What should you know about hard swelling above the knee?

A firm area above the kneecap may involve an irritated bursa, tendon, muscle, or soft tissue. Knee bursitis can produce a localised lump near a pressure point. A knee injury may cause swelling around the joint, while an ACL tear or meniscus tear can bring pain, stiffness, or a feeling that the knee gives way. Gout can cause a hot, tender, inflamed joint. Osteoarthritis may cause recurring swelling and stiffness rather than one new hard lump. A Baker's cyst usually sits behind the knee, but swelling can make the whole area feel tight.

A hard swelling that is growing, fixed in place, unexplained, or present without an injury should be examined. Knee swelling is a symptom, so its location alone cannot identify the cause.

Reduce activities that increase pain and avoid kneeling or repeated deep bending. Elevate the leg when resting. A wrapped cold pack can be used briefly for recent swelling, provided the skin remains protected. Do not press, puncture, or attempt to drain the lump. Note its size, tenderness, skin colour, and whether the knee bends and straightens normally. Arrange a clinical review if it persists, returns, or limits walking; joint aspiration may be considered when fluid in the joint needs evaluation or relief.

Seek urgent assessment for a hot red swelling with fever, severe pain after an injury, inability to bear weight, a visibly deformed knee, or sudden calf swelling. Emergency care is needed for a cold or pale foot, new numbness, severe weakness, or breathing difficulty with leg swelling. A rapidly enlarging or unexplained hard lump also warrants prompt review.

Ask whether the swelling is in the joint, bursa, tendon, or skin, and whether examination or imaging is needed. Tell the clinician about injury, fever, previous gout, locking, giving way, and how quickly the lump appeared. Ask which activities and pain measures are suitable while waiting.