(August 15, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
On a recent trip to Washington, we caught up with Dr. Wiemi Douoguih, MD, who is an Orthopedic Surgeon and the physician for the U.S. Judo team. Dr. Douoguih has worked in Major League Baseball, college sports, the National Football League, and, of interest, is also a national Judo champion.
If I felt my knee pop…
If I felt my knee pop, what i would say to the patient is; “first thing to do is look for swelling.” If there is unrelenting severe pain, if they are unable to weight on that leg, or if they feel instability when doing simple maneuvers, they should really contact a physician immediately, as soon as possible. Someone within the medical field that they trust that can either evaluate them, or refer them to someone to be evaluated. Once we’ve established that there is significant injury, swelling in the knee, the most likely players include the Anterior Cruciate Ligament or the ACL, the Meniscus and the shiny cartilage surface, or as we refer to it Articular Cartilage on the end of the bone.
How urgently should I seek help?
It really depends. Some of the things that you look for, are you limping, is your knee swollen, do you have pain after you felt the pop, does your knee feel unstable. Those are the things that you probably want to look for primarily. If you have severe unrelenting pain after you felt the pop in your knee, you should get off of your knee, and you should contact your doctor or someone in the medical field as soon as possible to get some advice. If you are able to squat down deep and jump up. If you can shuffle side to side and change direction without significant problems, and you are not having a lot of pain, then it’s probably reasonable to suspect that its not as urgent a problem. But again if there is any question you should contact medical personnel as soon as possible, because sometimes you can have subtle manifestations of more serious problems.
What should one do immediately after feeling the knee pop?
If there is not a lot of swelling. Not a lot of pain involved, it may be reasonable to just observe it and see how you do. If you have significant swelling I think it’s really important to check in with a physician before you do anything. Clearly rest, ice, compression, elevation, RICE is the abbreviation for those four things that you can do in the case of an acute injury. It’s not a bad thing but you have to be careful. You don’t want to keep ice on for more than twenty minutes, as you risk frostbite. A quick phone call sometimes can give you the yes-no answers that you need to those questions. There are certain things that if you delay treatment there can be serious consequences.
How will the doctor assess the situation?
First thing I can say as someone who takes care of sports medicine and orthopedic injuries most of my diagnosis comes from my observation, my question and answer session with the patient and then putting my hands on the patient. These other studies are very helpful. Some of which is helpful medically, and they act as adjuncts. But we are diagnosing these things pretty accurately years ago before we perfected some of the things like MRI and even understanding which x-rays to obtain and things like that. I think that the most important component of my evaluation is question and answer session with the patient, putting my hands on the patient and really looking at what we are dealing with.
What are the possible diagnoses?
Well first of all, in the setting of someone who has a pop and swelling in their knee, the most common injury is to the Anterior Cruciate Ligament. There have been a couple of studies that have shown, a number of studies which have shown a very high incidence of ACL injury with a traumatic effusion as we call it, effusion being swelling inside of the knee. Some studies show as high as seventy percent rate of ACL tear. Other injuries that can be associated are meniscal tears, damage to the cartilage and bone, the shinny lining on the end of the bone or the gristle, if you imagine the gristle on the end of a chicken bone, that allows our knee to glide properly. Anything that has blood supply to it when it is injured will release that blood into the knee joint causing and effusion. Those are some of the things that you will see.