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Chronic Swelling
Q: I'm a 41-year-old male and I have pain in my right knee. I recently noticed that I'm hearing popping, cracking and even grinding noise in my knee. I now have swelling and pain, sometimes accompanied by stiffness. I stand at work hours at a time every day. Ice seems to curb the pain but not the swelling. What should I do?
Answered by Jack Farr M.D. on November 12, 2001
A: Noises can be normal or abnormal, but swelling is abnormal. Your knee is "crying" and the tears do not escape, hence the swelling. This requires an in office knee expert exam as soon as possible.
 
Q: I've had water on the knee several times in the past, from wrestling. The doctors considered using a needle to aspirate my knee, but I treated with over-the-counter medications. Does this mean I am prone to osteoarthritis?
Answered by David Golden M.D.
A: No, it does not necessarily mean you are prone to osteoarthritis. The caveat to that is if you have cartilage damage that is causing your swelling, then you may be at an increased risk for arthritis in the future. It is not possible to know without a comprehensive evaluation of the injured knee, which may include an MRI. The key to preventing the repetitive swelling is to stop the inciting activity, which is wrestling. Aspirating, or draining, the knee with a needle is only a temporary “fix.” The problem may still exist. Aspiration alleviates pain, because the swelling of the joint lining is the source of the pain. The source of the swelling needs to be determined. Repetitive trauma to the knee, from any activity that causes swelling, can be damaging.
 
Q: How much swelling should I tolerate before going to have my knee aspirated again? I snapped something two weeks ago playing basketball and a week later had a half-pint of fluid (mostly blood) drained. I'm on crutches, waiting for MRI results, and the knee and ankle are filling up again. Is it dangerous to try to ride out the swelling?
Answered by David Golden M.D.
A: The usual answer is no, it is not dangerous to let the swelling naturally subside. Any aspiration, or tap, of the knee fluid poses a very small but real risk of introducing infection into the knee. The relief from the aspiration comes from relieving the stretching of the joint capsule that surrounds the knee. In addition, when there is fluid in the knee, bending the knee becomes difficult. Certainly, such repetitive swelling is a good reason to obtain an MRI. An inconclusive MRI may lead to a diagnostic arthroscopy, but modified weight bearing and use of crutches is the most effective immediate way to treat the swelling.
 
Q: I have some swelling in my knee. There is no pain and there has been no trauma to the knee. What could cause swelling if there has been no trauma to the knee?
Answered by David Golden M.D.
A: Depending on your age, spontaneous swelling may occur and may indicate an internal derangement of the knee. If the knee swells, there is something inside the joint that is problematic. Often, it comes with trauma, which can sprain or tear a ligament, or may affect the cartilage surface. As we age, degeneration of the meniscus, which is cartilage to help cushion the knee, may occur. This can irritate the knee joint and cause swelling. Sometimes, modified activity and weight bearing coupled with anti-inflammatory medications (if you can take them safely) can ease the swelling and allow it to resolve on its own. Other times, the problem inside the knee needs to be addressed in order to provide relief and prevent future inflammation and swelling.
 
Q: What are the best over-the-counter medications to treat chronically inflamed and swollen knees?
Answered by David Golden M.D.
A: Non-steroidal anti-inflammatory (NSAIDs) drugs and acetaminophen are the mainstay of treatment. Be sure to check with your doctor before taking any medications. There are occasionally unwanted side effects. They can range from an upset stomach to kidney or liver problems. They are rare, but it is important to know that even non-prescription medication can be dangerous. NSAIDs work to decrease pain by preventing the inflammation or swelling thought to cause pain. The most common side effect is an upset stomach. Acetaminophen is a good pain medication as well. It is very uncommon for it to cause stomach problems. The combination of the two for a short course will aid in pain control.
 
Q: My right knee is chronically swollen. Are there any exercises I can do to reduce swelling?
Answered by David Golden M.D.
A: There are no specific exercises that relieve swelling. The cause of the swelling must be sought. If there is an internal derangement of the knee, exercises may be harmful. Be sure to visit your doctor if your knee keeps swelling with or without exercise. If there is no damage to the knee, then your doctor may be able to suggest exercise to help strengthen the knee and help alleviate your pain.
 
Q: I have chronic swelling on my right knee. It is located on the lower part of the right side of the knee. I don't remember injuring this knee. It usually doesn't hurt except when my knee is bent for long periods of time. I have been waiting for this problem to dissipate but it hasn’t. What do you think my problem is?
Answered by David Golden M.D.
A: Unfortunately, without a detailed exam, it is not possible to diagnose your problem. Swelling is not caused by anything in particular, but rather is a sign of some abnormality in the knee. The outside, or lateral, part of the knee has many structures that may be the source of your problem. Sometimes, extended periods of sitting that causes pain and swelling may be indicative of tendonitis. Again, be sure to visit your doctor to have a detailed evaluation. In the meantime, avoid the activities that cause pain and try to ice the affected knee to control swelling.
 
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