Meniscal tear management
Causes include rheumatoid arthritis, osteoarthritis, and overuse of the knees. Baker's cysts are often indicative of arthritis - treatment for the underlying pathology may reduce swelling and permit resorption. Baker's cyst may be asymptomatic or may cause pain only with motion or, when inflamed or ruptured, cause continuous discomfort. On examination, a firm, sometime tender, nonpulsatile mass is usually palpable in the popliteal space. Because they produce pain and swelling behind the knee and in the upper calf, baker's cysts can be mistaken for deep venous thrombosis (DVT). Because it occasionally can also cause dvt in the adjacent popliteal vein, a baker's cyst should be evaluated with ultrasound or magnetic resonance imaging (MRI). Large or chronically symptomatic cysts can be removed surgically.
Ultrasound may be helpful in evaluating possible joint effusion, and other imaging modalities such as mri may provide details on soft tissue abnormalities. Diagnostic arthroscopy is necessary only in rare cases of acute knee swelling, such as when a biopsy is required. Every effort should be made to articulate a diagnosis before treatment is initiated, but therapy may begin while the diagnostic process continues. Limiting weight-bearing, splints, cold packs, and simple analgesics and nonsteroidal anti-inflammatory medications may be used initially for the management of acute knee swelling. Antibiotics should not be administered before appropriate diagnostic sampling of the joint fluid, and intraarticular corticosteroids should be held until an appropriate diagnosis has been made and potential contraindications have been ruled out. Patients with septic arthritis or those with an onset of swelling within 12 hours should be referred to a practitioner with experience in musculoskeletal diseases. Patients with suspected bone tumors should be seen by an orthopaedist within 1 week, whereas potential inflammatory arthritis should be evaluated by a rheumatologist within 6 weeks. Baker's Cyst (Popliteal Cyst a baker's cyst (described by morrant baker in the 19th century a s a cystic mass in the popliteal fossae of children) results from knee joint swelling, which causes herniation of joint fluid and synovium through the capsule of the knee. Most of these cysts connect volwassenen into the knee joint. They may also extend downward into the calf muscles.
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Important elements of the patient history in these cases include the speed of onset of swelling, any history of trauma, the characteristics of pain, the presence of fever, the involvement of other joints, recent history of infection, and first vs recurrent episodes of knee swelling. Physical examination should include an evaluation of other joints besides the affected knee, including the contralateral unaffected knee. The knee examination should assess the detection of effusion, stability testing, range of motion, and muscular and neurovascular assessment. However, the physical examination of the swollen knee alone generally lacks sensitivity and specificity in defining a diagnosis. Blood testing is unnecessary for most patients with a swollen knee, unless septic arthritis is strongly suspected. In contrast, joint aspiration should be performed among patients with suspected septic, crystal, or inflammatory arthritis. Joint aspiration should not be performed in cases of a possible tumor. A plain radiographic study in 2 planes, including a weight-bearing anterior-posterior oorsuizen view, should be performed to evaluate possible fracture or degenerative disease in patients with acute knee swelling. There was no consensus regarding including radiographic examination of the unaffected knee in the diagnostic process.
These patients would benefit from nonoperative management with optimized physical and medical therapy. Figure 2 Meniscal tear management tree. P- reviewers: Serhan h, sadoghi p s- editor: Wen ll l- editor: a e- editor:. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. Recovery from Surgery rehabilitation Exercise handouts pain Management. Key words: Meniscus ; Meniscectomy; Meniscal tear. Management of meniscal tears.
Meniscal tear Patterns Mark. A gradient-echo T2-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). Your doctor also may perform a mcMurray test to look for a meniscal tear. According to a study from 2008 published in the journal of Trauma management outcomes, the mris accuracy for. Doctors consider conservative management of a torn meniscus if the tear is small. Degenerative meniscal tears gemiddelde tend to be part of a severe arthritis flare that will lessen over time. Does a meniscus tear heal?
Meniscal blood supply is limited: your meniscus receives its nutrition from blood and synovial fluid within the joint. Arthroscopic partial meniscectomy is superior to physical rehabilitation in the management of symptomatic unstable meniscal tears. Meniscus handen tears : surgical and post op management When a significant tear or rupture of the medial surgical options partial meniscectomy meniscal repair Selection of procedure depends upon: The. Pain management health centre. American Academy of Orthopedic Surgeons web site: meniscal tears. L., and Hutchens,., American Family Physician, sept. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.
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Once reduced, the knee may react as an acute joint lesion. If this occurs, treat as described earlier in the chapter in the section on nonoperative management of joint hypomobility. Meniscus tears: surgical and post op management. When a significant tear or rupture of the medial or lateral meniscus occurs or if nonoperative management of a partial tear has been unsuccessful, surgical intervention often is necessary. Current-day surgical procedures are designed to retain as much of the meniscus as possible as a means of preserving the load transmission and shock-absorbing functions of the menisci and to reduce stress on the tibiofemoral articular surfaces.
Primary surgical options partial meniscectomy meniscal repair, selection of procedure depends upon: The location and nature of the tear patients age and level of activity. Tears of the outer area of a meniscus, which has a rich vascular supply, heal well, whereas tears extending into the central portion, where the vascular supply is considerably less, have marginal healing properties. Indications for surgery, a lesion in the vascular outer third of the medial or lateral meniscus. A tear extending into the central, relatively avascular third of the meniscus of a young (younger than age 40 to 50) or physically active older (older than age 50) individual. Complecations, intraoperative damage to the neurovascular bundle at the posterior aspect of the knee. Saphenous nerve with medial meniscus repair and peroneal nerve with lateral meniscus. Flexion contracture, extensor lag, post operative management, immobilization and protective bracing The knee is held in full extension, first in the postoperative immobilizer and then in a long-leg brace when the bulky compression dressing is removed a few days after surgery. To protect the repaired meniscus during the first few postoperative weeks, the range-limiting brace is worn continuously (day and night) and is locked in full extension. Soon after surgery, it is unlocked periodically during the day to initiate early rom exercises and for bathing.
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Management, often the patient can actively aanbieding move the leg to unlock the knee, or the unlocking happens spontaneously. Passive manipulative reduction of the medial meniscus may unlock the knee. After acute symptoms have subsided, exercises should be performed in open- and closed-chain positions to improve strength and endurance in isolated muscle groups and to prepare the patient for functional activities. Patient position and procedure: Supine. Passively flex the involved knee and hip, and simultaneously rotate the tibia internally and externally. When the knee is fully flexed, externally rotate the tibia and apply a valgus stress at the knee. Hold the tibia in this position, and extend the knee. The meniscus may click into place.
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A meniscus tear can cause acute locking of the knee or chronic symptoms with intermittent catching/locking. Pain during forced hyperextension or maximum flexion occurs along the joint line (due to stress to the coronary ligament) along with joint swelling and some degree of quadriceps atrophy. When there is joint catching/locking, the knee does not fully extend, and there is a springy end feel when passive extension tendons is attempted. If the joint is swollen, there is usually slight limitation of flexion or extension. The McMurray test or Apleys compression/distraction test may be positive. When the meniscus tear is acute, the patient may be unable to bear weight on the involved side. Unexpected locking or giving way during ambulation often occurs, causing safety problems.
Please download to view, meniscus tears: Non-operative management, meniscus tears: Non-operative management. Dr Wajeeha mehmood, mechanism of injury, the medial zwanger meniscus is injured more frequently than the lateral meniscus. Insult may occur when the foot is fixed on the ground and the femur is rotated internally, as when pivoting, getting out of a car, or receiving a clipping injury. An acl injury often accompanies a medial meniscus tear. Lateral rotation of the femur on a fixed tibia may tear the lateral meniscus. Simple squatting or trauma may also cause a tear. Impairements and functional limitations.
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Many of these cases reflect symptomatic osteoarthritis, which may occur in 5 to 10 of adults. However, there are many causes of painful swelling of the knee. There are also many approaches to the diagnosis and treatment of these patients. The current guidelines were written in an effort to standardize the diagnostic approach and initial treatment of patients with acute or recent-onset swelling of the knee. A total of 11 rheumatologists and 12 orthopaedists provided expert opinions on the subject, and they focused on knee swelling that had occurred in the past 4 to 6 haag weeks. Study highlights: A clinical examination is the first intervention for a patient with suspected knee swelling. The expert panel noted that many patients with presumed swelling actually had no increase in knee volume, and interobserver agreement regarding swelling of the knee on physical examination is poor.
Atraumatic etiologies include arthritis, infection, crystal deposition and rarely tumors. For more information please see the following article: diagnosis and Initial Management of Acute Knee swelling Recommendations. Medscapecme clinical Briefs, ann Rheum Dis. Abstract, the european league against Rheumatism (eular) and the european Federation of National Associations of Orthopaedics and Traumatology have issued consensus recommendations for the diagnosis and initial treatment of patients with acute or recent onset of swelling of the knee. These guidelines are reported in the january 2010 issue of the. Annals of the Rheumatic Diseases. Clinical context: knee symptoms are common reasons for physician visits, with a lifetime prevalence of up.