Swelling and bruising on the inside of the knee joint, local severe pain

Introduction In most cases of traumatic knee injury or rotational external force, after the ligament rupture, generally the inside of the knee joint is significantly swollen, local pain, subcutaneous congestion, bruising. In the knee ligament injury, the medial collateral ligament injury is the most common, and the injury often occurs when the knee joint is slightly flexed, and the calf suddenly abducts. For example, football, basketball or gravity on the outside of the knee joint can cause medial collateral ligament injury. If the external force is light, ligament strain may occur, or some fibers may break. In severe cases, severe rupture or anterior cruciate ligament rupture or meniscus rupture may occur.

Cause

(1) Causes of the disease

When the knee joint is in a mild flexion position, the outer side of the joint is subjected to gravity or severe damage, which may cause damage to the ligament.

(two) pathogenesis

In the knee ligament injury, the medial collateral ligament injury is the most common, and the injury often occurs when the knee joint is slightly flexed, and the calf suddenly abducts. For example, football, basketball or gravity on the outside of the knee joint can cause medial collateral ligament injury. If the external force is light, ligament strain may occur, or some fibers may break. In severe cases, severe rupture or anterior cruciate ligament rupture or meniscus rupture may occur.

an examination

Related inspection

Knee lateral motion test knee joint separation test CT examination of bone and joint and soft tissue

In most cases of traumatic knee injury or rotational external force, after the ligament rupture, generally the inside of the knee joint is significantly swollen, local pain, subcutaneous congestion, bruising. Blood in the joints is the main cause of pain. When the patient walks with the toes more, and the strength abducts the knee joint, there is obvious pain at the ligament rupture. Due to reflex muscle tension, joint activity is limited, resistance and pain during passive extension. If the blood is taken out, the joint activity can be restored. The positive signs are mainly the local tenderness of the medial collateral ligament.

The medial collateral ligament is divided into three types: partial fracture, complete fracture, combined meniscus rupture or cruciate ligament rupture.

Partial rupture can be limited to the shallow or deep layer of the ligament, the attachment of the upper or lower ligament, the posterior superior oblique or the posterior oblique portion, and occasional ligament rupture local bleeding ossification affects the joint flexion and extension.

Complete rupture may be avulsion of the superficial layer from the attachment of the tibia, and the deep layer may be avulsed from the femoral attachment or, in contrast, the broken end of the fracture ligament may break into the joint space and disturb the joint activity.

Because the ligament is elastic and not easy to break, the fracture of the superficial ligament often involves avulsion fracture of the femoral condyle, but the ligament is more extensive in the attachment of the humerus and the possibility of avulsion fracture is less. When the central part of the deep ligament is broken, the edge of the inner meniscus is ruptured. The deep layer of the deep ligament is broken at the central part of the ligament, and the cruciate ligament can also be broken at the same time. The stability of the knee joint will be seriously damaged.

Diagnosis is not difficult. The history of traumatic injury with calf abduction is the main basis for the diagnosis of this disease. Its clinical manifestations are swelling around the ligament, hemorrhage, bruising, and obvious tenderness. If it is completely ruptured, it can be found at the collateral ligament injury that there is a gap that is lost. The knee joint pull test is the most important test method to determine the degree of damage. The examiner holds the ankle joint in one hand and the other hand on the outside of the knee joint of the patient. The knee joint should be in the extended position or flexed at 30° to apply the eversion force. If the medial collateral ligament is cleft, it indicates that the ligament is damaged. If there is looseness at the same time and the joint is open, the ligament is broken. To avoid pain and reflex protection of the muscles, it is best to check under anesthesia or after the pain point is closed. During the examination, the patient must be relieved of the muscles to avoid false negatives.

Joint activity due to ligament rupture is limited, and joint activity can be restored after closure with procaine local ligament. However, if the joints are blocked by the meniscus rupture, although the joint hemorrhage or local procaine is closed, the interlocking may not be relieved. The structure is mainly the shallow layer of the knee joint MCL, which is the most vulnerable to damage. The order of stress tolerance is the order of damage. In addition, if the MCL injury is untreated, the other ligaments are loosened and the rotation is unstable.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Knee joint swelling: Knee joint swelling is knee joint synovitis. Knee synovium is the most extensive and complex part of the human joint, and it also forms the largest synovial cavity. Because the knee joint is heavy, it has many movements and is most vulnerable to injury.

2. Knee bruises and swelling: Knee pain: The sputum tip begins to have soreness and discomfort, and there is persistent dull pain in the future. The law is that when the activity starts, the pain is aggravated, and the pain is relieved after the activity is opened. In daily life and work (such as going down the stairs, squatting up, walking with weights, playing hard, etc.), when the quadriceps contraction is performed, There will be pain in the tip of the jaw. In patients with severe disease, pain in the tip of the sputum also occurs during normal walking. The patient feels that the knee is soft and weak, and the walking is easy to fatigue, so that the shoulder can not be picked, the hand can not be lifted, and the heavy object cannot be carried. There is obvious pressure pain at the tip of the sputum. When you touch it, you can feel a swollen, blunt change in the attachment. Some patients can touch the proliferated spurs. When the knee extension resistance test and the semi-squat test were performed, pain occurred at the tip of the ankle. Regardless of chronic or acute diaphragmatic injury, the main manifestation is that when the armpit is down or up, or when going upstairs or climbing a slope, there is pain in the armpit, and its nature can be intermittent or continuous. Most of the chronic injuries are manifested as For dull pain, acute injury is severe or severe tearing pain or pain.

3. Post-knee swelling and pain, limited activity: Axillary cysts are more common in middle-aged cases. The incidence is higher in men and women, more men than women, resulting in mechanical knee extension and knee flexion limitation, less pain, and a sense of tension and swelling. The patient's complaint is often characterized by a gradual swelling of the axillary area with pain in the back of the knee. Occasionally cysts can be oppressed to block venous return, causing calf edema. When the cyst grows to a certain extent, the knee flexion and extension activity is limited.

In most cases of traumatic knee injury or rotational external force, after the ligament rupture, generally the inside of the knee joint is significantly swollen, local pain, subcutaneous congestion, bruising. Blood in the joints is the main cause of pain. When the patient walks with the toes more, and the strength abducts the knee joint, there is obvious pain at the ligament rupture. Due to reflex muscle tension, joint activity is limited, resistance and pain during passive extension. If the blood is taken out, the joint activity can be restored. The positive signs are mainly the local tenderness of the medial collateral ligament.

The medial collateral ligament is divided into three types: partial fracture, complete fracture, combined meniscus rupture or cruciate ligament rupture.

Partial rupture can be limited to the shallow or deep layer of the ligament, the attachment of the upper or lower ligament, the posterior superior oblique or the posterior oblique portion, and occasional ligament rupture local bleeding ossification affects the joint flexion and extension.

Complete rupture may be avulsion of the superficial layer from the attachment of the tibia, and the deep layer may be avulsed from the femoral attachment or, in contrast, the broken end of the fracture ligament may break into the joint space and disturb the joint activity. Because the ligament is elastic and not easy to break, the fracture of the superficial ligament often involves avulsion fracture of the femoral condyle, but the ligament is more extensive in the attachment of the humerus and the possibility of avulsion fracture is less. When the central part of the deep ligament is broken, the edge of the inner meniscus is ruptured. The deep layer of the deep ligament is broken at the central part of the ligament, and the cruciate ligament can also be broken at the same time. The stability of the knee joint will be seriously damaged.

Diagnosis is not difficult. The history of traumatic injury with calf abduction is the main basis for the diagnosis of this disease. Its clinical manifestations are swelling around the ligament, hemorrhage, bruising, and obvious tenderness. If it is completely ruptured, it can be found at the collateral ligament injury that there is a gap that is lost. The knee joint pull test is the most important test method to determine the degree of damage. The examiner holds the ankle joint in one hand and the other hand on the outside of the knee joint of the patient. The knee joint should be in the extended position or flexed at 30° to apply the eversion force. If the medial collateral ligament is cleft, it indicates that the ligament is damaged. If there is looseness at the same time and the joint is open, the ligament is broken. To avoid pain and reflex protection of the muscles, it is best to check under anesthesia or after the pain point is closed. During the examination, the patient must be relieved of the muscles to avoid false negatives.

Joint activity due to ligament rupture is limited, and joint activity can be restored after closure with procaine local ligament. However, if the joints are blocked by the meniscus rupture, although the joint hemorrhage or local procaine is closed, the interlocking may not be relieved. The structure is mainly the shallow layer of the knee joint MCL, which is the most vulnerable to damage. The order of stress tolerance is the order of damage. In addition, if the MCL injury is untreated, the other ligaments are loosened and the rotation is unstable.

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