Puffy and inflamed

The swollen knee (also called “water in the knee”) is a common problem caused by fluid retention in or around the knee joint.

The knee swelling can happen suddenly or gradually, and can limit the movement of the leg, making walking very difficult.

The knee effusion mainly develops:

after an injury or distortion,
due to arthritis (joint inflammation),

sometimes for no apparent reason.

What causes a knee swelling?

The knee has a joint capsule that lies like a sack around the entire joint.
The capsule contains synovial fluid that nourishes and lubricates the joint so that it can move without difficulty.
The joint capsule works like a container that holds the fluid inside the joint.
Knee swelling occurs when excessive fluid builds up inside the capsule.
This can be caused by:

joint bleeding (Hemarthrosis): it is usually caused by an accident and the knee swells quickly.
The swelling can be very intense and cause stiffness all over the leg.
Accumulation of synovial fluid (Water in the knee): in this case the knee tends to gradually swell. In some cases, the swelling can go and come, and the amount of fluid in the knee is variable. The cause is usually osteoarthritis or arthritis.
Knee swelling can result from a surgical intervention be, for example, by replacing the joint with a prosthesis.
In this case, the swelling goes away a few months after the operation. The pain disappears beforehand.
My patients often ask me how much time it takes for the swelling to go out of the joint because they are in a hurry to heal.
I emphasize that healing and swelling do not correlate so closely.
The patient can return to work as the knee can be painless after surgery despite swelling.

Sudden knee swelling

Usually, a sudden knee swelling is caused by an injury from hemarthrosis. This is a build up of blood inside the joint.
In this case, a structure inside the knee is damaged, begins to bleed, increasing the pressure on the joint. The swelling spreads and the knee resembles a balloon:

In this case you can see the joint effusion in the upper and lower area and on the sides of the knee.
The joint appears:

stiff,
painful,
sometimes bluish.

There are 3 main causes of hemarthrosis:

1) Ribbon tear: a ribbon breaks completely. This is a common cause and mostly affects the anterior cruciate ligament of the knee (VKB).
In the event of a cruciate ligament injury, the knee cannot be bent more than 90/100 ° and it is not possible to fully extend it for a few weeks.
2) Meniscal lesion: the hematoma occurs when the lesion is in the outer area.
3) Knee fracture: the fracture of one of the bones that form the knee joint. A knee swelling due to this type of injury urgently needs medical treatment to avoid complications.

Swelling of the knee after an accident

If knee swelling develops for a certain time after an accident (hour-days), this is most likely due to an increase in synovial fluid in the joint (or synovitis).
This happens when something inside the joint has been injured.
The swelling varies from case to case.
If you put a hand over both knees, you can feel that the knee is swollen and hot. This is a normal inflammatory reaction.
You can see a bulge in the front of the knee after a trauma. Then it is a bursitis of the knee.

The most common causes of knee swelling are:
1) Violation of the meniscus: a lesion of the inner cartilage layer of the joint (the inner part of the meniscus is not supplied with blood and therefore does not bleed when injured).
2) Distortion of the knee: overstretching or tearing of the ligaments.
The fluid accumulation in the knee can vary from day to day. Improvement usually occurs when the injury heals.
For soft tissue injuries (muscles and joint capsule), healing usually takes 6-12 weeks. Cartilage injuries may require surgery because there is no blood supply.

Gradually swelling knee without injury

Possible causes of a knee that swells gradually and without trauma are chronic diseases such as:

Arthriti,
Osteoarthritis (occurs mainly in the elderly).

The swelling may vary depending on the day and the activities you have done.
The swelling is usually not very pronounced.
Osteoarthritis (or joint degeneration) is the pathology that most often leads to this type of swelling.
Osteoarthritis causes the body to produce more fluid in the knee.
On days when the leg is overworked, the knee may become inflamed, producing more fluid to try to protect and heal itself.
Swelling on the joint sides may result from cartilage reduction in these parts of the knee, as is usually the case in the early stages of osteoarthritis.
Swelling of the knees is less common on the outside than on the inside, which is greater.
Has a chance of developing osteoarthritis.
Swelling on the outside occurs especially when the knee is in a valgus position because there is a greater load on the knee side.

The tendinitis is an inflammation of the tendon, especially the quadriceps tendon in the upper part (above the kneecap) and the patella tendon in the lower part, but there is no swelling visible from the outside.

Knee that swells quickly without injury

Sometimes swelling develops very quickly even without trauma. The most common causes of this phenomenon are:

1) infection: Infections increase synovial fluid production. As a rule, infections develop after surgery or a deep cut and can reach the joints.
Treating a joint infection is very difficult. Sometimes surgery is also required to solve the problem.
2) gout: high uric acid levels cause the formation of crystals that settle in the joints.
The accumulation of these crystals causes inflammation in the knee and a slight swelling.
Gout is treated with medication and an adjusted diet.

Laterally swollen knee

The swelling can also manifest itself outside the joint capsule (extra-articular swelling).
Usually this is caused by:

a Inflammation of one of the bursae of the knee (bursitis),
on trauma the muscles surrounding the knee (hematoma).

The most common extra-articular swellings are:

1) bursitis: Bursa are small, fluid-filled sacs between the bones and soft tissue and are used to reduce the friction between the tissue structures.
If the friction increases with a certain disease, the pouches can catch fire.
In this case, the swelling does not extend over the entire knee joint, but is limited to the area of the bursa.
Swelling in front of the kneecap can be caused by pre-patellar bursitis (maid’s knee).
One in back of the knee joint Localized swelling, more or less the size of an orange, can result from popliteal bursitis, also known as the baker’s cyst.
2) hematoma: a blunt trauma in the soft tissue of the knee joint can cause bruising.
The blood that collects around the muscles can accumulate to harden.
If there is only a small amount of bleeding, there is usually a small bruise, which is also called contusion.

Swelling of the knee after surgery

It is normal for a knee to swell after surgery. The patient often also develops a fever.
Routine surgery, such as meniscus surgery after meniscus rupture (meniscectomy), causes swelling that can last for several weeks.
There is no need to worry about postoperative swelling as the knee takes a long time to swell.
After a VKB reconstruction (anterior cruciate ligament plastic), the knee takes about 4-6 months to swell.
It is often observed that a joint appears much larger after an operation due to a fracture. This is a normal consequence. This is not an effusion since the knee is hard in the swollen area.

Other causes of knee swelling

Most of the time, the fluid that forms remains inside the knee joint, as the joint capsule acts as a barrier and prevents fluid from escaping. However, there is sometimes an extra-articular swelling.

Infections can cause knee swelling, especially:

In this case, the doctor prescribes antibiotics to reduce the symptoms.

Rare causes of knee swelling

1) Patellaluxation: during flexion extension, the kneecap slides in a groove on the front of the knee. An external force can act on them from the side and cause them to slip out of their anatomical seat. This trauma causes knee swelling.
2) runner’s knee: Inflammation of the patellar tendon can cause swelling on the front of the knee.
3) bone tumor: there are different types of tumors that cause knee swelling in children.
4) TVT: Deep vein thrombosis is a blood clot that forms in one of the deep veins, usually on the leg.
These blood clots are usually painful and develop after bedriddenness, after surgery or on long flights.
5) Hemarthrosis due to Circulation problems: is a sudden bleeding that occurs within the joints in patients with:

with coagulation disorders,
who are taking blood thinning medications such as Coumadin.

Swollen knee during pregnancy

The knees often swell during pregnancy, especially from the second trimester.
This phenomenon arises because the weight of the child increases and therefore one Pressure increase of the uterus on the vena cava (a large venous blood vessel that transports blood from the legs to the heart).
This situation can lead to fluid retention on the knees, but can also affect hands and feet.
To reduce swelling on the legs, standing for a long time must be avoided. Rest as often as possible and put your legs up.
Standing for a long time increases the pressure on the vena cava and reduces blood circulation.
warmth increases leg swelling, while cold gauze bandages reduce knee swelling.
During pregnancy, great care must be taken of swollen legs, as this could also be a sign of a serious illness known as preeclampsia or gestosis.
The doctor should be consulted to rule out a serious illness if the swelling:

does not pass after sufficient periods of rest,
includes different parts of the body.

The doctor must be informed if the knee swelling occurs together with:

a headache,
blurred vision,
Abdominal pains.

Knee swelling in children

Children often have swollen knees due to a bump or fall, but sometimes this could be due to other causes.
Knee swellings due to a strain are less common than in adults.
The Lyme disease can cause inflammation and constant swelling of the joints. Lyme disease is particularly common in the northeastern region of the United States. In these areas of greater risk, it is important to rule out this disease.
Children may have fluid accumulation in the knee due to:

The septic arthritis is a painful infection that is accompanied by overheating and swelling. The bacterium that causes this infection usually affects the knee, but can also be present in other joints.

Therapy for knee swelling

There are many decongestant methods for the knee, but the choice of therapy depends on the cause of the swelling:

1) ice: can be very useful in slowing blood flow and reducing swelling and pain. It is important to use ice packs correctly every 10 minutes.
2) compression: to reduce swelling, use an elastic bandage or knee brace to create proper compression for the knee.
3) drugs: Anti-inflammatory non-steroidal drugs (NSAP) such as ibuprofen or Voltaren can be prescribed to reduce knee swelling.
4) aspiration: The liquid inside can be drained by the doctor with a syringe. Sometimes the aspirated fluid can form again.
5) cortisone infiltrations: Cortisone is a steroid hormone that reduces inflammation and pain by suppressing the immune system.

Natural remedies for knee swelling

If swelling and pain persist for more than 48 hours or if you experience fever and severe pain, you must always consult a doctor to be able to make a correct diagnosis.
Stress on the aching knee should be avoided as long as the swelling persists.
An elastic bandage does not help to remove the swelling. It is better to use an envelope with green clay all night long.

ice. Crush the ice cubes, wrap them in a cloth and put them on your knees for 20 minutes. Ice relieves swelling and pain in the knee.
Repeat the envelope every 2-4 hours, raising your leg.
Ice only helps:

in the first 24 hours after an injury,
after pain occurs / worsens.

elevation. You can put your foot up on a few pillows.
One trick to lifting the leg up is to raise the foot of the bed. The ankles are higher than the heart during the night.

Rehabilitation exercises. If you have knee osteoarthritis, it is important to do exercises:

These exercises help to warm and stretch the muscles and are very effective after a long period of rest.
Regular physical exercises serve:

of fitness,
improving muscle tone.

Don’t overdo the exercises if you’re inexperienced.
Choose moderate exercise that does not cause pain, such as:

overweight. If you are overweight, you have to adjust your diet to lose the extra pounds. To do this, you should always put yourself in the hands of a qualified nutrition expert.
Excess weight puts increased pressure on joints and muscles, especially on the knees and ankles.
Excessive pressure causes inflammation of the joints and is a risk factor for knee swelling.

massage therapy
Massage therapy is a helpful treatment that, together with the other methods, helps to reduce swelling in the knee.
Manual therapy promotes:

the release of endorphins and other pain relieving chemical substances,
the blood flow.

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