Kobe’s beef

Wednesday, May 19, 2010

Kobe Bryant should not be surprised that fluid accumulates in his knee since the body weeps when it is injured. Years of pounding up and down the basketball court has caused many of his joints to show some wear and tear and his coach revealed that Mr. Bryant had to have fluid removed from the knee during this past season. The presence of fluid presumes that an injury has occurred but does not determine the type or extent of that injury. Joint effusions are not normal and signal that there is inflammation ongoing within that joint.

Fluid on the knee or a joint effusion can occur from a variety of causes. Most commonly they occur because of injury to the ligaments or cartilage within the knee joint but can also be due to arthritis or other inflammatory causes. The initial evaluation that needs to happen depends upon what the story is and what the knee looks like. If the swelling occurred immediately after injury it is likely due to structural damage within the knee. A torn ACL will causes swelling within a few minutes, while a cartilage or meniscus tear may take many hours to cause fluid to accumulate. If there is not specific trauma and the knee is red and warm, the diagnosis would trend toward inflammation and gout (or pseudogout) would be a prime suspect. It’s important for the doctor to always keep infection in the back of their mind as a potential cause. An infection might occur because of a direct extension form a break in the skin of it could be delivered into the knee joint by the bloodstream from a remote source in the body.

Knee effusions hurt because the fluid stretches the capsule or lining structures of the knee causing pain. As well, the knee’s range of motion becomes limited because of hydraulics. The knee has its maximum space when it is flexed 15 degrees. Attempts to straighten the knee will cause significant pain since fluid cannot compress. Getting rid of the fluid to ease symptoms isn’t hard, the question always becomes why he fluid accumulated in the first place.

Diagnosis and treatment can go hand in hand. The knee joint is relatively easy to tap by inserting a long needle into the joint space. Withdrawing the fluid can relieve the pressure and pain and restore some range of motion. That fluid can then be sent for analysis to help with the diagnosis. Bloody fluid makes the diagnosis lean towards trauma, whether it is a torn ACL or a bony fracture. Clear fluid may not be so clear under the microscope and may be analyzed for infection or crystals. Uric acid crystals make the diagnosis of gout while the presence of calcium pyrophosphate crystals equals pseudogout.

The knee effusion is a sign that something is wrong in the knee and imaging (x-rays or MRI) may be appropriate. High paid athletes tend to get high tech tests while the real world relies more on clinical judgment. The drive to compete and playing through pain when there is a chance to win is another distinction between the real world and that of the elite athlete. For the LA Laker faithful, Mr. Bryant’s knee woes translate into the potential that he may not play effectively since removing the fluid does not fix the underlying problem. His motivation to win mirrors that of the fans’ but it is only Kobe’s body that is on the line.

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