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Definition
Water on the knee is a general term for excess fluid accumulation in or around your knee joint. Your doctor may refer to this condition as a knee "effusion."
Water on the knee may be the result of trauma, overuse injuries, or an underlying disease or condition. To determine the cause of water on the knee, your doctor may need to obtain a sample of the fluid for testing. If the fluid contains crystals, you might have gout or pseudogout. Bacteria indicates an infection, and blood suggests traumatic injury.
Removing some of the fluid also helps reduce the pain and stiffness associated with water on the knee. Once your doctor determines the underlying cause of your water on the knee, appropriate treatment can begin.
Symptoms
Signs and symptoms of water on the knee typically include:
- Swelling. One knee may appear larger than the other. Puffiness around the bony parts of your knee appears prominent when compared with your other knee.
- Stiffness. When your knee joint contains excess fluid, you may not be able to bend or straighten your knee as far as you normally could.
- Pain. Depending on the cause of the fluid buildup, the knee may be very painful — to the point that it's impossible to bear weight on it.
When to see a doctor
Seek prompt medical attention if:
- Self-care measures or prescribed medications don't relieve the pain and swelling
- One knee becomes red and feels warm to the touch as compared to your other knee
Causes
Water on the knee can be caused by many different types of problems, ranging from traumatic injuries to diseases and conditions.
Injuries
Damage to any part of your knee can cause the painful buildup of excess joint fluid. Examples of traumatic injuries that cause fluid buildup in and around the knee joint are:
- Broken bones
- Meniscus tear
- Ligament tear
- Overuse injuries
Diseases and conditions
Underlying diseases and conditions that may produce fluid buildup in and around the knee joint include:
- Osteoarthritis
- Rheumatoid arthritis
- Infection
- Gout
- Pseudogout
- Bursitis
- Cysts
- Bleeding disorders
- Tumors
Risk factors
- Age. Water on the knee tends to happen more often in people older than age 55.
- Sports participation. People who participate in sports that involve sudden changes of direction, such as basketball, are more likely to experience the types of knee injuries that cause water on the knee.
- Obesity. Excess weight causes more wear and tear on the knee joint. This increases your risk of osteoarthritis, one of the top causes of water on the knee.
Complications
If left untreated, water on the knee can severely limit your mobility. If the swelling is caused by an infection, it can destroy the joint.
Preparing for your appointment
While you may initially bring your symptoms to the attention of your family doctor, he or she may refer you to a doctor specializing in conditions related to arthritis (rheumatologist), in sports medicine or in orthopedic surgery.
What you can do
Before your appointment, you may want to write a list that answers the following questions:
- Have you injured your knee recently? If so, describe the injury in detail.
- Do you play recreational sports? If so, what sports?
- Do you have any type of arthritis?
- Has your knee felt warm or looked red? Do you have a fever?
- Do you have a family history of autoimmune disease?
What to expect from your doctor
During the physical exam, your doctor will need to press on different parts of your knee to check for pain and swelling. He or she will also ask you to try to move your knee into different positions, to check your range of motion.
Tests and diagnosis
Imaging tests
- X-ray. Your doctor will request an X-ray to make sure you haven't broken or dislocated any bones, or to determine if you have arthritis.
- Magnetic resonance imaging (MRI). This test detects abnormalities of the bone or knee joint, such as a tear in your ligaments, tendons or cartilage.
Blood tests
A sample of blood taken from your arm can be tested for evidence of:
- Infection
- Inflammation
- Rheumatoid arthritis
- Lyme disease
- Bleeding disorders
- Gout
Joint aspiration (arthrocentesis)
During this procedure your doctor withdraws fluid from inside your knee, so it can be checked for:
- Blood, which may stem from injuries or bleeding disorders
- Bacteria, which may be causing an infection
- The crystals common to gout or to pseudogout
Treatments and drugs
Medications
- Pain medications. If over-the-counter pain medications don't work well enough, your doctor may prescribe stronger drugs to help control your pain.
- Antibiotics. If your symptoms are being caused by an infection, your doctor may prescribe antibiotics to fight the infection.
- Corticosteroids. These strong anti-inflammatory drugs, such as prednisone, can be taken orally or may be injected directly into your knee joint. Corticosteroids can cause serious side effects, so you shouldn't use them too often or for a very long period of time.
Surgical and other procedures
- Joint aspiration (arthrocentesis). Removing fluid from your knee joint can help relieve the pressure of joint fluid buildup. After aspirating joint fluid, your doctor may inject a corticosteroid into the joint to treat inflammation.
- Arthroscopy. Using an arthroscope — a surgical tool designed to look inside your knee joint — an orthopedic surgeon examines the inside of your knee joint for wear and tear. The surgeon may also repair damage inside your knee joint with this instrument.
- Joint replacement. If bearing weight on your knee joint becomes intolerable, your doctor may refer you to an orthopedic surgeon for knee replacement.
Lifestyle and home remedies
Taking care of yourself when you have water on the knee includes:
- Rest. Avoid weight-bearing activities as much as possible when your knee is painful and swollen.
- Ice and elevation. Cold therapy can help control pain and swelling. Apply ice to your knee for 15 to 20 minutes every two to four hours. You may use a bag of ice, frozen vegetables or an iced towel cooled down in your freezer. When you ice your knee, raise your knee higher than the level of your heart, using pillows for comfort.
- Pain medication. Over-the-counter drugs such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) may help relieve your knee pain. If you need something stronger, ask your doctor about prescription medications.
Prevention
Water on the knee is typically the result of a chronic health condition or traumatic injury. To prevent water on the knee, work with your doctor and other members of your health care team to manage the condition or traumatic injury that causes it. Examples include:
- See your doctor regularly. See your doctor regularly if you have a chronic health condition, such as osteoarthritis, rheumatoid arthritis or gout.
- Follow through on your doctor's orders. Take the medications your doctor prescribes to treat the underlying disease or condition that causes water on the knee. If your doctor, physical therapist or sports trainer recommends you wear a knee brace because of a prior injury, be sure to follow through.
- Strengthen your thigh muscles. If your thigh muscles are weak, your doctor may refer you to a physical therapist to learn how to strengthen these muscles to better support your knee.
- Be gentle with your knees. If you're overweight and plan to start exercising as part of a weight-loss program, select an activity that doesn't place continuous weight-bearing stress on your knee joints — such as water aerobics or swimming.
Last Updated: 2010-03-06
