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Fell and hyperextended knee. Could not walk feeling painful. Having bruise, swelling and pain. Suggest

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1.5 weeks ago I fell from a scooter and it seemed that I twisted or hyperextended by knee, it was painful. I made the mistake of walking on it that night but it wasn't too painful then. The next day I could not walk on it and started using crutches for the next 2-3days, iced and elevated it. I was able to limp around on it and started to feel good. Last Sunday I turned and seemed that I slightly twisted it again, immediate pain, I iced/elevated and it was tolerable. I started self therapy with ROM exercises that I located on the internet, the stretching and strengthening exercises really help along with icing it and warm bath water soaks. (This morning the knee fet great.) However, I feel an ache in the calf area (last night and now later today), feels good when that area is massaged. The entire leg was bruised so I don't know if this is a DVT symptom or just a result of the injury. I also have intermittent inner knee pain; so not sure if I tore a ligament or just twisted.
Symptoms; bruising on entire leg as result of fall from scooter, had swelling and pain. Swelling has decreased significantly but knee shows swelling when used, pain intermittent, achy pain in calf area.
Posted Tue, 30 Jul 2013 in Bones, Muscles and Joints
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Hi and thanks for the query,

The knee joint is one of the most complex joints in the body. It s a good sign the pain has been reducing, but it is still advisable to get X rays of the knee done and a careful clinical evaluations. Asymptomatic and minor to medium intensity ligamentous lesions could be present, and might reveal themselves late. If not management appropriately earlier enough, In some patients, they do end up with chronic knee pain or abnormal movements due to ligament laxity or later ruptures.

The diagnosis of deep venous thrombosis is very simply, specific especially under such circumstances. The notion of trauma is an important risk factor in your case. It is very unlikely that it should be a deep venous thrombus for three main reasons:

1. In deep venous thrombosis, the pain in the calf is actually observed with flexion on the foot and also due to application of pressure of the calf muscle.

2. Generally, in deep venous thrombosis, the entire leg is swollen, which is not the case with you. There is a clear difference between the two legs.

3. The calf on the affected or suspected should be far bigger than that on the opposite side, superficial dilated veins should be seen and these veins are themselves also painful when pressure is applied on them. The affected leg should show changes in color show some weakness.

A family history of this pathology, or of cancer would have raised more worries.

The main risk factor identified here is the notion of trauma, some degree of immobilization and pain which are not really very characteristic. It is possible however, but the chances, based on the clinical scenario you describe are slim.

The diagnosis after a clinical evaluation by your physician is fairly simple. Bases on a pulse assymetry on legs on palpation, rapid pulse called the Pancard, s sign, pitting oedema on affected leg, change in color of affected leg, pain on cal muscle on flexion of the foot (Homan s manouvre)

Measurement of D dimers and doing a Phlebography generally clears the doubt added to a clinical evaluation. It is important however to clear the doubt for fear of risk of pulmonary emboli, which is of course a fatal disease.

I think the chances of the disease , as you present your clinical scenario are possible but NOT very high. Consulting a family physician for a complete clinical examination is however advisable.

Thanks and kind regards.

Bain LE, MD.
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