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RTA done. X-ray showed subcutaneous edema throughout knee joint. How to find the problem?

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Orthopaedic Surgeon
Practicing since : 1994
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I had a RTA 10 yrs ago in which one the injuries I sustained was closed XXXXXXX degloving injury to my right thigh, I was operated on successfully and had no further problems. 10 weeks ago however, I sustained a serious fall to my right knee, upon investigations I had a suspected MCL sprain. MRI and X-ray results showed dramatic subcutaneous edema throughout knee joint and popliteal fossa and muscle belly, no fractures or tears visible. 4 weeks ago and literally overnight I developed enormous "free swelling" that moves with gravity on my right thigh, accompanied by acute numbness and severe pain at the sight of the original scar. I also have severe pain with compression to the thigh and am unable to bear lying on my side. I have been tested on ultrasound both for DVT and a pelvic/ abdominal, blood tests, X-rays, all clear. Could the degloving occur again as a result of the recent leg trauma? And if yes, which is the best imaging to find the problem?
I am a heavy person, but I know there's something wrong with my thigh - it is 9cm larger than the left despite having tried all avenues to reduce swelling, and has been ongoing for a month. Any advice please.
I do apologise for giving the wrong email: please reply to my question with the following email ; YYYY@YYYY
Posted Mon, 20 Aug 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 7 hours later
Thanks for posting your query.
The extent of pain and swelling that you are having is suggestive of a thigh too due to the fall. Since DVT has been ruled out, the best test to find out the extent of soft tissue damage is MRI scan.
It is not likely to be due to degloving injury again but we need to have a clinical examination and investigations to find out the cause.
You need to have systemic antibiotics to prevent any infection in the area of injury along with mild pain killers.
Doing a cold sponging thrice daily and keeping the leg raised on two pillows will be helpful in reducing the swelling. Avoid weight bearing at all costs.
Since the swelling and pain is persistent you might consider using a knee brace or a cast to provide adequate rest to the area for early healing.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: RTA done. X-ray showed subcutaneous edema throughout knee joint. How to find the problem? 9 hours later
Thank you for your response, following the initial fall I was fitted with a knee brace which I wore for approximately 8 weeks, Infact until the thigh became to big for the knee brace to fit.
I also have had my leg elevated for the last 4 weeks and have been non weight bearing for 10 weeks due to the use of crutches, why then after doing what you have suggested has my swelling continued to increase and Infact gotten worse. The symptoms of numbness, and pain have gotten worse as the weeks have one on.
Any suggestions?
Answered by Dr. Praveen Tayal 27 minutes later
Thanks for writing again.
In spite of all the measures, if the swelling has increased, then other causes like infection or cellulitis needs to be ruled out. Color doppler study of legs is advisable to rule out any vascular blockage. You need to get your blood glucose levels evaluated to rule out diabetes.
An MRI of the affected region will guide us regarding the probable cause of swelling.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Above answer was peer-reviewed by
Follow-up: RTA done. X-ray showed subcutaneous edema throughout knee joint. How to find the problem? 3 hours later
Having been to my GP this morning, I was diagnosed with fluid in the thigh. He has suggested that there is nothing that can be done! Is this true? Can they not drain it or surgically remove it? And could fluid on thigh be indicative of a further degloving injury? It feels the same as before. If so, which is best imaging technique MRI or ultrasound or both?
Answered by Dr. Praveen Tayal 44 minutes later
The accumulation of fluid can be due to reactive inflammation or due to a fresh injury. Anything extensive like degloving is not likely.
The fluid can certainly be aspirated by a needle followed by local steroid injections to reduce the inflammation.
Other option is incisional drainage of the fluid with an open dressing to avoid further fluid accumulation.
MRI is the best option.
You can discuss the options with your orthopedician.
Take care.
Above answer was peer-reviewed by
Follow-up: RTA done. X-ray showed subcutaneous edema throughout knee joint. How to find the problem? 1 hour later
How do I go about requesting incisional drainage of the fluid with an open dressing? Am I best to go private and see somebody about it? As I have been having no luck getting an actual confirmed diagnosis of what is wrong with my thigh. It was only today after seeing a GP I have never met before that fluid in the thigh was mentioned, up until today, I have been turned away by hospitals and told "it will subside eventually". I'm getting really stressed because I don't know where to turn next, and the longer I leave it the worst it's getting.

Also, on a side note: it's been 10 weeks now since knee injury and I still can't weight bare, when I try I have a sharp pain on a 6-7 on a scale of 1-10 that goes through my whole knee joint. This makes it virtually impossible to walk without aid of a crutch. I can manage a few hobbled steps around my house, but no more than that. Also, whenever I have my leg elevated for the swelling on the thigh, my knee goes stiff and locks into the bent position, and it takes a few moments of manipulation on my part to "loosen" the knee again. Could I possibly have a meniscal injury that was missed on MRI? And if so, would you recommend a knee arthroscopy?

Thank you for your help - much appreciated.
Answered by Dr. Praveen Tayal 8 hours later
You can request your orthopedician or a general surgeon for the incisional drainage of the fluid.
The locking of the knee in the bent position is suggestive of a meniscal tear. A knee arthroscopy is needed for confirmation of the diagnosis and repair of the tear. Your orthopedician will do the needful after an examination.
Hope this is of some help.
Best regards.
Above answer was peer-reviewed by
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