Patient: I fell down two flights of concrete stairs and landed on my knees. It hurts to walk and bend my legs I think it might be my patella. On a pain scale of 1-10 (10 being the worst) it is an 8. I can’t see a doctor soon as I am in a remote area with limited access. What should I do?
Doctor: Acute knee pain after an injury and related symptoms may be caused by damage to one or more of the soft tissue structures that stabilize and cushion the knee joint (including the ligaments, muscles, tendons, and menisci). One of the most common causes of acute knee pain are sprains after injury, and these involve the stretching or tearing of non contractile structures, such as the ligaments or the joint capsule itself, also a strain refers to stretching or severing along the course of muscles or tendons. In your case possibly you are experiencing a prepatellar post traumatic bursitis; this bursa is a superficial structure with a thin synovial lining located between the skin and the patella. Normally, it does not communicate with the joint space and contains a minimal amount of fluid; however, if is injured by a direct trauma, the inflammation results in marked increase of fluid within its space, and of course pain and limitation of the flexo-extension movements. A uncomplicated knee injury with conservative treatment has a great chance to improve, anyways if you notice one or more of the following symptoms: inflammation, remarkable limitation on flexion-extension movements, locking of the knee, or instability, the next step would be an evaluation by an Orthopedic Surgeon and the corresponding imaging studies to rule out fractures and other more serious conditions caused by the previous trauma. But if this is not the case, the suggested strategy would be: protection (avoid activities or movements that reproduce the pain), rest, local ice packs for periods no more than 15 minutes each time the first 24 hours, and after, local hot compresses, and anti-inflammatory medication (i.e.: “Aleve”, “Advil”). The healing time is different for each patient but generally there is a progressive improvement during the next 4-6 weeks after the injury.