Another Blog Article by David E. Smalley, M.D.
This article is on a principle of general interest that is covered much more in depth in the book, The Miracle of Pain. The content is educational and should not be used as medical advice.
The original photos below emphasize the wonders of nature around and in us, which reflect the miracles within all of us.
October 22, 2019 — Is Swelling a Warning Sign?
The abnormality of swelling in a knee, an ankle or a wrist joint is a signal that a joint is struggling. The excess fluid softens joint surfaces and makes them more susceptible to additional injury. Swelling is not as bad as pain, but it is still a warning sign. Managing swelling is important in managing pain.
By comparing shoulder and knee surgeries, I learned how much control patients have over swelling. I also learned how little control I have, as a surgeon, over swelling. The choices patients make hour to hour and day to day directly influence the speed of swelling resolution after surgery.
Arthroscopy, with 3 little holes for a surgical procedure, creates predictable swelling in knees that lasts a minimum of 3-4 days. However, for a shoulder, the same or a similar procedure will have swelling that lasts less than 1-2 days.
Right Knee Joint Line at the arrow, Joint Fluid is white
Right Knee Joint Line behind Kneecap at arrow
If I can talk a patient into elevating their knee more consistently, which is always a challenge, they significantly lessen the time it takes to resolve the swelling. The elevation must be at the heart level or a little higher. If they sit in a recliner watching TV, with their knee at hip level, that is not elevation. With that, swelling will tend to persist, or even accumulate more swelling. Discoloration with the swelling is even more dangerous.
Right Foot Swelling and Discoloration
I have noticed that fractures do not heal as well if the patient does not control swelling at a fracture site with appropriate measures. At times, swelling can inhibit healing so much, that a fracture can become a delayed union or not heal at all. In other words, the healing can stop. We can restart the healing with surgery or an expensive electromagnetic device, but wouldn’t it be better to avoid the delay in healing in the first place?
Right Foot Delayed Fracture Healing at arrow
Elevation often, and movement if allowed, is terribly helpful to resolve swelling and facilitates healing. Also, there is another benefit of controlling swelling. When swelling is under control, pain is often easier to control. Swelling is more dangerous in a cast. In a way, swelling is a miracle, because the body is giving us a warning sign. Are we listening to our body, and are we giving our body the help that it needs?
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Right Forearm Both Bone Fractures at arrows in Cast