema and warmth tend to occur with osteoarthritis exacerbations. Radiographs reveal characteristic joint space narrowing and osteophytic spurring.
Serum laboratory testing is not necessary unless the diagnosis is unclear. A complete history, a thorough physical examination and judicious laboratory and radiologic testing can simplify evaluation of knee effusion Figure 4.
Traumatic knee injury with immediate effusion indicates severe intra-articular injury, the most common being ACL disruption. Osseous, ligamentous and peripheral meniscal injuries present with hemarthrosis. Arthrocentesis should be performed when the etiology of the effusion is unclear, when infection is suspected or to provide patient comfort and facilitate physical examination. The etiologies of nontraumatic effusion range from degenerative disorders to metastatic disease.
Algorithm for the assessment of a swollen knee. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Michael W. Reprints are not available from the author. The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Armed Forces or the Department of Defense. Sternbach GL. Evaluation of the knee.
J Emerg Med. Acute haemarthrosis of the knee in athletes. A prospective study of cases. J Bone Joint Surg [Br]. Hemarthrosis of the clinically stable knee due to sports and military training in young recruits: an arthroscopic analysis. Mil Med. Malignant joint effusions secondary to solid tumor metastasis. J Rheumatol. Magee DJ. Orthopedic physical assessment. Philadelphia: Saunders, — Morgan GJ. Joint examination: a study guide for medical students and house staff Hanover, N.
Cold therapy can ease symptoms by:. Apply a cold compress to the knee for no longer than 20 minutes at a time. This can be done several times a day. Ice should not be applied directly to the skin. Prevent skin damage by placing a towel or another material in between the icepack and skin. Compression involves wrapping the affected joint in an elastic bandage such as an Ace bandage. Compression may help limit or reduce swelling.
A 3- to 4-inch wide bandage is typically recommended. A smaller width bandage can increase the risk of cutting off circulation. Loosen or re-wrap the bandage if it is too tight.
Wrapping the swollen knee too tightly may cause increased swelling as well as numbness, tingling, increased pain, coolness, or swelling. Keep in mind that a compression bandage will not support the knee or protect it from further injury. Elevation Elevating the affected leg can help reduce blood flow to the knee, helping to alleviate inflammation, swelling, and discomfort.
Ideally, the affected leg should be elevated above the heart. To do this, lie down with the knee and calf propped up on pillows. Sitting down with the affected leg elevated on a stool or ottoman is considered less effective because the knee is below the heart. People who cope with chronic knee swelling might consider purchasing a leg elevation pillow.
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