From the Guidelines
I strongly recommend that the patient undergo a comprehensive evaluation by an orthopedic specialist to assess for potential deep tissue injury or knee joint involvement, as the current symptoms suggest a more serious injury than a simple contusion. The patient should continue to take ibuprofen 600mg every 6 hours with food for pain and inflammation, as NSAIDs may be used to reduce pain and swelling 1. However, it's essential to note that RICE therapy is not recommended as a treatment modality for ankle sprains, but in this case, since the injury is to the thigh and knee area, rest, ice, compression, and elevation may still be beneficial to reduce pain and swelling.
Considering the patient's limited mobility and persistent pain around the knee joint, it's crucial to evaluate for potential injuries to structures like ligaments or menisci. The migration of bruising downward and medially suggests significant bleeding within the tissue planes, which is concerning for a more serious injury. Early intervention can prevent long-term complications and expedite recovery to normal function.
The patient should use crutches to minimize weight-bearing on the affected leg until evaluated, and consider adding acetaminophen 1000mg every 8 hours if pain persists, as acetaminophen can be used for short-term pain relief 1. It's also essential to identify and address any modifiable risk factors that may be contributing to the patient's condition, such as predisposing factors for musculoskeletal symptoms 1.
Given the complexity of the patient's symptoms and the potential for deeper tissue damage, a comprehensive evaluation, including possible imaging studies like MRI, is necessary to determine the best course of treatment and prevent long-term complications. Exercise therapy should be started as soon as possible to recover joint functionality, and supervised exercises with a focus on proprioception, strength, coordination, and function may be beneficial for the patient's recovery 1.
From the Research
Presentation and Symptoms
- The patient is a 31-year-old male presenting for follow-up after a contusion from a snowboarding injury to the left upper leg.
- The patient has bruising to the posterior thigh, which has migrated medially and distally, with pain reported around the knee joint.
- The patient is still experiencing limited mobility to the limb despite rest, ice, elevation, compression, and ibuprofen.
Potential Treatment Options
- Platelet-rich plasma (PRP) therapy has been used to treat various medical conditions, including sports injuries 2.
- PRP injection has been shown to be effective in treating adhesive capsulitis, with less acetaminophen consumption compared to conventional physiotherapy 3.
- PRP injection has also been compared to corticosteroid injection and ultrasonic therapy in the treatment of periarthritis shoulder, with PRP resulting in statistically significant improvements in active and passive range of motion, pain, and function 4.
Considerations for PRP Therapy
- Certain medications, such as aspirin, acetaminophen, and nonselective NSAIDs, may affect platelet count or function and should be considered for suspension before a PRP injection 5.
- Post-PRP protocols, including restrictions on movement and weight bearing, use of orthoses, activity modifications, and rehabilitation protocols, may vary and can affect outcomes attributed to PRP therapy 6.