From the Guidelines
The next management for a knee injury with sharp pain, swelling, and effusion on X-ray should focus on the RICE protocol and consider intra-articular injection of long acting steroid, as recommended by the most recent EULAR guidelines 1. The RICE protocol includes:
- Resting the knee to prevent further injury
- Applying Ice for 15-20 minutes every 2-3 hours to reduce swelling
- Using Compression with an elastic bandage to support the joint and limit swelling
- Elevating the knee above heart level when possible Over-the-counter pain medications such as ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) can help manage pain and inflammation, with paracetamol being the preferred first-line oral analgesic 1. If symptoms don't improve within 3-5 days or if pain is severe, medical evaluation is recommended as an MRI may be needed to assess for ligament, meniscus, or cartilage damage. Physical therapy exercises to strengthen the muscles supporting the knee should begin once acute pain subsides. Avoid activities that cause pain and consider using crutches if walking is painful. Intra-articular injection of long acting steroid is indicated for acute exacerbation of knee pain, especially if accompanied by effusion, as stated in the latest EULAR recommendations 1. This approach addresses the acute inflammation while preventing further injury and promoting healing of the underlying tissue damage that caused the effusion. It is essential to consider the patient's individual factors, such as age, comorbidity, and the presence of inflammation, when tailoring the treatment plan 1.
From the Research
Next Management Steps
Given the sharp pain in the knee and swelling after stepping on a stair, with an X-ray showing effusion only, the next management steps can be considered as follows:
- The patient's symptoms and X-ray results suggest a possible meniscal tear or other soft tissue injury, which can be diagnosed clinically 2.
- First-line management for meniscal tears and other soft tissue injuries typically involves conservative management, including exercise therapy, rest, ice, compression, and elevation (RICE) 2, 3, 4.
- The use of RICE therapy can help reduce pain and swelling, although the evidence for its effectiveness is limited 3, 4.
- Immobilization may be considered in some cases, although the evidence for its use is also limited and practice patterns vary among physicians 5.
- Additional treatments, such as negative pressure therapy, may also be considered to stimulate lymphatic flow and reduce swelling 6.
Treatment Options
The following treatment options can be considered:
- Exercise therapy to improve knee function and reduce pain 2.
- RICE therapy to reduce pain and swelling 3, 4.
- Immobilization in some cases, although this should be used judiciously and with careful consideration of the potential risks and benefits 5.
- Negative pressure therapy to stimulate lymphatic flow and reduce swelling 6.
- Analgesic therapy to manage pain, although this should be used cautiously and with careful consideration of the potential risks and benefits.