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Bang to the knee

 
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Anonymous
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PostPosted: Thu Mar 19, 2009 12:14 pm GMT +0000    Post subject: Bang to the knee Reply with quote

Hello Doc,

Got one for you. I recently banged my knee pretty good when falling off the bike. I hit just under and to the right of my left knee 10 days ago. It immediately started swelling. I had full range of motion and walked 4 miles back to my vehicle. Got home and started RICE sessions (rest, ice, compression, elevation). The next day the swelling had started to subside and the 2nd day the bruising started to show, swelling was still going down and I was continuing with RICE. 3rd day after the incident, I woke up to increased swelling and alot more bruising.

Went to my PCP and X-rays showed no broken bones. Was told to take Ibuprofen (800 mg) 3 times a day and continue RICE treatements.

It is now 10 days later, my leg is now "growing" bruises from mid thigh to beneath my ankle. The hematoma below my patela has not reduced in size and appears to be larger at times with increasing pain below my patela and shin.

I have full range of motion in my knee, just feels very tight due to the swelling I assume. Knee does not "give way", nor do I have any popping or crackling when it moves.

Is it possible to continue to bleed within the leg 10 days later? That is what it looks like with the darkest areas of bruising collecting under my ankle and moving upward as the day goes on.

An MRI is scheduled in 7days. With the symptoms above should I try and get in sooner?

Could there be a possible torn tendon even though I have full range of motion and no problems supporting my weight (other than pain)?

Thanks in advance...
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The Bike Doc
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Location: Corpus Christi and Warda, Texas

PostPosted: Thu Mar 19, 2009 1:02 pm GMT +0000    Post subject: Reply with quote

bmc350:

Some things to think about:
1. 10 days out the clotted blood in the hematoma will begin to lyse, that is the clot fibrin starts to break down and the clot liquefies. Water and unclotted blood run down hill so the bruising will migrate to the ankle and work its way up the lower leg.
2. The ibuprofen around the clock does inhibit platelets which can aggravate bleeding. Ibuprofen’s inhibition of platelets, unlike aspirin, is not for the life of the platelets, only for the duration of adequate blood levels of the ibuprofen which when taken on a routine basis will keep the blood level up enough to inhibit the platelets and aggravate bleeding
3. The mechanism of injury, falling on the knee but not wrenching it sideways, would go against a tendon injury, but if you were clipped in when you went down, it is possible to have put a lateral (sideways) force on the knee that could tear a tendon.

My recommendations:
1. Stop the Ibupofen. If needed use acetaminophen (Tylenol™) for pain.
2. Elevate the leg.
3. Continue compressive dressing (Ace™ wrapping)
4. Get the MRI to make sure there is no tendon damage. If there is no worsening pain, you can wait till next week. If worsening pain, fever or worsening swelling get it ASAP.
5. See your doctor if there is any worsening.
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Anonymous
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PostPosted: Thu Mar 19, 2009 1:31 pm GMT +0000    Post subject: Reply with quote

Thanks for the reply.

I just got off the phone with my PCP's office. They were able to work my MRI in tomorrow and I'm stopping the Ibuprofen. I did not even think about the lateral load in my knee from the clipless pedals when I went down, that makes a lot of sense.

Thank you again for the reply and being here and taking the time to answer my/our questions.

It is very much appreciated, Bo...
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The Bike Doc
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PostPosted: Fri Mar 20, 2009 8:37 am GMT +0000    Post subject: Reply with quote

Bo:

You are welcome. I await your feed back on the MRI.

Thanks,
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Anonymous
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PostPosted: Tue Mar 24, 2009 8:00 am GMT +0000    Post subject: Reply with quote

Hello Doc,

The MRI did not show any damage to the knee. They gave me the option of seeing an Ortho, but I am not sure if I am going to make the appt or not. I am not experiencing any more pain and the swelling has gone down considerably. The hematoma itself has not gotten any smaller and the bruising continues to spread even though the dark areas are lightening up.

It has now been 15 days since the incident and my plan is to continue to watch it and test it on my spinner with very easy workouts and slowly raise the intensity over time. Does this sound like a good plan or should I go ahead and make the appt. with the Ortho?

Thanks again, Bo...
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Tue Mar 24, 2009 7:15 pm GMT +0000    Post subject: Reply with quote

Bo your plan sounds reasonable. If there is any worsening pain, swelling, local warmth or fever get a re-evaluation.
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