It then leaks out into the soft tissue around the joint. This can happen as a result of injury, infection, or arthritis:. Joint effusions also can happen in diseases such as gout, where crystals deposit in the joint, or in cancerous and noncancerous tumors. Treatment for joint effusion depends on the cause and often includes resting the joint and applying ice packs to reduce swelling.
In some cases, fluid may be removed from the joint to reduce swelling and increase the joint's range of motion. This fluid can be checked for signs of infection, crystals, and other substances to help find out the cause of the effusion. Effusion is a symptom of an injury or other condition affecting a joint. In almost all cases, if the underlying condition is identified and treated, the effusion will go away.
Joint effusion that happens for no apparent reason or with a fever should be checked by a doctor as soon as possible. The most important test is joint fluid evaluation. An elevated peripheral WBC and erythrocyte sedimentation rate also point to an infectious process. If the effusion recurs despite appropriate therapy, evaluation for fungal infection, tuberculosis and Lyme disease should be undertaken.
Swelling, whether an effusion or synovial thickening, is present in rheumatic disease and often presents with acute exacerbations. Symptoms are varied depending on the disease process, and articular complaints are often present in multiple joints. Examination reveals swelling, warmth, effusion, synovial thickening and tenderness.
More importantly, serum laboratory testing often reveals markers of rheumatic disease. Radiographs often reveal a specific pattern based on the disease process.
Rheumatoid arthritis leads to characteristic marginal erosions and osteopenia about the affected joint. Crystal-induced arthritis can present in a similar fashion as infectious arthritis. The patient often describes periodic exacerbations of joint erythema, edema and swelling in the past. A history of diuretic use, a high purine diet, increased alcohol intake or renal stones is often associated with gouty arthritis. A diagnostic evaluation of the inflamed joint fluid is essential.
The urate crystals seen in gout appear as negative birefringent rods or needles, while the calcium pyrophosphate crystals of pseudogout are weakly positive birefringent rectangles or rhomboids. The fluid should always be sent for Gram stain and culture. Benign and malignant tumors can present as knee effusion. Unless this entity is considered, significant delay in diagnosis and treatment can occur.
Worrisome symptoms include fever, night sweats, unintentional weight loss and night pain. If the patient's clinical course is prolonged or atypical, plain radiographs should be ordered to rule out a bone lesion. Symptoms of joint pain and effusion may antedate the diagnosis of cancer and may be the presenting symptom of advanced cancer.
Osteoarthritis is characterized by pain with use and relief with rest. It tends to occur in weight-bearing joints and in those that have sustained previous injury. Onset is insidious, and the course is progressive with occasional exacerbations.
Effusion can occur in joints subjected to repetitive microtrauma or overuse. Effusion can also occur with degenerative meniscal tears. Physical examination may reveal effusion and palpable osteophytes. Effusion, erythema and warmth tend to occur with osteoarthritis exacerbations. Radiographs reveal characteristic joint space narrowing and osteophytic spurring.
Serum laboratory testing is not necessary unless the diagnosis is unclear. A complete history, a thorough physical examination and judicious laboratory and radiologic testing can simplify evaluation of knee effusion Figure 4.
Traumatic knee injury with immediate effusion indicates severe intra-articular injury, the most common being ACL disruption.
Osseous, ligamentous and peripheral meniscal injuries present with hemarthrosis. Arthrocentesis should be performed when the etiology of the effusion is unclear, when infection is suspected or to provide patient comfort and facilitate physical examination. The etiologies of nontraumatic effusion range from degenerative disorders to metastatic disease. Algorithm for the assessment of a swollen knee. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Michael W.
Reprints are not available from the author. The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Armed Forces or the Department of Defense.
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Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients.
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Reliability of the clinical assessment in predicting the cause of internal derangements of the knee. J Fam Pract. Bakerman S. ABC's of interpretive laboratory data. Greenville, N. Guest editors of the series are Francis G.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. If your knee is not improving after using this method, it is highly suggested that you call your doctor.
A Physical Therapist can advise exercises and fitness activities to strengthen the area that is affected and treat your knee. By keeping your leg strength, you help your knee to be stable and relieve pressure on the joint. The doctor uses a needle to drain fluid out of the knee while the knee is numbed. This method helps to relieve pain, pressure and the appearance of swelling by minimizing the collection of fluid.
During this method, the doctor will thread an arthroscope into the knee. An arthroscope is a flexible tube with a camera at the end of it. Tools can be passed through the tube to repair damage to the cartilage and remove loose tissue, hopefully curing your knee.
In severe cases of osteoarthritis, the knee joint may need to be replaced with a prosthetic to relieve pain and improve function. Our customer support team is available Monday - Friday from a. Central time. Use our contact form to submit an email to customer support team. We typically respond within one business day or faster. This may affect your shipping time and they will be accounted for in the estimated ship date listed on each product page.
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