Why is it that my knee didn't hurt when I first sprained it, but it became more and more painful after a few days?

This is the 4572nd article of Da Yi Xiao Hu

Xiao Wang accidentally twisted his knee two weeks ago. It didn't hurt much at first, but after a few days, it became more and more painful. His knee was swollen like a steamed bun. He applied a lot of ointments but it didn't work. He took painkillers every day to relieve the pain. He couldn't stand it anymore and went to the hospital to see a doctor.

Xiao Wang: "Doctor, my knee has been sprained for almost two weeks. Why hasn't it healed yet? Instead, it's getting more swollen?"

Doctor Feng: "Your medical history and symptoms don't sound like a sprain or a hematoma. Maybe it's related to high uric acid. Did you have high uric acid in your previous physical examination?"

Xiao Wang: "Last year, the company's physical examination fee was a little higher, just over 500 yuan."

Doctor Feng: "What do you mean it's only over 500? Is over 500 not high? Then you probably have gouty synovitis of the knee joint this time."

Xiao Wang: "Don't people say that gout only occurs in small joints, such as toes and fingers? How did I find it in my knee joint?"

Doctor Feng: "Knee sprain is a triggering factor. It may be that the local damage after the sprain causes accelerated blood circulation, which is induced on the basis of hyperuricemia. In this way, you should first do a knee ultrasound and then do a blood test to evaluate the current situation."

Check back

Xiao Wang: "Doctor Feng, you are right. My uric acid level is over 600. The ultrasound doctor also said that my knee joints have severe synovial hyperplasia and effusion. Doctor, I am so sad. I can't walk. I have to go on a business trip the day after tomorrow. Can you get better soon? I have been taking anti-inflammatory and analgesic drugs for a long time, but they have no effect. They said that you can't take uric acid-lowering drugs when you have a gout attack. What should I do!?"

Doctor Feng: "Then let's arrange a local anesthesia knee arthroscopy examination and irrigation tonight, and also check the condition of the knee joint."

Under the microscope, a large number of white urate crystals can be seen on the hyperplastic synovium.

During the operation, the doctor said: "Look for yourself. The fluid that just came out is all turbid. The synovium of the knee joint is severely hyperplastic. There are also many white spots. These are all urate crystals!"

Xiao Wang: "Then what should I do?"

Doctor Feng: "It should be basically relieved today, but you need standardized treatment afterwards, otherwise it may relapse."

The onset of gouty synovitis may be caused by local trauma, the occurrence of other inflammatory diseases of the systemic disease, improper diet, excessive fatigue and even climate change on the basis of hyperuricemia. Do not apply hot compresses after an acute attack, as it will aggravate the condition. Oral and topical nonsteroidal anti-inflammatory drugs can relieve symptoms in the acute phase. If the symptoms persist and cannot be relieved, arthroscopic treatment can be considered, which generally can provide immediate relief, but follow-up standardized treatment is still required after the treatment is relieved. It is mainly anti-inflammatory in the subacute phase and uric acid-lowering treatment in the remission phase. Uric acid lowering is a chronic self-health management project during the childbirth period. Long-term hyperuricemia can lead to secondary kidney damage, joint damage, stones and gradually seriously affect life and health. It must be taken seriously! If the pain cannot be relieved, there will be no treatment or intervention. It requires a long-term struggle under the standardized guidance of a doctor!

In the following months, under the guidance of Dr. Feng, Xiao Wang gradually controlled his uric acid and lost a lot of weight. He no longer felt greasy on his body and face, and he no longer had gout attacks.

Author: Quyang Road Community Health Service Center, Hongkou District, Shanghai

Acupuncture and Traumatology Lu Wenting

1Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine

Department of Joint Surgery, Orthopedic Trauma Center, Feng Shengyi and Li Bo