Thursday, January 27, 2011

Treating and Preventing Meniscus Injuries - Part 2

In our previous blog (link) we discussed the causes and structural components of the knee and its menisci. Now…lets look at how we can treat injuries to the menisci.

Degree of Injury
Injuries to the menisci can range from minor, moderate, to more severe. Pain and swelling are the most common symptoms of a meniscus tear. With more severe menisci injuries, a person may notice some degree of “locking of the joint” accompanied by considerable instability of the knee. If “locking of the joint” occurs, it is imperative to immediately obtain medical attention from a sports physician, or some other medical practitioner who works with physical medicine. Your specialist should perform a physical examination on you to determine the severity of the injury.

Common Examination Findings
The following are common examination findings, which can indicate the presence of a meniscus injury

Effusion: Caused by an increased level of fluids in the synovial cavity of the knee joint.
Joint Line Tenderness: This is tenderness in the space (line) directly between your thigh bone, femur, and your shin (tibia). This line runs horizontally on both sides of your knee - from the front to the back.

Positive Orthopedic Test:
  • McMurray’s Test: This test is performed with the patient lying on their back, while the examiner flexes the patient’s knee. A positive finding of a suspected meniscus tear occurs when a click is felt as the knee is brought from full flexion to 90 degrees of flexion.
  • Ege's Test – In this test the patient is asked to squat in two positions, once with the feet rotated outwards (to detect a medial meniscus tear), and once with the feet rotated inwards (to identify a lateral meniscus tear). A positive finding of a suspected meniscus tear occurs when an audible click is heard (or a palpable click is felt) over the meniscus line.
Atrophy of the quadriceps or decreased quadriceps strength: The quadriceps muscle often starts to shut down shortly after a meniscus injury occurs. Considerable atrophy of the quadriceps can be noticed within one or two weeks after the injury.

The best and most accurate diagnostic results are achieved with an MRI (Sagittal images – fat suppression) - providing a 90% accuracy when diagnosing a meniscus injury.

Symptoms of Menisci Injuries
The following gives you a basic idea of the symptoms associated with the severity levels of menisci injury. Please be aware that these are general guidelines, to make a definitive diagnosis a medical professional should be consulted.
Symptoms of a minor meniscus tear:
  • Only minimal pain - you are still able to walk.
  • Some degree of swelling with increased pain when squatting.
  • Most of these symptoms should diminish within 2-3 weeks of initial injury.
Symptoms of a moderate meniscus tear:
  • Pain directly at the site of the meniscus (along the lateral or medial line).
  • Sharp pain with any type of squatting or twisting motion of the knee.
  • Considerable stiffness.
  • If these symptoms are ignored and rehabilitation is not implemented it could take several months to a year before they go away.
Symptoms of a severe meniscus tear:
  • Immediate sharp pain, swelling, and stiffness in the knee.
  • The knee may lock into position.
  • The patient is often unable to straighten the knee.
  • This is often a case for surgical intervention.
Differentiating a Meniscus Tear from other Knee Injuries
There are several subjective factors that can help you to differentiate a meniscus tear from other types of knee problems.
  • A meniscus tear is often caused by sudden trauma and compressive twisting motions. Other knee problems often take time to develop, with no clearly identifiable cause.
  • A meniscus injury will often create symptoms directly between the joint line of the femur and the tibia (shinbone).
  • Meniscus injuries can often create a locking of the knee. Other knee problems cause dull, aching pain, grating sounds, or crepitation.
  • Meniscus injuries often result in severe, sharp pain with any type of sharp angular maneuvers of the knee. Other knee problems only generate pain when the person is coming into or out of a squatting position.
Preventing Menisci Injuries – see the next installment of this blog for more information about how you can prevent menisci injuries. See the following sites for more information about knee injuries:

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